Stephen R. Wells MD

WHY ENDOMETRIAL BIOPSY IS RECOMMENDED

Endometrial biopsy is a diagnostic test that allows us to better evaluate the etiology of abnormal bleeding or of an abnormal thickening of the lining of the uterus. It may help to determine whether or not abnormal bleeding is caused by a physiologic hormonal imbalance, a structural abnormality such as an endometrial polyp or fibroid, or an existing pre-cancerous or cancerous lesion. An endometrial biopsy is usually reserved for patients with a significant change in their normal bleeding pattern. These changes may include recently heavy menstrual cycles or bleeding in-between periods or even light bleeding while on hormone replacement therapy. The tissue obtained from the endometrial biopsy is sent to a pathologist who is able to evaluate the tissue under a microscope. Typically, it takes anywhere from three to seven days to receive a final result. You may be asked to return to the office to discuss the results of the biopsy and discuss further management options or you may be called with the results depending on your particular situation. In more complicated situations it is better to come into the office to discuss the results and plan of treatment.

 

HOW ENDOMETRIAL BIOPSY IS PERFORMED

When performing an endometrial biopsy, a speculum will be placed into the vagina. The cervix will be cleansed with a Betadine solution to prevent the introduction of bacteria through the cervix into the uterus. At this time, a small clamp will be placed on the cervix to stabilize it during the biopsy procedure. You may feel a moderate amount of cramping with placement of this clamp. The biopsy instrument will then be introduced through the cervix into the endometrial cavity. The device is a long, small-diameter plastic hollow tube with a plunger that creates a vacuum to aspirate cells lining the uterine cavity. The diameter of this biopsy device is approximately the same as a coffee stirrer found in local coffee shops. Once the device is introduced into the uterus, it is rotated clockwise and withdrawn slowly, thus aspirating an adequate sample from the intrauterine cavity. During this time, you will experience significant cramping which is rather short lived. Many over-the-counter non-steroidal anti-inflammatory medications will be sufficient to control the cramping related to this procedure. The cramping tapers immediately following the procedure but may last for approximately one-half hour to one hour and may be similar to menstrual cramps. Following the completion of the procedure, you may have some very mild spotting that may last for one day.  IF YOU HAVE MITRAL VALVE PROLAPSE, YOU WILL NEED TO TAKE PROPHYLACTIC ANTIBIOTICS. PLEASE LET US KNOW BEFORE WE BEGIN.

 

BENEFITS, RISKS AND ALTERNATIVES

The benefit of this procedure is that it is able to diagnose the presence or absence of any significant pathology. It is able to determine the presence of a hormonal imbalance that may be a cause of bleeding. In addition, polyps may be identified which is also a common cause of bleeding. Lastly, it is able to diagnose uterine pre-cancerous or cancerous changes within the uterus, and is in fact one of the only office-based tests able to diagnose this more common female cancer.

The risks are minimal, but include some mild bleeding that usually resolves within a day. In addition, there may be an exceedingly small risk of developing an infection following this procedure. This would be treated with antibiotics and would most likely resolve in a short period of time.

The alternatives to this procedure would be expectant management and following your particular problem over time. Ultrasound may often times be used as an indicator of the presence or absence of a particular problem; however, it is impossible to rule out the presence of a uterine cancer using ultrasound.

 

AFTER CARE

Following the endometrial biopsy, there may be minimal discomfort as mentioned previously. Cramping can be relieved with Advil or other mild over-the-counter pain relievers. Should you have any significant side effects following this procedure such as fever, increasing abdominal pain, pelvic pain or heavy bleeding with the passage of blood clots, we would ask that you call our office so that you may be evaluated in a prompt manner.