Endometrial Biopsy

Test Overview

An endometrial biopsy is a way for your doctor to take a small sample of the lining of the uterus (endometrium). The sample is looked at under a microscope for abnormal cells. An endometrial biopsy helps your doctor find problems in the endometrium. It also lets your doctor check to see if your body's hormone levels that affect the endometrium are in balance.

There are several ways to do an endometrial biopsy. Your doctor may use:

  • A soft device shaped like a straw (pipette) to suction a small sample of lining from the uterus. This method is fast and may cause some cramping.
  • An electronic suction device (Vabra aspiration). This method can be uncomfortable.
  • A spray of liquid (jet irrigation) to wash off some of the tissue that lines the uterus. A brush may be used to remove some of the lining before the washing is done.

An endometrial biopsy may be done to find the cause of abnormal uterine bleeding, to check for overgrowth of the lining (endometrial hyperplasia), or to check for cancer.

When a woman is having a hard time getting pregnant, an endometrial biopsy may also be done to see whether the lining of her uterus can support a pregnancy.

An endometrial biopsy is sometimes done at the same time as another test, called hysteroscopy, which allows your doctor to look through a small lighted tube at the lining of the uterus.

Why It Is Done

An endometrial biopsy is done to:

  • Check for cancer of the uterus.
  • Find the cause of heavy, prolonged, or irregular uterine bleeding. It is often done to find the cause of uterine bleeding in women who have gone through menopause.
  • See whether the lining of the uterus (endometrium) is going through the normal menstrual cycle changes.

How To Prepare

Tell your doctor if you:

  • Are or might be pregnant. An endometrial biopsy is not done during pregnancy.
  • Are taking any medicines.
  • Are allergic to any medicines.
  • Have had bleeding problems or take blood-thinners, such as aspirin or warfarin (Coumadin).
  • Have been treated for a vaginal, cervical, or pelvic infection.
  • Have any heart or lung problems.

Do not douche, use tampons, or use vaginal medicines for 24 hours before the biopsy. You will empty your bladder just before your biopsy.

You may want to take a pain reliever, such as ibuprofen (Advil or Motrin), 30 to 60 minutes before having the biopsy. This can help decrease any cramping pain that can be caused by the biopsy.

You will need to sign a consent form that says you understand the risks of an endometrial biopsy and agree to have the test done. Talk to your doctor about any concerns you have regarding the need for the test, its risks, how it will be done, or what the results may mean. To help you understand the importance of this test, fill out the medical test information formmedical test information form(What is a PDF document?).

How It Is Done

Endometrial biopsy

An endometrial biopsy is usually done by a gynecologist, a family medicine physician, or a nurse practitioner who has been trained to do the test. The sample will be looked at by a pathologist. The biopsy can be done in your doctor's office.

You will need to take off your clothes below the waist. You will be given a covering to drape around your waist. You will then lie on your back on an examination table with your feet raised and supported by foot rests (stirrups).

Your doctor will insert a lubricated tool called a speculum into your vagina. The speculum gently spreads apart the vaginal walls so your doctor can see inside the vagina and the cervix. See a picture of a pelvic examination with a speculum. The cervix is washed with a special solution and may be grasped and held in place with a clamp called a tenaculum.

Your cervix may be numbed with a spray or injection of local anesthetic.

The tool to collect the sample is guided through the cervix into the uterus. The tool may be moved up and down to collect the sample. Most women have some cramping during the biopsy.

An endometrial biopsy takes 5 to 15 minutes.

How It Feels

Endometrial biopsy

You may feel a sharp cramp as the tool is guided through your cervix. You may feel more cramping when the biopsy sample is collected. Most women find that the cramping feels like a really bad menstrual cramp.

Some women feel dizzy and sick to their stomachs. This is called a vasovagal reaction. This feeling will go away after the biopsy.

An endometrial biopsy usually causes some vaginal bleeding. You can use a pad for the bleeding or spotting.

Risks

There is a small chance that the cervix or uterus could be punctured during the biopsy. Bleeding or a pelvic infection is also possible.

After the test

You may feel some soreness in your vagina for a day or two. Some vaginal bleeding or discharge is normal for up to a week after a biopsy. You can use a sanitary pad for the bleeding. Do not do strenuous exercise or heavy lifting for one day after your biopsy. Do not have sex, use tampons, or douche until the spotting stops.

Follow any instructions your doctor gave you. Call your doctor if you have:

  • Heavy vaginal bleeding (more than a normal menstrual period).
  • A fever.
  • Belly pain.
  • Bad-smelling vaginal discharge.

Results

An endometrial biopsy is a way for your doctor to take a small sample of the lining of the uterus (endometrium). Lab results from a biopsy may take several days to get back.

Endometrial biopsy
Normal:

No abnormal cells or cancer is found. For women who have menstrual cycles, the lining of the uterus is at the right stage for the time in the menstrual cycle when the biopsy was done.

Abnormal:

A noncancerous (benign) growth, called a polyp, is present.

Overgrowth of the lining of the uterus (endometrial hyperplasia) is present.

Cancer or cell changes that may lead to cancer are present.

For women who have menstrual cycles, the lining of the uterus is not at the right stage for the time in the menstrual cycle when the biopsy was done. More tests may be needed.

What Affects the Test

Reasons you may not be able to have the endometrial biopsy or why the results may not be helpful include:

  • If you are pregnant. An endometrial biopsy is not done during pregnancy.
  • If a vaginal or cervical infection is present. The infection could spread to the uterus if an endometrial biopsy is done.
  • If the endometrial biopsy sample is not large enough to see abnormal cells. Another test may be needed.

What To Think About

  • An endometrial biopsy is not done during pregnancy.
  • More of the uterine lining can be sampled during a dilation and curettage (D&C) than during an endometrial biopsy. Another test, called a hysteroscopy, is usually done with a D&C so that your doctor can see the lining of your uterus. A hysteroscopy may also be done instead of a D&C. For more information, see the topic Hysteroscopy.
  • An endometrial biopsy is not usually done during or after menopause unless a woman has abnormal vaginal bleeding.

References

Other Works Consulted

  • Pagana KD, Pagana TJ (2010). Mosby’s Manual of Diagnostic and Laboratory Tests, 4th ed. St. Louis: Mosby.

Credits

By Healthwise Staff
Primary Medical Reviewer Sarah Marshall, MD - Family Medicine
Specialist Medical Reviewer Femi Olatunbosun, MB, FRCSC - Obstetrics and Gynecology
Last Revised October 22, 2012

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