Patient Basics: Endometrial Biopsy

Originally published by Harvard Health.

What is the test?

In general, doctors take biopsies of areas that look abnormal and use them to detect cancer, precancerous cells, infections, and other conditions. For some biopsies, the doctor inserts a needle into the skin and draws out a sample; in other cases, tissue is removed during a surgical procedure.

This particular biopsy, endometrial biopsy, takes a tissue sample from the lining of your uterus (the endometrium). An endometrial biopsy is used to find endometrial cancer. Endometrial cancer might explain unexpected vaginal bleeding, particularly if bleeding occurs after menopause.

Often an ultrasound is used as a first test to check for endometrial cancer. The inner lining of the uterus looks like a “stripe” on an ultrasound, and it is normally a thin stripe. If a woman with unexpected vaginal bleeding has a thick stripe from the lining in the uterus, an endometrial biopsy may be used to check more specifically for cancer.

How do I prepare for the test?

If you are not bleeding heavily, you might want to take an NSAID medicine such as ibuprofen one to two hours before the test, to reduce the possibility of uterine cramps during the procedure. Ask your physician for a recommendation ahead of time.

It is best to avoid tampon use and avoid using vaginal creams during the day leading up to the procedure.

What happens when the test is performed?

This test is performed in the doctor’s office. It begins with a pelvic examination. Then, after cleaning your vagina with antibacterial soap, your doctor can inject or spray a local anesthetic to numb your cervix. Your cervix is the entrance to the uterus, and it is visible several inches into your vagina. In most cases the doctor will put a clamp on your cervix to hold it steady. If your biopsy is being done with the most commonly used method, the doctor will use a flexible, sterile plastic instrument called a Pipelle, which looks like a drinking straw. The doctor inserts the Pipelle through the opening in your cervix and positions it several inches into the uterus. Then the doctor pulls a thin wire out of the center of the Pipelle. As the rod is pulled out, the Pipelle becomes hollow and creates suction, drawing some of the cells from the lining of your uterus into the Pipelle. To get a good sample, the doctor will move the Pipelle forward and backward a few times before removing it. The cell sample is deposited in some fluid to be examined later under a microscope. The entire procedure takes about 10 minutes.
There are several variations in the way a doctor can do this procedure. Some doctors will use a scraping instrument (“curette”) in place of the Pipelle. In some cases, an electronic suction device is substituted for the Pipelle instrument.

What risks are there from the test?

You might have pelvic cramps (sometimes intense) during the procedure and sometimes for a day or two afterward; you may also experience a small amount of vaginal bleeding. It is extremely rare to have heavy bleeding or to develop an infection that needs treatment. This test could end a very early pregnancy. Your doctor might order a pregnancy test before performing the biopsy.

Must I do anything special after the test is over?

Call your doctor if you develop a fever of over 100° F, or if you have vaginal bleeding that lasts longer than two days or is heavier than your normal menstrual period. Your doctor may also recommend avoiding sexual intercourse until two or three days after any bleeding has stopped.

How long is it before the result of the test is known?

It may take up to a week for the doctor to know results from this biopsy test.