Why Would You be Doing an Endometrial Biopsy?
An endometrial biopsy is typically done when (not surprisingly) your doctor suspects you have a problem with your endometrium. Such problems can include endometrial hyperplasia, low estrogen or progesterone, and endometrial cancer. Blood tests are a more common (and less painful) way of detecting progesterone and estrogen problems. Endometrial hyperplasia and cancer are very rare in women under 40. Nonetheless, if you have problems with LP spotting and your progesterone levels are normal, an endometrial biopsy might be a good idea.
What You Can Expect
The biopsy is an outpatient procedure that only takes 10-15 minutes to complete. Before the biopsy you should take something for the pain, since the procedure isn’t performed under sedation. My doctor gave me the option to take 2 Percosets an hour beforehand. Two or three tablets of Motrin is an option if you don’t want to (or can’t) take something stronger.
The first stage of the biopsy is very similar to a normal PAP smear. After you get comfortable in the stirrups, your doctor will insert a speculum. If your cervix isn’t at the right angle, your doctor will need to use a tenaculum to move it into position. This does hurt, because the tenaculum has pincers that grip your cervix and usually cause some bleeding. After that, your doctor will dilate your cervix and insert a Pipelle aspirator, which uses suction to collect the sample. You’ll feel cramping and then a pulling as the aspirator gathers its sample. If you’ve had an HSG, this part of the biopsy will feel very familiar.
After the doctor has collected a large enough sample, he/she will remove the instruments, and you’re done! If the doctor needed to use a tenaculum, they will probably use some silver nitrate to stop the bleeding on your cervix.
Post-biopsy, you may have some cramping and tenderness, and your doctor will probably recommend that you take more pain medication that night. For what it’s worth, I felt absolutely no pain after getting home and didn’t need to take more painkillers. You’ll probably experience some spotting, possibly as heavy as a period. If you start bleeding more than that, or the bleeding lasts longer than a day or two, call your doctor.
Lab results should be available within a week. Before you leave, ask your doctor when you can schedule a follow-up appointment to discuss them.
Problems That Might Arise
The main problems you can encounter when doing an endometrial biopsy are pain and bleeding after the procedure. For the pain, my doctor recommended Motrin, but also gave me two extra Percosets just in case I needed them.
If you experience heavy bleeding (heavier than your period) or the bleeding continues for more than a day or two, call your doctor. It’s unusual, but it does happen. Also, try to refrain from any strenuous physical activity for a few days after the procedure. See below for my personal story about why this is a good idea.
Anything you can do to relax while you’re on the table will help make the procedure less uncomfortable. I did deep breathing exercises until after the sample had been collected. DEFINITELY take some kind of pain medication beforehand.
One of the things I really appreciated before the biopsy started was having my doctor explain to me which instruments she would be using and why. She also told me what she was going to do before she used each instrument. If your doctor doesn’t take a minute to walk you through the procedure before starting it, I recommend that you ask them to do so. Relaxing was much easier when I knew what she was doing and why.
Take it easy for a few days after the procedure. You don’t have to go on bedrest or anything, but try to refrain from any strenuous physical activity. I made the mistake of hauling some heavy things up and down stairs the day after my biopsy and spent the following day regretting it from the couch because it felt like someone had kicked me in the gut every time I moved. Be ye not so stupid.
As a final note, if you take Percoset or other narcotic painkiller beforehand, be sure to have someone at the clinic with you to drive you home. Not only can these painkillers impair your ability to operate a car, but they can also make you extremely nauseated. Let’s face it, no one wants to drive when all they really want to do is throw up.