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Endometrial Biopsy

An endometrial biopsy (EMB) is a medical procedure that involves taking a tissue sample of the lining of the uterus, known as the endometrium. The main indication for an endometrial biopsy is to rule out endometrial (uterine) cancer. The procedure can be accomplished by the use of a suction pipette, via hysteroscopy, or via a dilation and curettage. The tissue sampled must be of adequate volume for a histologic evaluation to take place.

Did you know…
That an endometrial biopsy may be performed without anesthesia? The procedure is usually performed in the office setting with minimal discomfort and is very well tolerated. In a typical suction pipette EMB, up to 15% of the endometrium is sampled. The use of ultrasound, hysteroscopy, and/or dilation and curettage may be indicated depending on the patient, the risk factors, and clinical findings.

When is an endometrial biopsy recommended?
Postmenopausal women – An EMB is offered to postmenopausal women who have abnormal uterine bleeding. An ultrasound can be used as an alternative to EMB in postmenopausal bleeding by assessing the endometrial thickness. If the endometrium is thickened on ultrasound, an EMB is indicated.
Age 45 to menopause – An EMB is indicated in any woman with bleeding that is irregular, prolonged, or heavy.
Younger than 45 years – An EMB is indicated in obese women with abnormal bleeding. An EMB is indicated in non-obese women with abnormal bleeding that fail medical management, or have ovulatory dysfunction, or are exposed to unopposed estrogen, or are at risk for endometrial cancer.

What should I expect during an endometrial biopsy?
If a suction pipette is used, the procedure is performed in the office with minimal discomfort.
If an EMB via hysteroscopy is performed, local anesthesia is used for an in-office procedure. If performed in the operating room, general anesthesia would be used. A hysteroscopy allows for visualization of the endometrium and sampling is improved compared to using a pipette.
If a dilation and curettage is performed, general anesthesia is used.
If pain is experienced after the procedure, over-the-counter pain medications can be used to ameliorate the discomfort. The pain is usually short-lived and well tolerated.

Will I need to follow any special post-endometrial biopsy instructions?
After the procedure, the patient will remain in a supine position to reduce a vasovagal response (dizziness, nausea). After several minutes, the patient may then leave the office if no heavy bleeding or dizziness is experienced. Cramping may be experienced, but it is usually well controlled with nonsteroidal anti-inflammatory drugs. The patient is instructed to report any fever, worsening pain, heavy bleeding, and foul smelling vaginal discharge. Regular activities, including intercourse, may resume at earliest convenience.

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