by Karen Schroeder, MS

Anatomy and Physiology
A woman's reproductive organs include the vagina, uterus, fallopian tubes, and ovaries. The endometrium lines the inside of the uterus.

The endometrial tissue is shed during each monthly menstrual period. The tissue then regrows and gradually thickens until the next menstrual period. This cycle ends with menopause.

During pregnancy the endometrium is retained and serves as the attachment sitefor the placenta and developing fetus.

Reasons for Procedure
An endometrial biopsy is the removal of a sample of tissue from the endometrium for testing. If you are still menstruating, your doctor may request that you schedule the test during a specific time in your menstrual cycle.

An endometrial biopsy may be done for a variety of reasons. One of the most common is to check for endometrial hyperplasia, which is an abnormal thickening of the endometrium due to excess growth of cells.

Early detection and treatment of endometrial hyperplasia can prevent the development of endometrial cancer.

An endometrial biopsy may be recommended to investigate: Irregular uterine bleeding, uterine bleeding after menopause, lack of menstrual bleeding before menopause, fertility problems, the effectiveness of certain medications used to treat infertility, abnormal findings from an ultrasound test, certain types of abnormal Pap smears, possible infection of the endometrial lining.

Endometrial biopsies are generally NOT done under the following conditions: pregnancy, infection in the deep pelvic organs, acute cervical or vaginal infections, blood clotting disorders, cervical cancer.

Treatments
An endometrial biopsy is a diagnostic procedure; it is not used to treat any conditions. Other common tests used to obtain information about the uterus include: hysteroscopy, where a lighted tube equipped with a camera is used to see inside the uterus and obtain tissue samples, hysterosalpingography, where a dye and x-ray machine are used to produce images of the uterus and fallopian tubes, transvaginal ultrasound, where high pitched sound waves projected from a transducer placed inside the vagina are used to create images of the pelvic organs, including the endometrium.

Procedure
In the days leading up to your procedure: Arrange for a ride to and from the hospital. The night before, eat a light meal and do not eat or drink anything after midnight. If you regularly take any medications, herbs, or dietary supplements, ask your doctor if there is a need to temporarily discontinue them. Do not start taking any new medications, herbs, or dietary supplements before consulting your doctor.

This procedure generally takes about 5-10 minutes and does not require sedation. You'll be asked to lie on an examining table as you would for a gynecologic exam: with your feet in stirrups and your knees apart.

Your doctor will begin by performing a manual exam to determine the position of your uterus. He or she will then insert a speculum into your vagina to open it up and keep it open so the cervix is clearly visible.

In some cases, your doctor may use a paracervical block at the tip of the cervix and around it. A paracervical block is used to numb the cervix and uterus. It is usually not required during an endometrial biopsy, but can be used to relieve discomfort if necessary.

Your doctor may use another instrument called a tenaculum to grasp the cervix and hold it steady during the procedure.

Your doctor will then pass a long, thin, flexible tube called a "pipelle" through your vagina and cervix and into your uterus. The pipelle is equipped with a device that creates suction when pulled. Your doctor will use the pipelle to suction up a sample of endometrial tissue for examination in a laboratory. At the end of the procedure your doctor will remove the tenaculum and speculum.

Risks and Benefits
Risks and complications of an endometrial biopsy include: dizziness, cramping, bleeding, infection.

If you feel dizzy, you'll be asked to lie still for 10-15 minutes until it passes. Cramping can usually be controlled with oral medications, such as acetaminophen or ibuprofen. A small amount of vaginal bleeding is not unusual after an endometrial biopsy.

There is also a small risk of perforation of the uterus. A perforation is a break in the wall of the uterus. Although perforations are not always serious, they can result in internal bleeding or infection. Perforations are not common; they occur in less than 1 out of 100 patients.

Even without perforation, there is a small risk of infection and heavy bleeding after an endometrial biopsy. Minor bleeding is normal, but if it lasts more than two days or increases during that time, you should contact your doctor.

Benefits of endometrial biopsy include: early diagnosis of endometrial hyperplasia or uterine cancer, possible determination of the causes of infertility, evaluation of the effects of medication on the endometrium.

In an endometrial biopsy, or any procedure, you and your doctor must weigh the risks and benefits to determine whether it's the most appropriate treatment choice for you.

After the Procedure
After your procedure: There is usually little to no recovery time; your doctor will send the sample to a lab for testing; you will get your results by phone, mail, or at a follow-up appointment.

Once home, be sure to contact your doctor if you experience: excessive vaginal bleeding-more than your normal menstrual period or saturating a pad within one hour, signs of infection, including fever and chills, severe pain in the abdomen or pelvis, foul-smelling vaginal discharge,other worrisome symptoms.

Sources:

• Diagnostic tests: endometrial biopsy. The Harvard Medical School Family Health Guide. Available at: http://www.health.harvard.edu/fhg/diagnostics/endobio/endobio.shtml. Accessed January 10, 2004.
• Endometrial biopsy. Greater Baltimore Medical Center website. Available at: http://www.gbmc.org/gynecology/patientinformation/procedures/EndometrialBiopsy03.doc. Accessed February 2, 2004
• Zuber TJ. Endometrial biopsy. American Family Physician. Available at: http://www.aafp.org/afp/20010315/1131.html. Accessed January 10, 2004.