What is an endometrial biopsy?

During an endometrial biopsy, your healthcare provider takes a small tissue sample from the lining of the uterus (endometrium) for study. The tissue is viewed with a microscope to look for abnormal cells. Your healthcare provider can also check the effects of hormones on the endometrium.

Why might I need an endometrial biopsy?

Your healthcare provider may suggest an endometrial biopsy if you have:

• Abnormal menstrual bleeding

• Bleeding after menopause

• No menstrual bleeding

Biopsy results may show cell changes linked to hormone levels. It may also show abnormal tissues, such as fibroids or polyps. These can lead to abnormal bleeding. Your provider can also check for uterine infections, such as endometritis.

Your provider may also use an endometrial biopsy to check the effects of hormone therapy. Or to find abnormal cells or cancer. Endometrial cancer is the most common cancer of the female reproductive organs.

Endometrial biopsy is no longer advised as a routine part of testing and treatment for women not able to get pregnant (infertility).  

Your healthcare provider may have other reasons to do an endometrial biopsy.

What are the risks of an endometrial biopsy?

Some possible risks may include:

• Bleeding

• Pelvic infection

• Puncture of the uterine wall (rare)

Tell your healthcare provider if you are allergic to or sensitive to medicines, iodine, or latex.

Tell your healthcare provider if you are pregnant or think you could be. Endometrial biopsy during pregnancy may lead to miscarriage.

You may have other risks based on your condition. Discuss any concerns with your healthcare provider before the procedure.

Certain things may interfere with an endometrial biopsy. These include:

• Vaginal or cervical infections

• Pelvic inflammatory disease

• Cervical cancer

How do I get ready for an endometrial biopsy?

• Your healthcare provider will explain the procedure and you can ask questions.

• You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something isn't clear.

• Generally, you won’t need to do any preparation before the procedure. But your healthcare provider may advise you to take a pain reliever 30 minutes before the procedure.

• Tell your healthcare provider if you are pregnant or think you could be. Your healthcare provider may want to do a pregnancy test to be sure.

• Tell your healthcare provider if you are sensitive to or are allergic to any medicines, iodine, latex, tape, or anesthesia.

• Tell your healthcare provider of all prescription and over-the-counter medicines, vitamins, and herbal supplements that you are taking.

• Tell your healthcare provider if you have a history of bleeding disorders. Also tell your provider if you are taking any blood-thinning medicines (anticoagulants), aspirin, or other medicines that affect blood clotting. You may be told to stop these medicines before the procedure.

• Your healthcare provider may ask you to keep a record of your menstrual cycles. You may need to schedule the procedure for a certain time of your cycle.

• If your provider gives you medicine to relax (sedative) before the procedure, you will need someone to drive you home afterward.

• You may want to bring a sanitary napkin to wear home after the procedure.

• Based on your condition, your healthcare provider may call for other preparation.

What happens during an endometrial biopsy?

An endometrial biopsy may be done in a healthcare provider's office. This would be on an outpatient basis. This means you go home the same day. Or it may be one as part of your stay in a hospital. Procedures may vary based on your condition and your healthcare provider’s practices.

Generally, an endometrial biopsy follows this process:

1. You will undress fully or from the waist down.

2. You will empty your bladder before the procedure.

3. You will lie on an exam table, with your feet and legs supported as for a pelvic exam.

4. Your healthcare provider will put a tool called a speculum into your vagina. It's used to spread the walls of the vagina apart to view the cervix.

5. Your provider may clean your cervix with an antiseptic solution.

6. Your provider may numb the area using a small needle to inject medicine. Or they may use a numbing spray on your cervix.

7. Your provider may use a type of forceps to hold the cervix steady for the biopsy. You may feel some cramping when it is used.

8. Your provider may put a thin, rod-like tool called a uterine sound through the cervical opening. This is done to find the length of the uterus and place for biopsy. This may cause some cramping. The sound will then be removed.

9. Your provider will put a thin tube (catheter) through the cervical opening into the uterus. The catheter has a smaller tube inside it. The provider will withdraw the inner tube, creating suction at the end of the catheter. The provider will then gently turn and move the tip of the catheter in and out to collect small pieces of endometrial tissue. This may cause some cramping.

10. The amount of and place where the tissue is removed depends on the reason for the endometrial biopsy.

11. Your provider will remove the catheter and speculum. They will send the tissue to a lab for study.

What happens after an endometrial biopsy?

After the procedure, you may rest for a few minutes before going home. If you had any type of sedative, you will need someone to drive you home.

You may want to wear a sanitary pad for bleeding. It's normal to have some mild cramping and spotting or vaginal bleeding for a few days after the procedure. Take a pain reliever as advised by your healthcare provider. Aspirin or certain other pain medicines may increase the chance of bleeding. Take only advised medicines.

Don’t douche, use tampons, or have sex for 2 to 3 days after an endometrial biopsy, or as advised by your healthcare provider.

You may also have other limits on your activity. This might be no strenuous activity or heavy lifting.

You may go back to your normal diet unless your healthcare provider tells you otherwise.

Your healthcare provider will tell you when to return for more treatment or care.

Tell your healthcare provider if you have any of the following:

• Excessive bleeding, or bleeding longer than 2 days after the procedure

• Foul-smelling fluid drains from your vagina

• Fever or chills

• Severe lower belly pain

Your healthcare provider may give you other instructions after the procedure, based on your situation.

Next steps

Before you agree to the test or procedure make sure you know:

• The name of the test or procedure

• The reason you are having the test or procedure

• What results to expect and what they mean

• The risks and benefits of the test or procedure

• What the possible side effects or complications are

• When and where you are to have the test or procedure

• Who will do the test or procedure and what that person’s qualifications are

• What would happen if you did not have the test or procedure

• Any alternative tests or procedures to think about

• When and how will you get the results

• Who to call after the test or procedure if you have questions or problems

• How much you will have to pay for the test or procedure