Endometrial Biopsy: Purpose of Uterine Tissue Sampling
Medically reviewed by Steffini Stalos, DO
An endometrial biopsy is a non-surgical procedure that is done to examine and assess the lining of the uterus (endometrium). Your healthcare provider may recommend this test if you have abnormal menstrual or uterine bleeding. They may also recommend it if you have trouble getting pregnant or trouble carrying a pregnancy to term.
In some instances, abnormal cell changes may be found in the endometrium during this test. Abnormal test results can indicate a variety of causes, including endometrial cancer or endometrial hyperplasia, a precancerous condition. Abnormal endometrial tissue or hormonal imbalances may also be identified.
This article will discuss the reasons you might need an endometrial biopsy. It will also describe the preparation, what to expect during the procedure, and management if post-biopsy bleeding, should it occur.
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What Is an Endometrial Biopsy?
Endometrial biopsies are outpatient procedures that may take place in a doctor's office, ambulatory care setting, or hospital.
During an endometrial biopsy, a small amount of tissue will be removed from the lining of your uterus via suctioning from a catheter (a thin tube). The tissue sample will then be analyzed under a microscope to look for abnormal cells and other issues that affect the uterine lining, such as a hormonal imbalance.
Reasons to Have an Endometrial Biopsy
The need for an endometrial biopsy is often triggered by symptoms such as uterine bleeding after menopause. It may also be done if you have problems with menstruation, such as very heavy periods, bleeding between periods, an irregular cycle, or amenorrhea (not menstruating for three months or longer).
Endometrial biopsies are commonly used to diagnose endometrial cancer. They're also used to diagnose endometrial hyperplasia, a precancerous condition that can turn into cancer if it's not diagnosed and treated. In a person with postmenopausal bleeding, a transvaginal ultrasound may be used as an alternative first diagnostic approach.
Estrogen and progesterone are hormones that help prepare the uterine lining for pregnancy. If you’re having trouble conceiving, an endometrial biopsy may be done along with other tests to identify problems with hormone production. These diagnoses include conditions such as polycystic ovary syndrome (PCOS).
Fibroids (benign uterine muscle growths) and polyps (endometrial masses) often cause no symptoms. However, in some instances, they cause pain, irregular bleeding, or infertility. Endometrial biopsies can help identify the presence of these types of abnormal tissues. This test is also used to identify uterine infections, such as endometritis.
An endometrial biopsy cannot be used to make a definitive diagnosis of endometriosis. However, it can be helpful for determining if a laparoscopic biopsy makes sense as a next step.
An Endometrial Biopsy Is Not an Endometriosis Biopsy
"Endometriosis," "endometrial biopsy," "and endometriosis biopsy" are terms that all come from the same root word. Since they sound similar, confusion about their meanings is common.
Endometriosis is named for the endometrial tissue that lines the inside of the uterus. It occurs when endometrial-like tissue grows outside the uterus, where it doesn't belong.
Endometrial biopsies and endometriosis biopsies both require endometrial tissue samples that are analyzed under a microscope. But these samples are obtained differently:
Endometrial biopsies are not surgical procedures. The acquired sample of tissue will come from your uterine lining (endometrium).
Endometriosis biopsies are done on tissues obtained through laparoscopic surgeries. The procedure provides your surgeon with a full view of your reproductive organs and intestines. Tissue from multiple locations may be obtained during this surgery.
Interpreting Abnormal Endometrial Biopsy Results
Endometrial tissue is analyzed in a laboratory by a pathologist (a physician specializing in laboratory and anatomic analysis) who will view it under a microscope. The pathologist will look for abnormal cells that indicate the presence of endometrial cancer.
The pathologist will analyze the sample's thickness and pattern, which provides information about hormone levels and balance. Endometrial tissue that is too thick can also indicate endometrial hyperplasia.
They will also look for tissue abnormalities, such as inflammation and scarring, which might indicate an infection or endometriosis.
How Painful Is an Endometrial Biopsy?
Concerns about pain during an endometrial biopsy are common. It's important to remember that every step will be taken to ensure that your experience is as comfortable as possible. Even so, cramping that feels like dysmenorrhea (menstrual cramps) is common during the procedure.
Some people describe feeling a quickly passing pinching sensation. Others experience more intense pain.
The reasons for these differences in pain perception vary, including underlying health conditions, your personal pain threshold, and your anxiety level. The experience level of the gynecologist (specialist in conditions of the female reproductive system) performing the procedure can also play a role.
Certain health conditions, such as vaginismus (chronic vaginal spasms), can cause heightened anxiety about vaginal penetration and fear and pain during the procedure.
Other conditions may physically tighten the cervix or cause inflammation in endometrial tissues, making it harder for the catheter to be inserted into the uterus.
Some conditions that might increase physical pain during an endometrial biopsy include:
Cervical stenosis (a narrow or closed cervix that obstructs the passageway between the vagina and uterus)
Endometriosis and pelvic adhesions
An active infection (like endometritis) or scarring from past infections
Vulvodynia (chronic vulval pain with an undiagnosed cause)
To reduce the amount of pain you experience, your healthcare provider may recommend taking a prescribed antianxiety medication or over-the-counter (OTC) nonsteroidal anti-inflammatory drugs (NSAID) such as Advil (ibuprofen) or Aleve (naproxen) before the procedure. They will also apply a topical anesthetic onto the cervix to lessen pain.
If you have concerns or are afraid, talk to your healthcare provider. Together, you may decide that sedation is warranted and makes sense.
Pre-Endometrial Biopsy Prep Steps
Your healthcare provider will explain the scheduling and timing you can expect before, during, and after the procedure. They may also recommend or prescribe medications for you to take on the day of the test.
If you are having this test done because you're having trouble getting pregnant, it may be timed to take place on or around the 21st day of your menstrual cycle. This is when your endometrium is at its thickest. If you don't menstruate regularly, your healthcare provider will work with you on test scheduling.
If you take anticoagulants (blood thinners) or have a bleeding disorder, inform your healthcare provider beforehand.
You will be given a consent form to fill out and sign. You will also be given a questionnaire to fill out, which provides information about your medications and allergies. Be sure to let your healthcare provider know if you are allergic to any medications, anesthesia drugs, iodine, or latex.
If you use cannabidiol (CBD) products or any substance that helps you relax, ask your healthcare provider if you should stop taking it before the test.
Endometrial biopsies are contraindicated (not recommended) for pregnant people. You may be required to take a pregnancy test before undergoing the procedure.
What to Expect the Day of Your Endometrial Biopsy
You'll be given a hospital gown to wear during the test. Wear non-constrictive clothing you can comfortably change back into afterward. Since post-procedure spotting is expected, you may also wish to bring a sanitary napkin (not a tampon). You can eat, drink, and take your usual medications if sedation is not used.
If you feel nervous or anxious, anxiety-reducing strategies such as meditating, doing deep breathing, or getting a pep talk from a good friend may be helpful in the hours leading up to the procedure.
You'll be asked to empty your bladder in a restroom before you lie on the exam table.
In general, you can expect these steps:
You'll lie down on a gynecological table with your feet in stirrups as if you were having a standard pelvic exam.
Your healthcare provider will place a speculum into your vagina so your cervix can easily be seen.
The cervix will be cleaned with antiseptic and numbed with a topical anesthetic, such as lidocaine.
In some instances, a rodlike device called a uterine sound will be inserted into the cervix to measure the length of your uterus and pinpoint the biopsy location.
A thin endometrial biopsy catheter, such as a Pipelle Endometrial Suction Curette, will be inserted through the cervix into your uterus. The catheter uses suction and rotation to extract tissue samples for laboratory analysis. No cutting is done, and stitches are not needed.
The catheter and speculum will be removed, and the tissue samples will be sent to the laboratory.
Endometrial biopsies typically take around 15 minutes from start to finish. Cramping is most common when the instruments are inserted and the suctioning takes place. These periods are short and only last for a few minutes.
If you were not given a sedating drug, you can leave as soon as you are ready after the test is done.
If you were given anesthesia or any sedating drug, you'll be taken to a recovery room after the procedure, where you can rest for about an hour before discharge. As with any procedure that uses anesthesia, you should not drive after the procedure and must be accompanied home by a companion.
It's a good idea not to schedule activities such as exercise or returning to work after an endometrial biopsy. Avoid having penetrative vaginal sex for 2 to 3 days afterward or longer if you don't feel comfortable.
Mild cramping, spotting, or light vaginal bleeding are expected after the test and may last several days.
Possible Risks to Be Aware Of
You and your healthcare provider should discuss the potential risks or complications that may result from this procedure, which may include:
Miscarriage (if you're pregnant)
Heavy bleeding
Painful cramping
Pelvic infection
Allergic reaction to a material used, like latex
Very rarely, perforation of the uterine wall caused by an inserted device
Bleeding and Cramping After Endometrial Biopsy
Mild cramping and light bleeding are expected and aren't a cause for alarm. Let your healthcare provider know if you have heavy bleeding, intense cramping, or severe pain in your lower abdomen. These symptoms require medical attention.
You should also be on the lookout for potential signs of infection. These include:
Foul-smelling or pus-like vaginal discharge
Fever
Chills
Next Steps With Abnormal Results
This test aims to determine what's causing your symptoms and to treat their underlying cause. Getting abnormal results may not be what you want to hear, but it is the first step toward resolution.
Your healthcare provider will schedule a follow-up appointment with you to review your test results and discuss next steps. Those steps may include hormonal drugs that improve ovulation, surgical removal of growths like polyps, or additional testing.
If evidence of cancer is found, a dilation and curettage (D&C) may be done to collect additional tissue. You may also need further testing that provides information about your cancer stage. Once this information has been gathered, a care plan will be put in place for you.
Summary
Endometrial biopsies are nonsurgical, outpatient procedures. During this test, endometrial tissues will be extracted from the uterus to be analyzed under a microscope in a laboratory.
Endometrial biopsies are useful for diagnosing several conditions, including endometrial cancer, endometritis, and hormonal imbalances. Abnormal results may indicate the need for further testing or treatments ranging from medication to surgery.
This procedure can be painful for some people. Talk to your healthcare provider if you're worried about how the test will feel. Together, you can devise a plan to make your endometrial biopsy as comfortable as possible.
Read the original article on Verywell Health.
