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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 Values

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
• 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
• Endometritis

What the risks are

• Infection
• Making a hole in (perforating) the uterus or tearing the cervix (rarely)
• Prolonged bleeding
• Slight spotting

Special considerations

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.