Endometrial Biopsy

What To Expect From an Endometrial Biopsy and the Next Steps

Healthcare providers and fertility doctors order endometrial biopsies to confirm or rule out various conditions, including uterine cancer. Endometrial biopsies involve taking a small piece of your uterine lining and examining it under a microscope. A biopsy is often ordered when you have irregular periods, abnormal ultrasound scan results, or unexplained infertility. Here’s an overview of what to expect from an endometrial biopsy and the next steps to take:

Why Do Doctors Order Endometrial Biopsies?

Abnormal bleeding and irregular periods are the primary reasons why doctors order endometrial biopsies. In pre-menopausal women, abnormal bleeding refers to heavy, extended, or unusual periods or not getting periods at all. After menopause, abnormal bleeding refers to any form of bleeding from the vagina. Doctors order a biopsy if you’re experiencing abnormal bleeding while under hormone therapy. Other reasons for such biopsies include thick uterine lining, unexplained infertility, hereditary cancer syndromes, and treatment monitoring.

If you’re unable to get pregnant without a medical explanation, the issue could be endometriosis. This condition occurs when endometrial cells that grow in the uterus grow elsewhere, like around the ovaries or in the fallopian tube. Endometriosis causes inflammation, irregular periods, unusual bleeding, and fertilization issues. A positive BCL-6 test may prompt your doctor to order a full endometrial biopsy to confirm or rule out endometriosis. Biopsies are used to monitor endometrial hyperplasia or investigate abnormal uterine scan results.

What Does an Endometrial Biopsy Involve?

During an endometrial biopsy, a speculum is inserted into the vaginal opening, similar to a Pap test. You will only need to undress from the waist down and then lie on your back on a reclined examination table. The doctor may clean your cervix using an antiseptic solution and pass a pipelle through the cervix. A pipelle is a tiny, flexible, straw-like instrument with a soft feel. Once the pipelle touches the uppermost part of your uterus, the doctor gently moves it around while drawing the plunger. This action creates suction and captures some of the uterine tissues.

Your doctor then removes the instrument and empties the uterine tissue sample for further examination under a microscope. No blades or cutting is involved during an endometrial biopsy, and the procedure takes a few minutes to complete. The biopsy requires no special preparation other than what your doctor recommends. Common preparations include taking NSAIDs to reduce cramping and pain. Your doctor may prescribe a medication to prepare the cervix for the procedure and ask you to empty your bladder. Inform the doctor of any medications or supplements you take or if you’re pregnant.

What Are My Steps After an Endometrial Biopsy?

After an endometrial biopsy, rest for a few minutes and wear a sanitary pad in case you bleed. Bleeding is normal after the procedure and subsides after a couple of days. Avoid douching, sexual intercourse, tampons, and strenuous activities like heavy lifting for a few days.

Use only the painkillers your doctor recommends. Watch out for cramping that lasts more than a couple of days, heavy bleeding, foul-smelling discharge, and pain that doesn’t subside. These issues need immediate attention by a healthcare provider to prevent infection and perforation.

The test results will determine the follow-up actions after an endometrial biopsy. Proliferative or atrophic endometrium means the results are normal. Hyperplasia or carcinoma implies the examination revealed abnormal cells. Abnormal test results are usually caused by uterine lining infections, uterine polyps, and fibroids, hormonal imbalances, or endometrial cancer.

Some results may be inconclusive and require further tests to confirm or rule out suspected conditions. Your doctor will provide comprehensive answers to help you determine the next steps after diagnosis.

Diagnosing Unexplained Infertility and Endometriosis

Endometrial biopsies help to reveal the underlying causes of irregular periods or unusual bleeding in both pre-and post-menopausal women. Abnormal bleeding and irregular periods are associated with infertility and uterine conditions like endometriosis. Before taking an endometrial biopsy, schedule a BCL-6 test to determine if endometriosis is the cause of your unexplained infertility.

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