Endometrial Biopsy

Definition

Endometrial biopsy is a procedure in which a sample of the endometrium (tissue lining the inside of the uterus) is removed for microscopic examination.

Purpose

The test is most often performed to find out the cause of abnormal uterine bleeding. Abnormal bleeding includes bleeding between menstrual periods, excessive bleeding during a menstrual period, or bleeding after menopause. Since abnormal uterine bleeding can indicate cancer, an endometrial biopsy is done to rule out endometrial cancer or hyperplasia (a potentially precancerous condition).

Endometrial biopsies are also done as a screening test for endometrial cancer in postmenopausal women on hormone replacement therapy. Hormone replacement therapy usually requires a woman to take estrogen and progesterone. An endometrial biopsy is particularly useful in cases where postmenopausal women take estrogen, but cannot take progesterone. Estrogen in the system without the balancing effect of progesterone has been linked to an increased risk of endometrial cancer.

An endometrial biopsy can also be used as part of an infertility exam to rule out problems with the development of the endometrium. This condition is called luteal phase defect and can cause the endometrium to not support a pregnancy. An endometrial biopsy can also be used to evaluate the problem of repeated early miscarriages.

Precautions

If the endometrial biopsy is being done to investigate why a woman is unable to get pregnant, the test must be performed at a specific time during the menstrual cycle. Since the test evaluates whether the endometrium is developed adequately to support implantation and growth of a fertilized egg, it is critical to perform the test approximately three days before the expected menstrual period.

Description

The test is performed by a doctor who specializes in women's reproductive health (an obstetrician/gynecologist). The test is performed either in the doctor's office or in a local hospital. The patient may be asked to take pain medication (like Motrin or Aleve) an hour or so before the procedure. A local anesthetic may be injected into the cervix in order to decrease pain and discomfort during the procedure.

The woman will be asked to lie on her back with knees apart and feet in stirrups. The doctor will first conduct a thorough exam of the pelvic region, including the vulva (the external genitals), vagina, and uterus. A speculum (an instrument that is used to hold the walls of the vagina open) will be inserted into the vagina. A small, hollow plastic tube is then passed into the uterine cavity. A small piece of the uterine lining is sucked out with a plunger that is attached to the tube. Once the sample is obtained, the instruments are removed. The sample is sent to the laboratory for microscopic examination.

The patient may experience some pain when the cervix is grasped. The patient may also feel some cramping, pressure, and discomfort when the instruments are inserted into the uterus and the tissue sample is collected.

Preparation

For the small number of endometrial biopsies that are done as part of infertility testing, a pregnancy test is also often performed before the procedure. Since the biopsy is performed late in the menstrual cycle, it is possible that the woman may be pregnant.

Aftercare

The biopsy may cause a small amount of bleeding (spotting). The woman can resume normal activities right away. If cramping becomes severe, heavy bleeding occurs, or the woman develops a high temperature, the doctor should be notified immediately.

If the test is being done to determine the cause of infertility, the onset of the menstrual period following the biopsy should be reported to the doctor. This will allow the doctor to correctly predict if the endometrium has been developing at the expected rate.

Risks

The risks of an endometrial biopsy are very small. There is a possibility that prolonged bleeding may occur after the procedure. There is also a slight chance of an infection. Very rarely, there are instances when the uterus is pierced (perforated) or the cervix is torn because of the biopsy.

Normal results

Most biopsies are done to rule out endometrial cancer or endometrial hyperplasia. A normal result shows no cancerous or precancerous cells. Normal results also show that the uterine lining is changing at the proper rate. If it is, then the results of the biopsy are said to be "in-phase" because the tissue looks appropriate and has developed normally for the late phase of the menstrual cycle.

Abnormal results

If the endometrium is not developing at the appropriate rate, the results are said to be "out-of-phase" or abnormal. The endometrium has not developed appropriately and cannot support a pregnancy. This condition is called luteal phase defect and may need to be treated with progesterone.

Abnormal appearance of the cells forming the uterine tissue could also indicate uterine cancer, or the presence of fibroids or polyps in the uterus.

KEY TERMS

Biopsy— The surgical removal and microscopic examination of living tissue for diagnostic purposes.

Cervix— The opening of the uterus extending into the vagina.

Endometrium— The layer lining the inner cavity of the uterus; this layer changes daily throughout the menstrual cycle.

Uterus— The hollow, muscular female organ that supports the development and nourishment of the unborn baby during pregnancy.

Resources

ORGANIZATIONS

American Cancer Society. 1599 Clifton Rd., NE, Atlanta, GA 30329-4251. (800) 227-2345. 〈http://www.cancer.org〉.

Cancer Research Institute. 681 Fifth Ave., New York, N.Y. 10022. (800) 992-2623. 〈http://www.cancerresearch.org〉.

Gynecologic Cancer Foundation. 401 North Michigan Ave., Chicago, IL 60611. (800) 444-4441.

National Cancer Institute. Building 31, Room 10A31, 31 Center Drive, MSC 2580, Bethesda, MD 20892-2580. (800) 422-6237. 〈http://www.nci.nih.gov〉.