Endometrial Biopsy

What is an endometrial biopsy?

An endometrial biopsy is a medical procedure in which your healthcare provider removes a small piece of tissue from the lining of your uterus (the endometrium) to examine under a microscope. When this tissue is analyzed under a microscope, a provider may see abnormal cells and cells that could be cancerous. The procedure itself takes less than 15 minutes and happens in your provider’s office. It’ll cause mild cramping and discomfort, and may be slightly painful to some people.

A healthcare provider may recommend an endometrial biopsy to help them find the cause of certain symptoms or problems you’re having. It can also help them further diagnose conditions they may suspect after seeing results from tests like an ultrasound or Pap smear.

Reasons for an endometrial biopsy include:

• Irregular periods. This includes heavy, long and abnormal bleeding or not getting your period at all.
• Bleeding after menopause.
• Abnormal bleeding while taking tamoxifen or other hormone therapy.
• Thickened uterine lining.
• Pap test results that show irregular cells in your uterus.

Who can get an endometrial biopsy?

An endometrial biopsy is the most common and accurate test to diagnose endometrial cancer. People over 35 with a uterus are most likely to have an endometrial biopsy.

Pregnant people can’t get an endometrial biopsy. However, people who are having trouble getting pregnant may have one to determine if their endometrial lining is contributing to infertility.

How does an endometrial biopsy work?

A healthcare provider inserts a thin tube through your cervix and into your uterus. A small sample of your endometrium is removed through the tube using suction. It takes less than15 minutes.

How do I prepare for an endometrial biopsy?

You shouldn’t need to do much to prepare for an endometrial biopsy. Let your healthcare provider know what medications or supplements you take and if you have any allergies. They can let you know if you should stop taking certain medications before the biopsy.

Some healthcare providers recommend taking a nonsteroidal anti-inflammatory drug (NSAID) like ibuprofen before the biopsy to help with pain. Your provider may recommend a medication to help prepare your cervix for the biopsy, often taken by mouth one and two days before the procedure.

Ask your healthcare provider any questions you have before the procedure so you know exactly what to expect. Generally, an endometrial biopsy is very low-risk and safe.

What should I expect during an endometrial biopsy?

An endometrial biopsy usually happens in your healthcare provider’s office or another outpatient facility without anesthesia.

The procedure follows these steps:

• You’ll undress from the waist down and cover yourself with a sheet.
• You’ll place your feet in stirrups and lay back on a reclined exam table like you would for a pelvic exam or Pap smear.
• Your healthcare provider will insert a speculum into your vagina to hold it open so that they can see your cervix (similar to a Pap test).
• Your provider will clean your cervix with a special solution.
• They may use a special instrument called a tenaculum to help hold your cervix steady so they can insert a suction tube into your uterus. Some people find this step to be the most painful.
• Finally, your provider places a very thin suction tube through your cervix into your uterus to collect the tissue sample. You may feel your provider moving the instrument around to get the tissue sample.
• Your provider sends the tissue to a pathologist who analyzes the cells.

The procedure itself usually takes between five and 15 minutes.

What happens after an endometrial biopsy?

After your healthcare provider removes the instruments from your vagina, you can get dressed. Feel free to take a few moments to rest before leaving the room. You should be able to drive home shortly after the procedure.

You may place a sanitary pad in your underwear immediately after the biopsy. Vaginal bleeding and cramping is normal and expected, but shouldn’t last longer than a few days. Using an over-the-counter (OTC) pain reliever, such as ibuprofen or acetaminophen, can help with cramping.

Your healthcare provider will review the exact recovery instructions with you. There are several things they may ask you to avoid while you recover. For example, they may tell you:

• Don’t use tampons or place anything inside your vagina for seven days. This includes douching — which you should always avoid, anyway.
• Don’t have sexual intercourse for at least seven days or for as long as your provider tells you not to.
• Refrain from strenuous activities, heavy lifting, swimming, using a hot tub or taking a bath for several days.

How long does it take to recover from an endometrial biopsy?

It’s normal to have soreness and cramping for 48 hours. It shouldn’t take longer than a few days to completely recover from an endometrial biopsy.

Call your healthcare provider if you have any of the following:

• Bleeding that lasts longer than two to three days.
• Foul-smelling vaginal discharge.
• Fever and flu-like symptoms such as chills.
• Anything stronger than menstrual cramping after two to three days.

What are the risks of an endometrial biopsy?

Risks of an endometrial biopsy include:

• Infection.
• Bleeding.
• Spotting and cramping that last several days.
• Perforating or tearing your uterus or cervix (this is rare).

Is an endometrial biopsy painful?

It’s normal to feel mild cramping (like menstrual cramps) during and after the procedure. Everyone has a different tolerance for pain, so you may experience more pain than some or less than others. Generally, healthcare providers don’t consider an endometrial biopsy to be a very painful procedure.

Contact your healthcare provider if you have pelvic pain that lasts several days after the biopsy.

What do the results of an endometrial biopsy mean?

If your results are normal, that means your provider found no abnormal cells.

If your results are abnormal, that means your provider found abnormal cells. The possible reasons for abnormal results could be:

• Endometrial cancer.
• Uterine polyps or fibroids.
• Infections in your uterine lining.
• Hormonal imbalance.

Sometimes the results can be inconclusive. Your healthcare provider may want to remove a bigger piece of tissue to look for abnormal cells in a procedure called a dilation and curettage (D&C).

What happens if my endometrial biopsy is abnormal?

Your healthcare provider will review your results with you and determine the next steps. Treatment isn’t always necessary. An abnormal result doesn’t always mean you have cancer. Talk to your healthcare provider to make sure you understand your test results and what they mean.

When should I know the results of an endometrial biopsy?

It takes up to one week to receive results of a biopsy from your healthcare provider.

When should I call my healthcare provider?

Contact your healthcare provider if you:

• Have cramping or pain that lasts several days after the procedure.
• Continue to bleed for longer than 72 hours after the procedure or begin to bleed heavily (soaking through a pad every one to two hours).
• Receive normal results from your biopsy but still experience symptoms like irregular bleeding.

A note from Cleveland Clinic

Endometrial biopsy is a procedure your healthcare provider may use to diagnose endometrial cancer or find the cause of irregular bleeding. It takes about 15 minutes and is a relatively low-risk procedure. It involves your provider removing a sample of endometrial tissue from your uterus and sending it to a lab for further analysis. You can expect cramping similar to menstrual cramps and light bleeding for a few days.

Don’t be afraid to discuss the procedure with your provider so you know what to expect during and after the biopsy. Your healthcare provider will discuss your results with you and determine if you need further tests or treatment.