Endometrial biopsy

  • Definition
    • Endometrial biopsy is the removal of a small piece of tissue from the lining of the uterus (endometrium) for examination.

  • Alternative Names
    • Biopsy - endometrium

  • How the Test is Performed
    • This procedure may be done with or without anesthesia. This is a medicine that allows you to sleep during the procedure.

      • You lie on your back with your feet supported by a footrest.
      • Your health care provider gently inserts an instrument (speculum) into the vagina to hold it open so that your cervix can be viewed. The cervix is cleaned with a special liquid. Numbing medicine may be applied to the cervix.
      • The cervix may then be gently grasped with an instrument to hold the uterus steady. Another instrument may be needed to gently stretch the cervical opening if there is tightness.
      • An instrument is gently passed through the cervix into the uterus to collect the tissue sample.
      • The tissue sample and instruments are removed.
      • The tissue is sent to a lab. There, it is examined under a microscope.
      • If you had anesthesia for the procedure, you are taken to a recovery area. Nurses will make sure you are comfortable. After you wake up and have no problems from the anesthesia and procedure, you are allowed to go home.
  • How to Prepare for the Test
    • Before the test:

      • Tell your provider about all the medicines you take. These include blood thinners such as warfarin, clopidogrel, and aspirin.
      • You may be asked to have a test to check if you are pregnant.
      • In the 2 days before the procedure, do not use creams or other medicines in the vagina.
      • Do NOT douche. (You should never douche. Douching can cause infection of the vagina or uterus.)
      • Ask your provider if you should take pain medicine, such as ibuprofen or acetaminophen, just before the procedure.
  • How the Test will Feel
    • The instruments may feel cold. You may feel some pain when the cervix is grasped. You may have some cramping as the instruments enter the uterus and the sample is collected.

  • Why the Test is Performed
    • The test is done to find the cause of:

      • Abnormal menstrual periods (heavy, prolonged, or irregular bleeding)
      • Bleeding after menopause
      • Bleeding from taking hormone therapy medicines
      • Thickened uterine lining seen on ultrasound
      • Endometrial cancer
  • Normal Results
    • The biopsy is normal if the cells in the sample are not abnormal.

  • What Abnormal Results Mean
    • Abnormal menstrual periods may be caused by:

      • Uterine fibroids
      • Fingerlike growths in the uterus (uterine polyps)
      • Infection
      • Hormone imbalance
      • Endometrial cancer or precancer (hyperplasia)

      Other conditions under which the test may be performed:

      • Abnormal bleeding if a woman is taking the breast cancer medicine tamoxifen
      • Abnormal bleeding due to changes in hormone levels (anovulatory bleeding)
  • Risks
    • Risks of endometrial biopsy include:

      • Infection
      • Causing a hole in (perforating) the uterus or tearing the cervix (rarely occurs)
      • Prolonged bleeding
      • Slight spotting and mild cramping for a few days
  • References
    • Choby BA. Endometrial biopsy. In: Pfenninger JL, Fowler GC, eds. Pfenninger & Fowler's Procedures for Primary Care. 3rd ed. Philadelphia, PA: Elsevier Saunders; 2010:chap 143.

      Lentz GM. Endoscopy: hysteroscopy and laparoscopy: indications, contraindications and complications. In: Lentz GM, Lobo RA, Gershenson DM, Katz VL, eds. Comprehensive Gynecology. 6th ed. Philadelphia, PA: Elsevier Mosby; 2012:chap 10.