What is an endometrial biopsy?
An endometrial biopsy, also known as a uterine biopsy, is a procedure in which a small sample of tissue is removed from the lining of your uterus, also called the endometrium. Once removed, your doctor can look at the tissue under a microscope to determine the cause of the abnormal uterine bleeding. It can also tell if the cause of the bleeding is a sign of endometrial cancer or uterine cancer.
Like a Pap smear, an endometrial biopsy is a simple procedure performed in your doctor’s office during a pelvic exam. It is a safe and relatively quick procedure.
Why might I need an endometrial biopsy?
The most common reason providers order endometrial biopsies is to investigate abnormal bleeding, often caused by endometrial polyps. However, these procedures can also help healthcare professionals check for cancer.
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Diagnosis
Your OBGYN may want to perform an endometrial biopsy to find the cause of symptoms, such as:
- Abnormal bleeding, including irregular spotting or very heavy menstrual bleeding
- Abnormal bleeding while taking hormone therapy
- Abnormal bleeding while taking tamoxifen
- Certain abnormal cervical cancer screenings in some women over 35
- Thickened uterine lining is visible in ultrasound
- Vaginal bleeding that occurs after menopause
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Screening
If you are at high risk of endometrial cancer, you may need regular biopsies to screen for precancerous or cancerous cells. You may need regular biopsies if you:
- Are over 30 and have an inherited genetic disorder called Lynch syndrome (hereditary nonpolyposis colorectal cancer)
- Have endometrial hyperplasia, a thickening of the uterine lining that can be benign or precancerous.
How to prepare for an endometrial biopsy
In the days before your endometrial biopsy, you may be asked to follow these guidelines:
- Do not use vaginal creams or other medications for at least two days before the procedure.
- Do not use tampons for at least a day before the procedure.
- Do not douche.
- If you have not gone through menopause, you will need to take a pregnancy test. (A biopsy cannot be performed if you are pregnant.)
- If you take aspirin or any other blood-thinning medications, ask your provider if you need to stop taking them.
Your OBGYN may provide additional instructions. Make sure you follow all the instructions at the appropriate times.
The endometrial biopsy procedure
Before the procedure
To prevent endometrial biopsy pain, your doctor may tell you to take an over-the-counter pain reliever such as ibuprofen 30 to 60 minutes before the procedure.
During the procedure
An endometrial biopsy takes only a few minutes. Your doctor will have you sit on an exam table and place your feet into footrests. Just as in a regular pelvic exam, they will insert a speculum into your vagina. They will then clean your cervix with an antiseptic solution.
Your doctor will then insert a thin instrument called a Pipelle. The Pipelle is a straw that takes a sample from the lining of the uterus for testing. Your doctor may remove several small pieces of tissue from the lining.
You may feel cramping, pain or discomfort during the procedure. However, it will last for a very short time.
After the procedure
You will be able to drive yourself home from the biopsy. You may want to wear a sanitary pad for any bleeding, as mild cramping, spotting, or vaginal bleeding is normal for a few days after the procedure. Take a pain reliever as recommended by your healthcare provider, but avoid aspirin and certain other pain medications, as they may increase the risk of bleeding. Follow your provider’s instructions on which medications are safe to use.
Avoid douching, using tampons, or having sex for 2 to 3 days after the endometrial biopsy or for the duration your healthcare provider suggests. You may also be advised to avoid strenuous activities or heavy lifting.
Unless otherwise directed by your healthcare provider, you can return to your normal diet.
What are the risks of an endometrial biopsy?
The risks of an endometrial biopsy are very low. There is a small risk of infection or poking a small hole in the uterus, known as uterine perforation. Call your OBGYN if you experience any of the following symptoms:
- Fever
- Heavy bleeding
- Lower abdominal pain
- Vaginal discharge with a strong odor
Understanding the results
A pathologist will evaluate your endometrial tissue sample in a laboratory. It may take a week or two to receive your endometrial biopsy results. If the biopsy does not show cancerous cells, you need to talk to your doctor about the next steps, which may involve medications or another procedure to treat your bleeding.
If there are cancerous cells present, an abnormal result, you will be referred to gynecologic oncology for further management. Potential causes of abnormal results include:
- Uterine polyps
- Infections in the uterine lining
- Hormonal imbalances
- Endometrial cancer or precancer (hyperplasia)
In some cases, the results may be inconclusive. Your healthcare provider might recommend a procedure called dilation and curettage (D&C) to remove a larger tissue sample for further examination or to continue to investigate any symptoms.