Table of ContentsView AllTable of ContentsWhat It IsWhy It’s DoneInterpreting ResultsIs It Painful?PreparationDuring the ProcedureAfter EffectsNext StepsNext in Endometrial Cancer GuideWhat Is Endometrial Cancer?
Table of ContentsView All
View All
Table of Contents
What It Is
Why It’s Done
Interpreting Results
Is It Painful?
Preparation
During the Procedure
After Effects
Next Steps
Next in Endometrial Cancer Guide
Anendometrial biopsyis a non-surgical procedure that is done to examine and assess the lining of theuterus(endometrium). Your healthcare provider may recommend this test if you have abnormal menstrual or uterine bleeding.They may also recommend it if you have trouble getting pregnant or trouble carrying a pregnancy to term.
In some instances, abnormal cell changes may be found in the endometrium during this test. Abnormal test results can indicate a variety of causes, includingendometrial cancerorendometrial hyperplasia, a precancerous condition. Abnormal endometrial tissue or hormonal imbalances may also be identified.
This article will discuss the reasons you might need an endometrial biopsy. It will also describe the preparation, what to expect during the procedure, and management if post-biopsy bleeding, should it occur.
Drazen Zigic / Getty Images
What Is an Endometrial Biopsy?
Endometrial biopsies are outpatient procedures that may take place in a doctor’s office, ambulatory care setting, or hospital.
During an endometrial biopsy, a small amount of tissue will be removed from the lining of your uterus via suctioning from a catheter (a thin tube). The tissue sample will then be analyzed under a microscope to look for abnormal cells and other issues that affect the uterine lining, such as a hormonal imbalance.
Reasons to Have an Endometrial Biopsy
Endometrial biopsies are commonly used to diagnose endometrial cancer.They’re also used to diagnose endometrial hyperplasia, a precancerous condition that can turn into cancer if it’s not diagnosed and treated.In a person with postmenopausal bleeding, atransvaginal ultrasoundmay be used as an alternative first diagnostic approach.
Estrogen and progesterone are hormones that help prepare the uterine lining for pregnancy. If you’re having trouble conceiving, an endometrial biopsy may be done along with other tests to identify problems with hormone production. These diagnoses include conditions such aspolycystic ovary syndrome (PCOS).
Fibroids(benign uterine muscle growths) andpolyps(endometrial masses) often cause no symptoms. However, in some instances, they cause pain, irregular bleeding, or infertility. Endometrial biopsies can help identify the presence of these types of abnormal tissues. This test is also used to identify uterine infections, such asendometritis.
An endometrial biopsy cannot be used to make a definitive diagnosis ofendometriosis. However, it can be helpful for determining if a laparoscopic biopsy makes sense as a next step.
An Endometrial Biopsy Is Not an Endometriosis Biopsy"Endometriosis," “endometrial biopsy,” “and endometriosis biopsy” are terms that all come from the same root word. Since they sound similar, confusion about their meanings is common.Endometriosis is named for theendometrial tissuethat lines the inside of the uterus. It occurs when endometrial-like tissue grows outside the uterus, where it doesn’t belong.Endometrial biopsies and endometriosis biopsies both require endometrial tissue samples that are analyzed under a microscope.But these samples are obtained differently:Endometrial biopsies are not surgical procedures. The acquired sample of tissue will come from your uterine lining (endometrium).Endometriosis biopsiesare done on tissues obtained through laparoscopic surgeries. The procedure provides your surgeon with a full view of your reproductive organs and intestines. Tissue from multiple locations may be obtained during this surgery.
An Endometrial Biopsy Is Not an Endometriosis Biopsy
“Endometriosis,” “endometrial biopsy,” “and endometriosis biopsy” are terms that all come from the same root word. Since they sound similar, confusion about their meanings is common.Endometriosis is named for theendometrial tissuethat lines the inside of the uterus. It occurs when endometrial-like tissue grows outside the uterus, where it doesn’t belong.Endometrial biopsies and endometriosis biopsies both require endometrial tissue samples that are analyzed under a microscope.But these samples are obtained differently:Endometrial biopsies are not surgical procedures. The acquired sample of tissue will come from your uterine lining (endometrium).Endometriosis biopsiesare done on tissues obtained through laparoscopic surgeries. The procedure provides your surgeon with a full view of your reproductive organs and intestines. Tissue from multiple locations may be obtained during this surgery.
“Endometriosis,” “endometrial biopsy,” “and endometriosis biopsy” are terms that all come from the same root word. Since they sound similar, confusion about their meanings is common.
Endometriosis is named for theendometrial tissuethat lines the inside of the uterus. It occurs when endometrial-like tissue grows outside the uterus, where it doesn’t belong.
Endometrial biopsies and endometriosis biopsies both require endometrial tissue samples that are analyzed under a microscope.But these samples are obtained differently:
Interpreting Abnormal Endometrial Biopsy Results
The pathologist will analyze the sample’s thickness and pattern, which provides information about hormone levels and balance.Endometrial tissue that is too thick can also indicate endometrial hyperplasia.
They will also look for tissue abnormalities, such as inflammation and scarring, which might indicate an infection or endometriosis.
How Painful Is an Endometrial Biopsy?
Concerns about pain during an endometrial biopsy are common. It’s important to remember that every step will be taken to ensure that your experience is as comfortable as possible. Even so, cramping that feels like dysmenorrhea (menstrual cramps) is common during the procedure.
Some people describe feeling a quickly passing pinching sensation. Others experience more intense pain.
The reasons for these differences in pain perception vary, including underlying health conditions, your personal pain threshold, and your anxiety level. The experience level of thegynecologist(specialist in conditions of the female reproductive system) performing the procedure can also play a role.
Certain health conditions, such asvaginismus(chronic vaginal spasms), can cause heightened anxiety about vaginal penetration and fear and pain during the procedure.
Other conditions may physically tighten the cervix or cause inflammation in endometrial tissues, making it harder for the catheter to be inserted into the uterus.
Some conditions that might increase physical pain during an endometrial biopsy include:
To reduce the amount of pain you experience, your healthcare provider may recommend taking a prescribed antianxiety medication or over-the-counter (OTC) nonsteroidal anti-inflammatory drugs (NSAID) such as Advil (ibuprofen) or Aleve (naproxen) before the procedure. They will also apply a topical anesthetic onto the cervix to lessen pain.
If you have concerns or are afraid, talk to your healthcare provider. Together, you may decide that sedation is warranted and makes sense.
Pre-Endometrial Biopsy Prep Steps
Your healthcare provider will explain the scheduling and timing you can expect before, during, and after the procedure. They may also recommend or prescribe medications for you to take on the day of the test.
If you are having this test done because you’re having trouble getting pregnant, it may be timed to take place on or around the 21st day of your menstrual cycle.This is when your endometrium is at its thickest. If you don’t menstruate regularly, your healthcare provider will work with you on test scheduling.
If you take anticoagulants (blood thinners) or have a bleeding disorder, inform your healthcare provider beforehand.
You will be given a consent form to fill out and sign. You will also be given a questionnaire to fill out, which provides information about your medications and allergies. Be sure to let your healthcare provider know if you are allergic to any medications, anesthesia drugs, iodine, or latex.
If you usecannabidiol (CBD) productsor any substance that helps you relax, ask your healthcare provider if you should stop taking it before the test.
Endometrial biopsies are contraindicated (not recommended) for pregnant people. You may be required to take a pregnancy test before undergoing the procedure.
What to Expect the Day of Your Endometrial Biopsy
You’ll be given a hospital gown to wear during the test. Wear non-constrictive clothing you can comfortably change back into afterward. Since post-procedure spotting is expected, you may also wish to bring a sanitary napkin (not a tampon). You can eat, drink, and take your usual medications if sedation is not used.If you feel nervous or anxious, anxiety-reducing strategies such as meditating, doing deep breathing, or getting a pep talk from a good friend may be helpful in the hours leading up to the procedure.
You’ll be asked to empty your bladder in a restroom before you lie on the exam table.
In general, you can expect these steps:
Endometrial biopsies typically take around 15 minutes from start to finish. Cramping is most common when the instruments are inserted and the suctioning takes place. These periods are short and only last for a few minutes.
If you were not given a sedating drug, you can leave as soon as you are ready after the test is done.
It’s a good idea not to schedule activities such as exercise or returning to work after an endometrial biopsy. Avoid having penetrative vaginal sex for 2 to 3 days afterward or longer if you don’t feel comfortable.
Mild cramping, spotting, or light vaginal bleeding are expected after the test and may last several days.
Possible Risks to Be Aware Of
You and your healthcare provider should discuss the potential risks or complications that may result from this procedure, which may include:
Bleeding and Cramping After Endometrial Biopsy
Mild cramping and light bleeding are expected and aren’t a cause for alarm. Let your healthcare provider know if you have heavy bleeding, intense cramping, or severe pain in your lower abdomen. These symptoms require medical attention.
You should also be on the lookout for potential signs of infection. These include:
Next Steps With Abnormal Results
This test aims to determine what’s causing your symptoms and to treat their underlying cause. Getting abnormal results may not be what you want to hear, but it is the first step toward resolution.
Your healthcare provider will schedule a follow-up appointment with you to review your test results and discuss next steps. Those steps may include hormonal drugs that improve ovulation, surgical removal of growths like polyps, or additional testing.
If evidence of cancer is found, adilation and curettage (D&C)may be done to collect additional tissue. You may also need further testing that provides information about your cancer stage.Once this information has been gathered, a care plan will be put in place for you.
Summary
Endometrial biopsies are nonsurgical, outpatient procedures. During this test, endometrial tissues will be extracted from the uterus to be analyzed under a microscope in a laboratory.
Endometrial biopsies are useful for diagnosing several conditions, including endometrial cancer, endometritis, and hormonal imbalances. Abnormal results may indicate the need for further testing or treatments ranging from medication to surgery.
This procedure can be painful for some people. Talk to your healthcare provider if you’re worried about how the test will feel. Together, you can devise a plan to make your endometrial biopsy as comfortable as possible.
12 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Long S.Endometrial biopsy.Primary Care: Clinics in Office Practice. 2021;48(4):555-567. doi:10.1016/j.pop.2021.07.003Johns Hopkins Medicine.Endometrial biopsy.American Cancer Society.Tests for endometrial cancer.Yale Medicine.Endometrial hyperplasia.ACOG Committee Opinion No. 734:The role of transvaginal ultrasonography in evaluating the endometrium of women with postmenopausal bleeding.Obstet Gynecol. 2018;131(5):e124-e129. doi:10.1097/AOG.0000000000002631Goldrick KM, Kostroun KE, Mondshine JN, Robinson RD, Mankus EB, Knudtson JF.Characteristics of women with PCOS who undergo endometrial biopsies.Fertility and Sterility. 2020;114(3):e407-e408. doi:10.1016/j.fertnstert.2020.08.1193Yale Medicine.Diagnosing endometriosis.Giri SK, Nayak BL, Mohapatra J.Thickened endometrium: when to intervene? A clinical conundrum.J Obstet Gynecol India. 2021;71(3):216-225. doi:10.1007/s13224-020-01415-4American College of Obstetricians and Gynecologists.Endometrial hyperplasia.Terzic M, Aimagambetova G, Ukybassova T, et al.Factors influencing on pain in patients undergoing pipelle endometrial biopsy for abnormal uterine bleeding: why a personalized approach should be applied?JPM. 2022;12(3):431. doi:10.3390/jpm12030431Penn Medicine Chester County Hospital.Endometrial biopsy.Dana-Farber Cancer Institute.Endometrial cancer.
12 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Long S.Endometrial biopsy.Primary Care: Clinics in Office Practice. 2021;48(4):555-567. doi:10.1016/j.pop.2021.07.003Johns Hopkins Medicine.Endometrial biopsy.American Cancer Society.Tests for endometrial cancer.Yale Medicine.Endometrial hyperplasia.ACOG Committee Opinion No. 734:The role of transvaginal ultrasonography in evaluating the endometrium of women with postmenopausal bleeding.Obstet Gynecol. 2018;131(5):e124-e129. doi:10.1097/AOG.0000000000002631Goldrick KM, Kostroun KE, Mondshine JN, Robinson RD, Mankus EB, Knudtson JF.Characteristics of women with PCOS who undergo endometrial biopsies.Fertility and Sterility. 2020;114(3):e407-e408. doi:10.1016/j.fertnstert.2020.08.1193Yale Medicine.Diagnosing endometriosis.Giri SK, Nayak BL, Mohapatra J.Thickened endometrium: when to intervene? A clinical conundrum.J Obstet Gynecol India. 2021;71(3):216-225. doi:10.1007/s13224-020-01415-4American College of Obstetricians and Gynecologists.Endometrial hyperplasia.Terzic M, Aimagambetova G, Ukybassova T, et al.Factors influencing on pain in patients undergoing pipelle endometrial biopsy for abnormal uterine bleeding: why a personalized approach should be applied?JPM. 2022;12(3):431. doi:10.3390/jpm12030431Penn Medicine Chester County Hospital.Endometrial biopsy.Dana-Farber Cancer Institute.Endometrial cancer.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Long S.Endometrial biopsy.Primary Care: Clinics in Office Practice. 2021;48(4):555-567. doi:10.1016/j.pop.2021.07.003Johns Hopkins Medicine.Endometrial biopsy.American Cancer Society.Tests for endometrial cancer.Yale Medicine.Endometrial hyperplasia.ACOG Committee Opinion No. 734:The role of transvaginal ultrasonography in evaluating the endometrium of women with postmenopausal bleeding.Obstet Gynecol. 2018;131(5):e124-e129. doi:10.1097/AOG.0000000000002631Goldrick KM, Kostroun KE, Mondshine JN, Robinson RD, Mankus EB, Knudtson JF.Characteristics of women with PCOS who undergo endometrial biopsies.Fertility and Sterility. 2020;114(3):e407-e408. doi:10.1016/j.fertnstert.2020.08.1193Yale Medicine.Diagnosing endometriosis.Giri SK, Nayak BL, Mohapatra J.Thickened endometrium: when to intervene? A clinical conundrum.J Obstet Gynecol India. 2021;71(3):216-225. doi:10.1007/s13224-020-01415-4American College of Obstetricians and Gynecologists.Endometrial hyperplasia.Terzic M, Aimagambetova G, Ukybassova T, et al.Factors influencing on pain in patients undergoing pipelle endometrial biopsy for abnormal uterine bleeding: why a personalized approach should be applied?JPM. 2022;12(3):431. doi:10.3390/jpm12030431Penn Medicine Chester County Hospital.Endometrial biopsy.Dana-Farber Cancer Institute.Endometrial cancer.
Long S.Endometrial biopsy.Primary Care: Clinics in Office Practice. 2021;48(4):555-567. doi:10.1016/j.pop.2021.07.003
Johns Hopkins Medicine.Endometrial biopsy.
American Cancer Society.Tests for endometrial cancer.
Yale Medicine.Endometrial hyperplasia.
ACOG Committee Opinion No. 734:The role of transvaginal ultrasonography in evaluating the endometrium of women with postmenopausal bleeding.Obstet Gynecol. 2018;131(5):e124-e129. doi:10.1097/AOG.0000000000002631
Goldrick KM, Kostroun KE, Mondshine JN, Robinson RD, Mankus EB, Knudtson JF.Characteristics of women with PCOS who undergo endometrial biopsies.Fertility and Sterility. 2020;114(3):e407-e408. doi:10.1016/j.fertnstert.2020.08.1193
Yale Medicine.Diagnosing endometriosis.
Giri SK, Nayak BL, Mohapatra J.Thickened endometrium: when to intervene? A clinical conundrum.J Obstet Gynecol India. 2021;71(3):216-225. doi:10.1007/s13224-020-01415-4
American College of Obstetricians and Gynecologists.Endometrial hyperplasia.
Terzic M, Aimagambetova G, Ukybassova T, et al.Factors influencing on pain in patients undergoing pipelle endometrial biopsy for abnormal uterine bleeding: why a personalized approach should be applied?JPM. 2022;12(3):431. doi:10.3390/jpm12030431
Penn Medicine Chester County Hospital.Endometrial biopsy.
Dana-Farber Cancer Institute.Endometrial cancer.
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