If your doctor has asked you to undergo an endometrial biopsy, you may have questions about the procedure. What is it? Why is it performed? How can you best prepare for the procedure? It’s common to feel nervous or anxious about a biopsy, but you can calm some of that stress by learning more about the procedure. This will help you know what to expect before your appointment.

What Is an Endometrial Biopsy?

An endometrial biopsy is a procedure in which a gynecologist or other specialist takes a small sample from the inner lining of the uterus (the endometrium). The tissue sample will be examined and tested in a laboratory. This testing helps providers determine whether there are any abnormalities or concerns with the endometrial tissue. A biopsy can also show if you have inflammation that could be associated with other conditions, such as infertility.

Researchers are exploring whether endometrial biopsy can be used to diagnose endometriosis. Some research, however, suggests it may not be the best tool for the job.

Keep in mind that an endometrial biopsy is different from a biopsy of endometriosis. An endometrial biopsy evaluates irregularities with endometrial tissue. However, a biopsy of endometriosis examines tissue from an endometriosis lesion. These biopsies are often done to confirm endometriosis and to rule out cancer or look-a-like diseases in people with suspected endometriosis.

When Is an Endometrial Biopsy Performed?

An endometrial biopsy may be done for a variety of reasons and to address a number of medical conditions. In general, the procedure is performed on individuals who seem likely to have endometrial abnormalities. They’re also done in cases when doctors want to rule out any abnormalities before making another diagnosis or performing a procedure.

For Abnormal Monthly Periods

Doctors may recommend an endometrial biopsy if you’re experiencing abnormalities with your monthly periods. This can include heavy bleeding, no monthly bleeding, extended bleeding, irregular bleeding, and bleeding after menopause. Any abnormal uterine bleeding or vaginal bleeding without another explanation may be cause for an endometrial biopsy.

Before a Hysterectomy

Endometrial biopsies are often performed before a hysterectomy (surgical removal of the uterus) to check for uterine cancer. Some research, however, shows that a biopsy may not be necessary in every case.

What Do Doctors Learn From an Endometrial Biopsy?

An endometrial biopsy allows doctors to gather more information about your endometrium. It can show them:

• The presence of endometrial cancer or abnormal cells that can lead to endometrial cancer
• Changes in uterine cells that are related to hormones
• Unusual tissues, like polyps or fibroids
• What effect hormonal treatments are having on the endometrium

An endometrial biopsy may also show the presence of endometrial hyperplasia (abnormal thickening of the endometrial lining). This can be a risk factor for endometrial and uterine cancer.

What To Expect When Getting an Endometrial Biopsy

As with any unknown medical procedure, it’s common to feel anxious after learning you need to have an endometrial biopsy. However, many people undergo this procedure every year. It can be helpful going into your appointment knowing what to expect.

Your doctor will usually perform your endometrial biopsy in their office. If you want general anesthesia — or if the biopsy is being done alongside another procedure that can’t be performed in the office — you might have it done in an outpatient facility or hospital.

After you arrive for your appointment and check in, you’ll be asked to remove your clothes from the waist down and cover up with a gown.

Your doctor will have you sit on a table and put your feet in stirrups, as you would during a routine gynecological exam. Similarly, the doctor will insert a speculum into your vagina to hold it open.

Your doctor will clean your cervix. If you want, they can apply a cervical numbing cream to help alleviate any discomfort and help you relax. Next, the doctor will pass a thin, tube-shaped instrument through the cervix. They may also use a tool to grasp and hold the cervix steady. Using the tube’s suction, the doctor will take a sample of your endometrial tissue.

When the doctor is sure that they have a good sample, they will remove all of the instruments. If you have received general anesthesia, you will be taken to a recovery room. Otherwise, your doctor should tell you when you will get your biopsy results and release you to go home.

Post-Biopsy Care

Your doctor or health care provider will give you instructions for taking care of yourself after an endometrial biopsy. They may advise you not to use any products that are inserted into the vagina, like tampons, or to avoid having sex for several days following the procedure. You may also need to avoid heavy lifting and other strenuous activities after your biopsy.

You may experience abdominal cramping or bleeding for a few days after your biopsy. This is normal. You can wear a sanitary pad (do not use a menstrual cup or tampon) if you experience bleeding. Your doctor may also recommend taking over-the-counter pain relievers to deal with cramping.

If you develop a fever, have bad-smelling vaginal discharge, or experience severe pelvic pain after your procedure, call your doctor right away.

Endometrial Biopsy and Pain

Although many people feel cramps similar to those caused by menstruation after an endometrial biopsy, some experience significant cramping pain. As one MyEndometriosisTeam member wrote, “I’ve had an endometrial biopsy before, and that was the worst pain I’ve ever felt. I could have climbed the walls with that pain.” Another member wrote that their doctor “tried to do the endometrium biopsy, but it was beyond painful and difficult.”

If you are concerned about pain, talk to your doctor ahead of time. The procedure can be done with both local and general anesthesia, if necessary. You should not have to experience extreme pain — or extreme anxiety about pain — to get the endometrial biopsy you need.

Many people find that taking ibuprofen or another over-the-counter pain reliever before the procedure is enough to manage their pain or discomfort. Talk to your doctor about what to take before you get to the office to help manage pain.

Find Your Endometriosis Team

On MyEndometriosisTeam, you’ll find more than 127,000 people who will support you as you journey through life with endometriosis. Ask your pressing questions, share the ups and downs of your story with endometriosis, and join in ongoing conversations about the condition.

Have you had an endometrial biopsy? Share your experience or tips in the comments below or by posting on MyEndometriosisTeam.