Definition and Overview

Endometrial biopsy is the process of obtaining a tissue sample of the endometrium for assessment. The doctor who specializes in the procedure is called a gynecologist.

The female reproductive system is composed of several parts such as the ovaries that produce the eggs, the uterus or the womb, the fallopian tube where the eggs travel, and the cervix that connects the womb to the vagina and thus serves as the entrance to the uterus.

The uterus, meanwhile, is largely composed of the corpus or the body where the baby develops. It has two linings, one of which is the endometrium, which is found in the inner part.

The endometrium is a good indication of any hormonal problems since its structure, such as its thickness, changes during a menstrual cycle. If the woman has become pregnant, it becomes thicker in response to increased production of estrogen to prepare the uterus for fetal growth. If there’s no fertilization, the body produces more progesterone, which thins out the endometrium so it sheds and becomes blood flow during menstruation.

Abnormalities, nevertheless, can develop in any part of the reproductive system especially the uterus and even the endometrium itself. These include uterine or endometrial cancer, endometriosis, and fibroids. The biopsy can help gynecologists better understand the causes of these abnormalities so they can also provide the right treatment.

Why Should Undergo and Expected Results

Endometrial biopsy is often recommended to women who experience abnormal bleeding. This may mean profuse or heavy flow during menstruation, irregular menstruation, or the lack of it. All of these may point out to several problems including hormonal imbalance or diseases such as cancer.

Endometriosis is a disorder wherein the endometrium develops outside the uterus, spreading to nearby organs such as the ovaries and the bowel. They can still thicken, which may irritate the organs, causing lesions in the process. The disorder often leads to very painful periods and infertility. Both uterine and endometrial cancers are caused by certain abnormal cells that continue to grow and spread. Uterine cancer refers to the cancer of the body of the uterus.

The biopsy can also be used to confirm or rule out hyperplasia, which is the enlargement of the endometrium due to the abnormal production of cells. This is often considered as a pre-cancer stage.

The biopsy can also be one of the evaluation tools for infertility, but it’s largely due to hormonal imbalance and metabolic disorders, which prevent eggs to mature or the endometrium to thicken and support the uterus for pregnancy.

Women who have already undergone menopause may also be requested to undergo the exam if they continue to experience abnormal bleeding. Endometrial biopsy is also a good determinant whether hormone and fertility therapies have been working.

Some women go through Pap smear first. Pap smear is the screening test for cervical cancer, and it involves scraping sample cells from the cervix. If the result of the test shows any abnormality, the gynecologist may ask for more exams such as endometrial biopsy to make an accurate diagnosis.

Endometrial biopsy is not performed on women who are pregnant, are morbidly obese, or have already been diagnosed with gynecological cancers. Any inflammation of the vagina or the pelvis may also hinder the test’s ability to detect any abnormalities. Women may have to wait it out until the bleeding has stopped before the test can be performed.

The test can be completed within 10 minutes, but it may take a week for the results to come out, which by then will determine if there are abnormalities in the structure, tissue, and cells present.

How Does the Procedure Work?

The biopsy doesn’t require any anesthesia, although some patients request for it to reduce anxiety. During the exam, the patient is made to lie on the examination table, with feet resting on the stirrups and the legs spread open.

The gynecologist then slowly inserts a speculum to keep the vagina open and steady all throughout the exam. This will then allow the gynecologist to see the cervix. An instrument will then be used to open the cervix and sometimes to stretch it if the opening is still quite narrow. A numbing agent may be applied to minimize discomfort and pain.

At this point, the gynecologist has at least three options on how to obtain samples of the endometrium. The sample can be obtained using a pipette, which suction the lining. The procedure can also be performed through electronic suction or jet irrigation, which uses water to wash off the lining.

Once the sample has been obtained and the tissue is sent to the lab for assessment, the patient is scheduled for a follow-up appointment where the results of the biopsy will be discussed.

Possible Complications and Risks

Patients may feel discomfort and pain during the exam. There may also be abdominal cramping and bleeding, but these should stop within a few hours after the procedure. Rarely, the exam leads to a puncture of the uterus or infection of the pelvis.

References:

  • Choby BA. Endometrial biopsy. In: Pfenninger JL, Fowler GC, eds. Pfenninger & Fowler’s Procedures for Primary Care. 3rd ed. Philadelphia, Pa: Elsevier Mosby; 2010:chap 143.
  • Lentz GM. Endoscopy: hysteroscopy and laparoscopy: indications, contraindications and complications. In Lentz GM, Lobo RA, Gershenson DM, Katz VL, eds. Comprehensive Gynecology. 6th ed. Philadelphia, Pa: Elsevier Mosby; 2012:chap 10.
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