The internal lining of the uterus is called ‘Endometrium’. Scraping and collecting a part of the endometrium to check for cancer cells or abnormal cell growth is called endometrial biopsy. Variation in hormone levels, uterine infections such as endometritis can also be inferred from endometrial biopsy. Endometrial biopsy is done as an outpatient procedure without anesthesia and doesn’t take longer than 10 to 15 minutes.
Why is endometrial biopsy done?
If you report to your gynaecologist or urogynecologist with any of the following problems, he/she can do an endometrial biopsy to diagnose the problem:
- Abnormal bleeding during periods
- Bleeding after menopause
- Fertility evaluation
- To detect endometrial cancer
- Check your body’s response for undergoing hormone therapy
Are there any scenarios when endometrial biopsy is not done by your (uro)gynaecologist?
Yes, there are certain important situations when endometrial biopsy is not done by your doctor. They include:
- During pregnancy.
- Blood clotting disorder
- Acute PID (Pelvic inflammatory Disease)
- Acute cervical or Vaginal infection
- Cervical cancer
- Severe narrowing of the cervix (Cervical Stenosis)
If you are pregnant or missed your period and think that you might be pregnant, you must inform your doctor. Your doctor would then do a pregnancy test to confirm and decide whether to go ahead with sampling the endometrium.
Before undergoing endometrial biopsy
As said, you must inform your doctor if you are pregnant or if you missed your period. Inform your doctor about the medications that you are taking, if any, before endometrial biopsy is done. If you are taking any blood thinners, they interfere with body’s ability to clot the blood after the sampling of the endometrium is done. Tell your doctor if you are allergic to latex or iodine. An experienced gynaecologist will surely pose these questions before proceeding with the procedure. If you have come alone to the clinic/hospital for endometrial biopsy, you should wait until the sedative given wears off. (In cases where a sedative is administered).
How is endometrial biopsy done?
- Your doctor will do a physical exam of the pelvis region.
- A little bit of clean up vagina and cervix may be done if necessary.
- A clamp will be placed on the cervix to hold it in place. This may be a little uncomfortable.
- A thin, flexible tube called ‘Pipelle’ will be then inserted through the vagina, cervix and into the uterus. The Pipelle will be moved back and forth after reaching the walls of the uterus to scrape the inner lining to collect the sample. It is very important for the gynaecologist NOT to puncture your uterus. There is a very small probability for such accidents to happen, but cannot be ruled out. Always see an experienced gynaecologist for such important and sensitive procedures.
- The scraped sample will then be removed and sent to lab for analysis.
Once the sampling is done, you may see little bit of spotting which is normal and the spotting should stop in a day or two. You will be advised to use menstruation pad to wear. You should not use tampons or indulge in penetrative sexual activities without checking with your doctor.
Risks associated with endometrial biopsy
As said, very rarely uterus may be punctured in the process of sampling the inner lining of the uterus. A little bit of bleeding is ok but you must get in touch with your urogynecologist immediately if:
- If you are bleeding for more than two days after sampling
- If the bleeding is heavy. (Usually only spotting should be seen)
- If you run a fever or have chills
- Stinking vaginal discharge or abnormal looking vaginal discharge (this can indicate infection)
- Pain in the lower abdomen.
What are the possible outcomes of endometrial biopsy?
- Endometrial biopsy can confirm if there is any growth of cancer cells
- If you are suffering from Endometrial Hyperplasia (thickening of the inner lining of the uterus)
- Growth of abnormal benign cells