What to expect from an endometrial biopsy

If you’ve been told you need an endometrial biopsy, you probably have some questions. Why has it been ordered? What will it involve? And, most importantly, what will the results show your doctors?

We sat down with gynecologic oncologist Larissa Meyer, M.D., to learn more.

What is an endometrial biopsy?

It’s a very simple, in-office procedure that allows doctors to obtain a sample of the cells that form the lining of the uterus, also known as the endometrium. 

Doctors use these samples to look for evidence of abnormalities that could indicate precancerous changes in the cells or the presence of actual cancer in the endometrium.

Why are endometrial biopsies usually performed?

Your doctor could order an endometrial biopsy for several reasons: 

• Abnormal bleeding from the vagina: In post-menopausal women, this would mean any bleeding at all. In pre-menopausal women, this would mean unusual patterns of bleeding.
• Hereditary cancer syndromes: We don’t normally screen for endometrial cancer in women at average risk. But for certain patients in high-risk groups, such as those with Lynch syndrome or other hereditary cancer syndromes, screening may be recommended.
• Abnormal scan results: An endometrial biopsy may be needed if an ultrasound reveals a thick endometrial “stripe,” for example, or a radiologist sees something unusual that they don’t think should be there. 
• Treatment monitoring: Sometimes, a hysterectomy is recommended for someone with endometrial hyperplasia (a type of abnormal cell growth that can lead to cancer), early-stage endometrial cancer, or a uterine tumor that is not otherwise removable. Patients who wish to preserve their fertility may wish to be treated with hormone therapy instead. In those situations, doctors would likely perform an endometrial biopsy every three months to monitor their progress.

What happens during an endometrial biopsy?

The doctor inserts a speculum into the vagina so that they can see the cervix. A speculum is the same instrument used to hold open the vagina during a Pap test. 

Then, the doctor passes a tiny, soft, flexible straw called a pipelle through the cervix until it touches the fundus, or uppermost part, of the uterus. They gently move it around while drawing back the plunger to suck in some tissue. Then, they remove the pipelle, which is only about the diameter of a piece of linguine.

That’s really all there is to it. Other than the speculum, which is usually made out of stainless steel, there’s no metal involved. There’s also no blade and no cutting.

What happens if the pipelle can’t pass easily through the cervix?

If the uterus is moving around too much, we have an instrument called a tenaculum that we can place on the cervix to help stabilize the uterus and hold it steady. 

If the cervical canal is too narrow, we have a series of very small rounded instruments to gently dilate it in the clinic.

If all else fails, we can perform the biopsy under general anesthesia. But that scenario is very rare.

What do the results of my endometrial biopsy mean?

Here are some words and phrases you might see on your biopsy results: 

• Proliferative endometrium
• Atrophic endometrium         
• Hyperplasia
• Carcinoma

If you see either of the first two phrases, your results are normal.

If you see either of the other two phrases, your results indicate that some abnormal/precancerous or cancerous cells were found. Ask your doctor what that means for next steps, as you will likely need some form of treatment.

What is the recovery process like for an endometrial biopsy?

The cervix doesn’t like to be opened, so many patients compare the experience to having bad menstrual cramps. Unfortunately, topical anesthesia hasn’t been shown to be effective in reducing this sensation. But it’s often helpful to take ibuprofen before the procedure. Talk to your doctor to see if that might be appropriate for you, and if so, what dosage they’d recommend. 

Any lingering discomfort from the biopsy usually goes away within 10 to 20 minutes. After that, most people are fine, and can go right back to doing whatever they were doing before the procedure.

Request an appointment at MD Anderson online or by calling 1-877-632-6789.