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DESCRIPTION
An endometrial biopsy (also known as an uterine biopsy) is a diagnostic procedure that involves removal of tissue from the endometrium, the inner lining of the uterus. The sample is looked at under a microscope for abnormal cells. An endometrial biopsy helps your health care provider to find any problems in the endometrium. It also lets your health care provider to 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 grown thicker until a mature egg is released from an ovary during ovulation. If the egg is not fertilized by a sperm, the endometrial lining is shed during normal menstrual bleeding.
REASONS FOR PROCEDURE
Investigation of fertility issues in a patient who has been unable to become pregnant. This procedure will help your health care provider to see whether the lining of the uterus (endometrium) is going through normal menstrual cycle changes and whether or not it can support a pregnancy. Hormonal levels may be analyzed.
Investigation of bleeding between menstrual periods, heavy, prolonged and/or irregular uterine bleeding. An endometrial biopsy may be done to find the cause of abnormal uterine bleeding, to check for overgrowth of the lining (endometrial hyperplasia).
Post-menopausal bleeding.
Check for cancer. An endometrial biopsy is done to help determine the cause of a Pap test result showing glandular cell changes that may lead to cancer in women older than 35. Glandular cells are a type of cell found in the cervix and the endometrium.
An endometrial biopsy is sometimes done at the same time as another test, called hysteroscopy, which allows your health care provider to look through a small lighted tube at the lining of the uterus.
Laboratory examination of the removed tissue aids in diagnosis. If appropriate, the procedure is performed during the last 2 weeks of the patient's menstrual cycle. This is the best time to identify possible hormonal problems and to determine if ovulation is occurring.
RISK
None expected. There are very few risks with endometrial biopsy. The leading risk is pain, followed by possible infection, bleeding and rarely perforation of the uterus.
DESCRIPTION OF PROCEDURE
PREPARING FOR THE PROCEDURE
Let your health care provider know if you:
- Are or might be pregnant. An endometrial biopsy is not done during pregnancy.
- Are taking any medications.
- Are allergic to any medications.
- Have ever 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 medications 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 the biopsy. This can help decrease any cramping pain that can be caused by the biopsy.
You will be asked to sign a consent form that says you understand the risks of an endometrial biopsy and agree to have the test done. Talk with your health care provider about any concerns you have regarding the procedure, its risks, how it will be done, or what the results may mean.
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 medications. Ask your health care provider what medications you can take the day of the test.
PERFORMING THE PROCEDURE
The procedure is Usually performed in the health care provider's office with little or no anesthesia necessary by a practitioner trained to do the procedure. The sample will be looked at by a pathologist.
You will need to take off your clothes below the waist. You will be given a covering to drape around your waist. You will lie on your back on an examination table with your feet raised and supported by stirrup foot rests.
A speculum with smooth, curved blades resembling a "duck bill" is inserted into the vagina to bring the cervix into view. The speculum gently spreads apart the vaginal walls so your health care provider can see inside the vagina and the cervix. The cervix is washed with a special solution. In some cases, it is necessary to use a clamp called a tenaculum (a hook-like instrument that holds and helps stabilize the cervix).
A 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 usually takes 5 to 15 minutes to perform.
There are several methods of obtaining an endometrial biopsy. Your health care provider may use one of these methods:
A small, spoon-shaped instrument (or other biopsy instrument) is inserted through the cervix into the uterus. It is gently scraped against the inner lining of the uterus to gather tissue. A curette is used for 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 alternate method involves obtaining the tissue sample with a suction instrument. The suction instrument may be a soft, straw-like device that suctions a small sample of the lining from the uterus. This method is fast and is not very painful. An electronic suction device (Vabra aspiration) may be used. This method can be uncomfortable.
A spray of liquid (jet irrigation) to wash off some of the tissue that lines the uterus may be done. A brush may be used to remove some of the lining before the washing is done.
The instruments are removed. The surgery may cause slight pain, but it should be minor and temporary.
WHAT TO EXPECT
If you have not had any pain medication, you may feel a sharp cramp as the tool is guided through the 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.
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 procedure. You may experience a mild sore throat if a tube, called an 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.
You will need to have someone drive you home after the procedure, especially if you have had any kind of anesthesia. Be sure to make arrangements for a ride prior to the procedure.
EXPECTED OUTCOME
Tissue obtained successfully without complications in virtually all cases. Allow about 1 week for recovery from the procedure. During this time, you should expect vaginal discharge.
Laboratory testing on the tissue can confirm ovulation has occurred and may identify other causes of infertility, such as infection.
Laboratory examination will generally determine if there are any abnormal cells found in the uterine lining.
RESULTS
Lab results may take several days to get back. A report will be sent to your health care provider.
ENDOMETRIAL BIOPSY RESULTS
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.
A non-cancerous (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.
FACTORS THAT AFFECT 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 performed.
- If the endometrial biopsy sample is not large enough to see abnormal cells, another test may be needed.
- More of the uterine lining can be sampled during a D&C than during an endometrial biopsy. A hysteroscopy may be done with a D&C so that the health care provider can see the lining of your uterus. A hysteroscopy may also be done instead of a D&C.
- An endometrial biopsy is not done during pregnancy.
- An endometrial biopsy is not usually done during or after menopause unless a woman has abnormal vaginal bleeding. Some health care providers may do a biopsy before prescribing hormone replacement therapy (HRT).
MoonDragon's Obgyn Procedures: Dilation & Curettage (D&C)
POSSIBLE COMPLICATIONS
Excessive bleeding.
Surgical-wound infection.
Inadvertent injury to the uterus.
POST PROCEDURE CARE
GENERAL MEASURES
Bathe or shower as usual. Use mild, non-scented, non-perfumed soap.
Wear sanitary pads for the rest of this menstrual period. Avoid tampons temporarily; they may lead to infection. Your menstrual flow may be heavier than usual.
Wear cotton underpants and pantyhose with a cotton crotch. Avoid underwear made from nylon, polyester, silk or other non-ventilating materials.
Do not douche unless it is prescribed for you.
MEDICATION
Hormonal therapy, if a hormonal imbalance is confirmed.
You may use non-prescription drugs, such as acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs), for minor pain.
ACTIVITY
Resume daily activities and work as soon as possible. You can usually do most of your 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 procedure.
DIET
No special diet. However, you should follow a healthy, balanced nutritional program for a healthy immune system and to assist in a rapid recovery from your procedure.
NOTIFY YOUR MIDWIFE OR HEALTH CARE PROVIDER IF...
Vaginal discharge increases or begins to have an unpleasant odor.
You experience pain that simple medication does not relieve quickly.
Unusually heavy vaginal swelling or bleeding develops.
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