What is an Endometrial Biopsy ?
An endometrial biopsy is a procedure which is generally performed in the office in order to obtain a small portion of tissue from the lining of the uterus, the endometrium. The tissue is then looked at under the microscope to make what is called a histopathologic diagnosis. This can also be referred to as a tissue sampling.
Why is it Recommended ?
The most common reason for a physician to recommend an endometrial biopsy is to evaluate for abnormal vaginal bleeding, in order to determine a cause and to assure that there is not a cancerous or precancerous condition present. Women who have heavy periods, bleeding or spotting between periods or bleeding or spotting after menopause may be recommended to have an endometrial tissue sampling. It may also be recommended for women who have irregular periods or a shorter time between periods. For women who have an absence of periods it may also be recommended. A biopsy may also be recommended if a woman has an abnormal appearing endometrium on pelvic ultrasound imaging. Other reasons to recommend a biopsy are to rule out an infection called chronic endometritis, or a low grade infection of the lining of the uterus, or to evaluate for bleeding or spotting after intercourse An endometrial biopsy may also be recommended in order to evaluate an abnormal Pap smear.
What to Expect
The procedure usually takes 15 minutes and is performed in a physician’s office. A NSAID (nonsteroidal anti inflammatory medication) may be recommended to be used 30 minutes prior to the procedure. An injectable NSAID called Toradol may also be given in the office prior to the actual procedure. In order to help open and soften the cervix (the opening to the uterus), some physicians may also recommend that a medication called misoprostol be inserted into the vagina the evening prior to the procedure. This is a small tablet. The procedure may or may not be performed with guidance of an ultrasound. We find that the procedure is less painful when ultrasound is used.
A written informed consent should be obtained where the risks, benefits and alternatives of the procedure are explained to you and your questions and concerns are reviewed. Risks include, but are not limited to: infection, bleeding, trauma or damage to the uterus, cramping/pain. All of these are uncommon occurrences.
You will then be placed in the lithotomy position, which is the same position a pelvic examination in done. A speculum is then placed into the vagina. The cervix is prepped with a cleaning solution, generally an iodine solution called Betadine. This may be different if you have an iodine allergy. Local anesthesia may or may not be used, but we have found that an injection in a paracervical fashion with 2% lidocaine is beneficial to help you be more comfortable. You may feel a burning sensation with this injection. The cervix is then properly positioned with an instrument called a tenaculum. You may feel a bit of pressure when the tenaculum is placed. The biopsy instrument, which is usually a thin straw like device measuring only a few millimeters, is then passed through the cervix to the uterus. If you have scarring of the cervix, a dilator, which is either a thin plastic or thin metal instrument may be used to gently dilate, or open, the cervix. Scarring of the cervix may be present due to previous procedures, lack of estrogen, or sometimes it may be present without a clear cause. In our office the biopsy instrument is tracked with ultrasound to assure that it is in the proper location, this is called ultrasound guidance. The biopsy and cervical dilatation may be associated with a cramping type of pain. There is generally a bit of spotting and possible vaginal bleeding after the procedure, but it should not be heavier than a normal period. We generally ask that you relax and recover for 20 to 30 minutes after the procedure as some women may experience a vagal type response where one becomes light headed and nauseous, it is during this time that the heart slows down a bit and blood pressure may drop a bit. This generally passes after 20 to 30 minutes. You may have some cramping after the procedure for the next few hours. Ibuprofen and other NSAIDs may be very effective to help relive this pain. The tissue is then sent to the laboratory for microscopic analysis.
Complications are not common. However, any instrumentation of the uterus can lead to:
Trauma or damage to the uterus or cervix
Preparation for an endometrial biopsy
There is no special preparation other than the recommendation to soften the cervix with misoprostol as noted above and the use of an NSAID 20 to 30 minutes prior to the procedure. You should assure that you are not pregnant prior to a recommended procedure.
Post Procedure Instructions
It is common to have spotting and light bleeding. Cramping is also common and NSAIDs can be effective for pain relief. You can return to your normal activities after the procedure. We generally recommend that there is pelvic rest for 2 weeks after the procedure in order to avoid infection. This means no tampons, douching or intercourse. While many women come to the office without a companion, you may want have someone to help you to your home. After you arrive at home, relax a bit if possible.
Call you physician for:
Temperature greater than 100.0 F
Pelvic pain which is severe or not improving
Yellow vaginal discharge
Call for the pathology
Always make sure that you have a follow-up appointment in order to review results and review them in context of your personal medical history. Never assume that “no news” is “good news”. You should also have a copy of your results for your personal records.
If you have not already started a folder of your personal health records, do so now. Make sure you have a copy of your results with important findings highlighted.
Results may be read as “non-diagnostic” and additional procedures such as a dilatation and curettage (D&C) may be recommended in order to evaluate your situation further. It is always important to review your results in the context of you medical history. Endometrial biopsies have a false negative rate of 10%, meaning that they miss significant and meaningful pathology 10% of the time. If symptoms persist, additional procedures may be recommended. Methods to decrease false negatives include saline infusion hysterogram and in office hysteroscopy.