Endometrial Biopsy

An endometrial biopsy is performed to obtain a small tissue sample from the lining of the uterus, called the endometrium. After the biopsy, the endometrial tissue is examined under a microscope to identify the presence of abnormal cells or the effects of hormones on the endometrium.

The purposes for an endometrial biopsy may include:

  • Examining cells for the presence of cancer after an abnormal cervical cancer screening (Pap exam)
  • Identifying the cause of heavy uterine bleeding, especially in postmenopausal women; after the cause of the bleeding is identified, treatments such as Mirena, oral contraceptives, or NovaSure may be prescribed
  • For patients who have experienced difficulties becoming pregnant, evaluating whether the uterus is capable of supporting a pregnancy
  • Determining whether the endometrium is undergoing normal changes that are synchronized with the menstrual cycle
  • Checking for uterine infections such as endometriosis
  • Evaluating the effects of hormone replacement therapy
  • Detecting the presence of abnormal cells or cancer

Preparing for Endometrial Biopsy

  • Your healthcare provider will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.
  • Generally, no prior preparation such as fasting or sedation is required. Your healthcare provider may recommend that you take a pain reliever 30 minutes before the procedure.
  • If you are pregnant or suspect that you are pregnant, you should notify your healthcare provider.
  • Notify your healthcare provider if you are sensitive to or are allergic to any medications, iodine, latex, tape, and anesthetic agents (local and general).
  • Notify your healthcare provider of all medications (prescription and over-the-counter) and herbal supplements that you are taking.
  • Notify your healthcare provider if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure.
  • Your healthcare provider may request that you keep a record of your menstrual cycles. You may need to schedule the procedure for a specific time in your cycle.
  • If a sedative is given before the procedure, you will need someone to drive you home afterwards.
  • You may want to bring a sanitary napkin to wear home after the procedure.
  • Based upon your medical condition, your physician may request other specific preparations.

What to Expect During the Procedure

Generally, an endometrial biopsy follows this process:

  • You will be instructed to empty your bladder prior to the procedure.
  • You will be asked to undress completely or from the waist down and put on a hospital gown.
  • You will lie on an examination table, with your feet and legs supported as for a pelvic examination.
  • Your physician will insert an instrument called a speculum into your vagina to spread the walls of the vagina apart and expose the cervix.
  • Your cervix will be cleansed with an antiseptic solution.
  • The clinician may numb the area using a small needle to inject medication, or a numbing spray may be applied to your cervix.
  • A type of forceps may be used to hold the cervix steady for the biopsy. You may feel some cramping when this occurs.
  • A thin, rod-like instrument, called a uterine sound, may be inserted through the cervical opening to determine the length of the uterus and location for biopsy. This may cause some cramping. The sound will then be removed.
  • A thin tube called a catheter will be inserted through the cervical opening into the uterus. The catheter has a smaller tube (internal piston) inside it. The clinician physician will withdraw the inner tube creating suction at the end of the catheter. The clinician  will then gently rotate and move the tip of the catheter in and out to collect small pieces of endometrial tissue. This may cause some cramping.
  • The amount and location of tissue removed depends on the reason for the endometrial biopsy.
  • The catheter and speculum will be removed and the tissue will be placed in a preservative.
  • The endometrial tissue will be sent to a lab for examination.

After the Procedure

  • After the procedure, you may rest for a few minutes before going home. If you received any type of sedative, you will need to have someone drive you home.
  • You may want to wear a sanitary pad for bleeding. It is normal to have some mild cramping and spotting or vaginal bleeding for a few days after the procedure. Take a pain reliever for soreness as recommended by your clinician. Aspirin or certain other pain medications may increase the chance of bleeding. Be sure to take only recommended medications.
  • You may be instructed not to douche, use tampons, or have intercourse for two to three days after an endometrial biopsy or for a period of time recommended by your clinician.
  • You may also have other restrictions on your activity including no strenuous activity or heavy lifting.
  • You may resume your normal diet unless your physician advises you differently.
  • Your clinician will advise you on when to return for further treatment or care.

Notify your clinician if you experience any of the following:

  • Excessive bleeding or bleeding longer than two days after the procedure
  • Foul-smelling drainage from your vagina
  • Fever and/or chills
  • Severe lower abdominal pain

You may be given additional or alternate instructions after the procedure depending on your particular situation.