Endometrial biopsy (EMB) is an office procedure that samples the inside lining of the uterus looking for cancer or precancerous changes. This test is most frequently done as part of the evaluation for abnormal vaginal bleeding. The endometrial biopsy causes some cramping only for a minute or two while the procedure is being done. Women who have an endometrial biopsy done typically do not leave the office in pain.
The common indications for an endometrial biopsy are women with abnormal vaginal bleeding over the age of 40, or with risk factors for uterine cancer. Risk factors for uterine cancer include obesity, high blood pressure, diabetes, and infrequent periods. Certain ultrasound findings may necessitate an endometrial biopsy especially if the endometrium (inside lining of the uterus) appears thickened on ultrasound.
Endometrial biopsies are done in the doctor’s office. The patient is in the same position as a pap smear. A speculum is place in the vagina and a small plastic tube called an endometrial currette, or pipel, is placed through the cervix. Cells from inside the cervix are then collected and these cells are sent to the pathologist for review. Sometimes an instrument is placed on the cervix to stabilize the cervix. This will cause cramping. For some women the cramping is very significant but for others it can be mild. I recommend taking ibuprofen (400 – 600mg) before coming to the appointment to decrease the cramping. The procedure only takes a few minutes. It is normal to have spotting for a day or two after the procedure, there should not be pain after the procedure is done. Pelvic rest (nothing in the vagina) is usually recommended for 2 days after the biopsy.
The results can take a few days to a little over a week to come back so I usually arrange a follow up appointment for 2 weeks after the procedure to discuss the results. The results can diagnose a cancer or a precancerous lesion. Even if there is nothing dangerous, the biopsy results can give information about why the abnormal bleeding is happening. This can help guide treatment options to correct the bleeding.