Test Overview
An endometrial
biopsy is a way for your doctor to take a small sample
of the lining of the uterus (endometrium). The sample is looked at
under a microscope for abnormal cells. An endometrial biopsy helps your doctor
find any problems in the endometrium. It also lets your doctor check to see if
your body's hormone levels that affect the endometrium are in balance.
The lining of the uterus changes throughout a woman's
menstrual cycle. Early in the menstrual cycle, the
lining grows thicker until a mature egg is released from an ovary (ovulation). If the egg is
not fertilized by a sperm, the lining is shed during normal menstrual
bleeding.
There are several ways to do an endometrial biopsy. Your doctor may
use:
- A soft, straw-like device (pipelle) to suction
a small sample of lining from the uterus. This method is fast and is not very
painful.
- A sharp-edged tool called a curette. Your doctor will
scrape a small sample and collect it with a syringe or suction. This is called
a
dilation and curettage (D&C). A D&C may be
done to control heavy uterine bleeding (hemorrhage) or to help find the cause
of bleeding. This is done with
general or regional anesthesia.
- An
electronic suction device (Vabra aspiration). This method can be uncomfortable.
- A spray of liquid (jet irrigation) to wash off some of the tissue
that lines the uterus. A brush may be used to remove some of the lining before
the washing is done.
When a woman is having a hard time becoming pregnant, an
endometrial biopsy may be done to see whether the lining of her uterus can
support a pregnancy.
An endometrial biopsy may also be done to find the cause of
abnormal uterine bleeding, to check for overgrowth of the lining (endometrial
hyperplasia), or to check for cancer.
An endometrial biopsy is sometimes done at the same time as another
test, called
hysteroscopy, which allows your doctor to look through
a small lighted tube at the lining of the uterus.
Why It Is Done
An endometrial biopsy is done to:
- Check for cancer. For example, an endometrial
biopsy may be done to help determine the cause of some abnormal
Pap test results.
- Find the cause of heavy, prolonged, or irregular uterine
bleeding. It is often done to find the cause of uterine bleeding in women who
have gone through
menopause.
- See whether the lining of the
uterus (endometrium) is going through the normal menstrual
cycle changes.
How To Prepare
Tell your doctor if you:
- Are or might be pregnant. An endometrial biopsy
is not done during pregnancy.
- Are taking any
medicines.
- Are allergic to any medicines.
- Have had
bleeding problems or take blood-thinners, such as aspirin or warfarin
(Coumadin).
- Have been treated for a vaginal, cervical, or pelvic
infection.
- Have any heart or lung problems.
Do not douche, use tampons, or use vaginal medicines for 24 hours
before the biopsy. You will empty your bladder just before your biopsy.
You may want to take a pain reliever, such as ibuprofen (Advil or
Motrin), 30 to 60 minutes before having the biopsy. This can help decrease any
cramping pain that can be caused by the biopsy.
You will need to sign a consent form that says you understand the
risks of an endometrial biopsy and agree to have the test done. Talk to your
doctor about any concerns you have regarding the need for the test, its risks,
how it will be done, or what the results may mean. To help you understand the
importance of this test, fill out the
medical test information form (What is a PDF document?).
If you are having a dilation and curettage (D&C) and will go to
sleep (general anesthesia) for the test, do not eat or drink
anything for 8 hours before the test. If you are taking any medicines, ask your
doctor what medicines you can take the day of the test.
How It Is Done
Endometrial biopsy
An endometrial biopsy is usually done by a
gynecologist, a
family medicine physician, or a
nurse practitioner who has been trained to do the
test. The sample will be looked at by a
pathologist. The biopsy can be done in your doctor's
office.
Your cervix may be numbed with a spray or injection of
local anesthetic.
You will need to take off your clothes below the waist. You will
be given a covering to drape around your waist. You will then lie on your back
on an examination table with your feet raised and supported by foot rests
(stirrups).
Your doctor will put an instrument with smooth, curved blades
(speculum) into your vagina. The speculum gently spreads apart the vaginal
walls so your doctor can see inside the vagina and the cervix. See a picture of
a pelvic examination with a speculum. The cervix is washed with a special
solution and may be grasped and held in place with a clamp called a tenaculum.
The tool to collect the sample is guided through the cervix into
the
uterus. The tool may be moved up and down to collect
the sample. Most women have some cramping during the biopsy.
An endometrial biopsy takes 5 to 15 minutes.
Dilation and curettage (D&C)
A D&C is usually done in a hospital or clinic. Most women do
not need to stay overnight but can go home the same day.
Your doctor will put an instrument with smooth, curved blades
(speculum) into your
vagina. The speculum gently spreads apart the vaginal
walls so your doctor can see inside the vagina and the
cervix. Your cervix will be gently spread open
(dilated). Depending on the reason for the D&C, your doctor may use a tool
called a hysteroscope to look inside the uterus. A small spoon-shaped
instrument (curette) is then guided through the cervix and into the uterus. The
top layer of the lining of the uterus is carefully scraped off and removed
(along with any other tissue that looks abnormal) for biopsy.
If you have general anesthesia, you will be watched by a nurse in
the recovery room until you are fully awake.
You can do most of your normal activities in a few days. Do not
lift anything heavy for a few days after the test. Do not douche or have sex
for one week after the test.
How It Feels
Endometrial biopsy
If you have not had any pain medicine, you may feel a sharp
cramp as the tool is guided through your cervix. You may feel more cramping
when the biopsy sample is collected. Most women find that the cramping feels
like a really bad menstrual cramp.
Some women feel dizzy and sick to their stomachs. This is called
a
vasovagal reaction. This feeling will go away after
the biopsy.
An endometrial biopsy usually causes some vaginal bleeding. You
can use a pad for the bleeding or spotting.
Dilation and curettage (D&C)
If general anesthesia is used during a D&C, you will be
asleep and feel nothing. After the test, you will feel sleepy for a few hours.
You may be tired for a few days after the test. You may also have a mild sore
throat if a tube (endotracheal tube, or ET) was placed in your throat to
help you breathe during the test. Using throat lozenges and gargling with warm
salt water may help relieve your sore throat.
Risks
There is a small chance that the cervix or uterus could be
punctured during the biopsy. Bleeding or a pelvic infection is also
possible.
After the test
You may feel some soreness in your vagina for a day or two. Some
vaginal bleeding or discharge is normal for up to a week after a biopsy. You
can use a sanitary pad for the bleeding. Do not do strenuous exercise or heavy
lifting for one day after your biopsy. Do not douche. You may have to avoid sex
or using tampons for several days. Ask your doctor when you can have sex or use
tampons again.
Follow any instructions your doctor gave you. Call your doctor if
you have:
- Heavy vaginal bleeding (more than a normal
menstrual period).
- A fever.
- Belly
pain.
- Bad-smelling vaginal discharge.
Results
An endometrial biopsy is a way for your doctor to take a small
sample of the lining of the uterus (endometrium). Lab results from a biopsy
may take several days to get back.
Endometrial biopsy| Normal: | No abnormal cells or cancer is found. For women who have
menstrual cycles, the lining of the uterus is at the right stage for the time
in the
menstrual cycle when the biopsy was done. |
|---|
|
Abnormal: | A noncancerous (benign) growth, called a
polyp, is present. |
|---|
Overgrowth of the lining of the uterus (endometrial
hyperplasia) is present. |
Cell changes that may lead to cancer are present. |
For women who have menstrual cycles, the lining of the
uterus is not at the right stage for the time in the menstrual cycle when the
biopsy was done. More tests may be needed. |
What Affects the Test
Reasons you may not be able to have the endometrial biopsy or why
the results may not be helpful include:
- If a vaginal or cervical infection is present.
The infection could spread to the uterus if an endometrial biopsy is
done.
- If the endometrial biopsy sample is not large enough to see
abnormal cells. Another test may be needed.
What To Think About
- An endometrial biopsy is not done during
pregnancy.
- More of the uterine lining can be sampled during a
dilation and curettage (D&C) than during an endometrial biopsy. Another
test, called a
hysteroscopy, is usually done with a D&C so that
your doctor can see the lining of your uterus. A hysteroscopy may also be done
instead of a D&C. For more information, see the medical test
Hysteroscopy.
- An endometrial biopsy is not
usually done during or after
menopause unless a woman has abnormal vaginal
bleeding. Some doctors may do a biopsy before prescribing
hormone replacement therapy (HRT).
References
Other Works Consulted
- Pagana KD, Pagana TJ (2006). Mosby’s Manual of Diagnostic and Laboratory Tests, 3rd ed. St. Louis:
Mosby.
Credits
| Author | Maria G. Essig, MS, ELS |
| Editor | Susan Van Houten, RN, BSN, MBA |
| Associate Editor | Tracy Landauer |
| Primary Medical Reviewer | Kathleen Romito, MD - Family Medicine |
| Specialist Medical Reviewer | Liisa Honey, MD, FRCSC - Obstetrics and Gynecology |
| Last Updated | February 22, 2008 |