In endometrial biopsy, a thin, flexible tube (catheter) is passed through the vagina and cervix and into the uterus. A suction device attached to the catheter is used to obtain tissue samples from the lining of the uterus (endometrium); these specimens are sent to a laboratory for analysis.
Alternatively, the cervix may be dilated and surgical instruments may be used to scrape tissue samples from the endometrium while you are under local or general anesthesia. This procedure, called dilatation and curettage (D & C), is more painful and entails more risk than suction biopsy; thus, it is generally reserved for cases where suction biopsy cannot be done. (It may also be used as a treatment to stop heavy bleeding or remove residual tissue after miscarriage or abortion.)
Purpose of the Endometrial Biopsy
- To evaluate abnormal uterine bleeding, such as heavy or prolonged periods of bleeding after the menopause, especially in women over age 35 with a family history of endometrial cancer
- To diagnose endometrial cancer, polyps, or inflammatory conditions
- To document ovulation and help evaluate the cause of infertility
- To monitor the uterine lining or the endometrial health in women taking estrogen replacement therapy (ERT) without progesterone (since this regimen increases the risk of developing endometrial cancer)
- To help determine the cause of repeated miscarriages
Who Performs Endometrial Biopsy
- A gynecologist, an infertility specialist, or a specially trained physician’s assistant performs suction biopsy.
- D & C is performed by a gynecologist in a hospital operating room or surgery clinic.
Special Concerns about Endometrial Biopsy
- Endometrial biopsy is not appropriate in women with an active infection of the vagina or cervix (such as gonorrhea or a yeast infection) or those in whom the cervix cannot be visualized (due to irregular position or prior surgery, for example).
- The time of the menstrual cycle can affect the accuracy of results. If you are being evaluated for fertility, the test should be done approximately 2 days before you expect your period to begin.
- Suction biopsy may be performed using local anesthesia, but anesthesia is not usually required.
Before the Endometrial Biopsy
- The biopsy may need to be scheduled during a certain time in your menstrual cycle.
- A physical exam, pelvic exam, blood tests and urine test may be performed before the procedure.
- You may be given a pregnancy test before the procedure to ensure you are not pregnant; if the test is positive, the procedure will be canceled.
- Empty your bladder just before the test.
- You will be asked to undress from the waist down and put on a drape or hospital gown.
- Your doctor may give you an over-the-counter pain reliever, such as ibuprofen, and/or a mild sedative about 30 minutes before the procedure.
- If you are undergoing a D&C under general anesthesia, do not eat or drink anything for at least 8 hours before the procedure.
- Tell your doctor about medications, herbs or dietary supplements you take. In some cases, you may be instructed to stop taking them temporarily.
- Prior to the biopsy, do not take any new medications, herbs, or dietary supplements before consulting your doctor.
What You Experience during Endometrial Biopsy
- You will lie on your back on an examining table with your knees bent and your feet placed in stirrups.
- The examiner will conduct a manual pelvic exam—which involves inserting a gloved, lubricated finger into the vagina—to determine the size, shape, and location of the uterus.
- Next, a lubricated speculum—a metal or plastic instrument that pushes apart the walls of the vagina to provide a view of the cervix—is gently inserted. The device may feel cold and uncomfortable, but causes no pain. Relax and breathe through your mouth to ease the insertion.
- When the cervix is centered in the speculum, a 20 percent benzocaine spray is used to numb the cervix.
- The cervix is cleansed with a povidone-iodine solution.
- A narrow, flexible catheter attached to a vacuum device is inserted through the vagina and cervix into the uterus. Suction is initiated to obtain samples from the endometrium. You may feel some cramping as this is done.
- The tissue samples and instruments are withdrawn.
- The procedure takes only about 5 minutes to perform.
D & C:
- A general anesthetic medication is administered through an intravenous (IV) needle or catheter inserted into a vein in your arm.
- The doctor inserts a speculum into your vagina and uses a special clamp to grip the cervix.
- Your cervix is slowly opened, or dilated, using blunt metal instruments of increasing diameter.
- A spoon-shaped instrument called a curette is inserted into the uterus to scrape tissue from the endometrium.
- The tissue samples and instruments are removed.
- This procedure takes about 30 minutes.
Risks and Complications of Endometrial Biopsy
- Some women experience dizziness, cramping and infection after the procedure.
- Rare but serious complications include infection, severe bleeding, and inadvertent perforation of the uterine wall (which requires surgical repair).
- Rarely, D & C may result in damage to the bladder or bowel. If general anesthesia is used, it entails all of the associated risks.
After the Endometrial Biopsy
- You will remain in a recovery room until the effects of sedation or anesthesia wear off. You may return home and should rest for about 24 hours. (If you received general anesthesia, be sure to arrange for a ride home.)
- You may experience mild cramping for several days. Over-the-counter pain relievers, such as ibuprofen, may help. (A prescription painkiller may be given after D & C.)
- You may experience slight vaginal bleeding for 1 or 2 days after suction biopsy, and for up to several weeks after D & C. Use sanitary napkins rather than tampons.
- Avoid sexual intercourse and do not douche for 72 hours after a suction biopsy, and for at least 2 weeks after D & C.
- Call your doctor if you experience severe pain, excessive vaginal bleeding, abnormal vaginal discharge, or fever.
Endometrial Biopsy Results
- A pathologist examines the tissue samples under a microscope.
- This test usually results in a definitive diagnosis. If tissue abnormalities are detected, your doctor will recommend a course of medical or surgical treatment, depending on the specific problem.
The Johns Hopkins Consumer Guide to Medical Tests
Simeon Margolis, M.D., Ph.D., Medical Editor
Updated by Remedy Health Media