What to Know Before an Endometrial Biopsy

The female reproductive system.
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An endometrial biopsy is a procedure where a small tissue sample is taken from the lining of the uterus, (called the endometrium, to be studied under a microscope. The endometrial tissue is examined for abnormal cells or for hormonal effects on the endometrium.

The uterine lining is thin after menses and as the ovaries prepare for ovulation, estrogen levels rise, which increasingly thickens the endometrium. After ovulation occurs, the endometrium enters the luteal or secretory phase, which means that the lining has undergone a series of changes which will prepare it for a possible pregnancy. If pregnancy does not occur, the thickened endometrium will be shed during menstruation.

What an Endometrial Biopsy Looks For

During the procedure, which occurs a few days before menses, a small amount of endometrial tissue is removed and examined under a microscope. While, occasionally, this is useful to evaluate whether ovulation has occurred, an endometrial biopsy is most often done to rule out endometrial hyperplasia or cancer. Endometrial cancer is the most common cancer of the female reproductive organs.

Your doctor may suggest that you undergo an endometrial biopsy for many different reasons, such as:

  • Very heavy or abnormal menstrual bleeding.
  • A biopsy may show abnormal tissues, such as fibroids or polyps.
  • Bleeding even after menopause may be a reason doctors request a biopsy.
  • To check the effects of hormone therapy or to find abnormal cells or cancer.
  • An absence of uterine bleeding may warrant a biopsy.
  • The doctor may use the endometrial biopsy to check for uterine infections, such as endometritis.
  • Any cell changes linked to hormone levels can also lead to abnormal bleeding.

Your biopsy results may state early secretory endometrium, which happens when the uterine lining has changed due to progesterone (a pregnancy hormone). Unless you've taken progesterone pills, this usually just means that you've ovulated recently.

Feel free to ask your doctor or nurse to explain any medical terms or concepts that you are not sure about.

How the Biopsy Is Performed

An endometrial biopsy may be done in your doctor's office, as it is a fairly simple procedure. A speculum is inserted into the vagina so the cervix can be visualized. After the cervix is cleaned, a small instrument is inserted through the cervix and into the uterus. Samples of endometrial tissue are taken from various locations within the uterus and placed in a special solution for examination.

After the procedure, a small amount of bleeding is normal. However, notify your physician if bleeding becomes heavy (soaking through more than one pad an hour) or if you begin feeling faint or dizzy. Make sure to tell your doctor if you notice a rise in your temperature, as this could be a sign of infection. Avoid intercourse or douching for at least 72 hours.

Possible Risks

Though an endometrial biopsy is a fairly simple procedure, there are some possible complications that you should be aware of before your appointment, such as:

    • Bleeding
    • Pelvic infection
    • Rare, but a possible puncture of the uterine wall with the biopsy device

Will It Hurt?

You can expect some mild cramping or discomfort during the procedure. Let your doctor know if you are:

    • Allergic to or sensitive to medicines, iodine, or latex
    • Pregnant or think you could be as an endometrial biopsy during pregnancy may lead to miscarriage.
    • Undergoing any other treatments or medication as certain things may interfere with an endometrial biopsy including vaginal or cervical infections, pelvic inflammatory disease, and cervical cancer.
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