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Endometrial biopsy
Definition
Endometrial biopsy is a procedure in which a tissue sample is taken from the lining of the uterus (endometrium), and is checked under a microscope for any abnormal cells or signs of cancer.
Alternative Names
Biopsy - endometrium
How the Test is Performed
This procedure may be done with or without anesthesia. You will lie on your back with your feet in stirrups.
The health care provider will do a pelvic examination, and will insert an instrument (speculum) into the vagina to hold it open and see the cervix.
The cervix is cleaned with an antiseptic liquid and then grasped with an instrument (tenaculum) to hold the uterus steady. A device called a cervical dilator may be needed to stretch the cervical canal if there is tightness (stenosis). Then a small, hollow plastic tube is gently passed into the uterine cavity.
Gentle suction removes a sample of the lining. The tissue sample and instruments are removed. A specialist called a pathologist examines the sample under a microscope.
How to Prepare for the Test
There is no special preparation for the biopsy. You may want to take ibuprofen (Advil, Motrin IB) or acetaminophen (Tylenol) 1 hour before the procedure to reduce cramping.
How the Test Will Feel
The instruments may feel cold. You may feel some pain when the cervix is grasped. You may have some cramping as the instruments enter the uterus and the sample is collected.
Why the Test is Performed
The test is done to find the cause of:
- Abnormal menstrual periods (heavy, prolonged, or irregular bleeding)
- Bleeding after menopause
- Bleeding from taking hormone therapy medications
- Thickened uterine lining seen on ultrasound
The test is usually done in women over age 35.
This test can also be used to test for endometrial cancer. Sometimes, it is used as part of the diagnosis in women who have been unable to become pregnant (see infertility).
Normal Results
The biopsy is normal if the cells in the sample have no abnormalities.
What Abnormal Results Mean
Abnormal menstrual periods may be caused by:
- Endometrial cancer or precancer (hyperplasia)
- Uterine fibroids
- Uterine polyps
- Infection
- Hormone imbalance
If the lining is being tested for infertility, the sample may determine if hormones are properly stimulating the lining so that the fertilized egg can implant.
Other conditions under which the test may be performed:
- Abnormal bleeding if a woman is taking the breast cancer medication, tamoxifen
- Anovulatory bleeding
Risks
- Infection
- Making a hole in (perforating) the uterus or tearing the cervix (rarely)
- Prolonged bleeding
- Slight spotting and mild cramping for a few days
References
Katz VL. Diagnostic procedures. Imaging, endometrial sampling, endoscopy: indications and contraindications, complications. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby; 2007:chap 11.
Bulun SE. Physiology and pathology of the female reproductive axis. In: Kronenberg HM, Melmed S, Polonsky KS, Larsen PR, eds. Williams Textbook of Endocrinology. 12th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 17.
Reviewed By: Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Redmond, Washington: Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
