Background Information:

What are the other Names for the Procedure?

• Biopsy - Endometrium
• Biopsy of Uterus Lining
• Endometrial Scraping

What is Endometrial Biopsy surgical procedure?

Endometrial Biopsy is a diagnostic procedure that involves the removal and examination of tissues taken from within the endometrium (the inner lining of the uterus).

What part of the Body does the Procedure involve?

An Endometrial Biopsy involves the interior lining of the uterus, cervix, and vagina.

Why is the Endometrial Biopsy surgical procedure Performed?

An Endometrial Biopsy is performed for the following reasons:

• Examining the cause of excessive bleeding during or between menstrual periods
• Examining the cause of postmenopausal bleeding

What are some Alternative Choices for the Procedure?

An Endometrial Biopsy remains the gold standard technique to study the inner lining of the uterus.

What are the Recent Advances in the Procedure?

Endometrial Biopsy has been the standard technique to obtain tissue samples from the inner lining of the uterus.

What is the Cost of performing the Endometrial Biopsy surgical procedure?

The cost of Endometrial Biopsy procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused by the information regarding an Endometrial Biopsy and on what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required
• They can also choose to approach another physician independently. Besides, if the procedure has many alternatives, the patient may take a second opinion to understand and choose the best one

What are some Helpful Resources?

http://www.nlm.nih.gov/medlineplus/ency/article/003917.htm

http://www.hopkinsmedicine.org/healthlibrary/test_procedures/gynecology/endometrial_biopsy_92,P07773/

http://www.aafp.org/afp/2001/0315/p1131.html

Complete Guide to Symptoms, Illness & Surgery; Written by H Winter Griffith, M.D.; Revised and updated by Stephen Moore, M.D. and Kenneth Yoder, M.D.; The Berkley Publishing Group, 5^th Edition, New York, 2006

Prior to Endometrial Biopsy surgical procedure:

How is the Endometrial Biopsy surgical procedure Performed?

• The individual is placed in a lithotomy position. The patient lies flat on the back (supine), with feet raised and supported by foot rests, called stirrups
• An instrument called a speculum, is inserted into the vagina
• The speculum gently spreads the vaginal walls following which the vagina and the cervix are exposed
• Various devices (such as a curette, pipette, electronic suction device, jet irrigation device, or a brush) can be used to obtain samples from the inner lining of the uterus
• The device is passed through the cervix into the uterus and may be moved up and down to obtain the sample

Where is the Procedure Performed?

An Endometrial Biopsy is usually performed in an out-patient surgery center facility, a physician’s clinic/office, or a hospital. Normally, the person can go home once the procedure is completed.

Who Performs the Procedure?

Endometrial Biopsy is performed either by an obstetrician, a gynecologist, a family physician, or a general surgeon, with assistance from an anesthesiologist.

How long will the Procedure take?

An Endometrial Biopsy procedure usually takes about 20-30 minutes.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the surgical procedure and helps avoid unnecessary complications.

• Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication or food items
• If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
• If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
• If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
• A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
• Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
• Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
• Normally local anesthesia is not used; however, do inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
• Avoid application of any deodorant, or topical medicines on the area, prior to the procedure
• It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
• Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
• The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
• For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines
• A physician will request your consent for Endometrial Biopsy procedure using an Informed Consent Form

What is the Consent Process before the Procedure?

A physician will request your consent for the Endometrial Biopsy procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Endometrial Biopsy surgical procedure?

Before an Endometrial Biopsy procedure, the patient has to undergo certain tests such as:

• Pap smear
• Pregnancy study (blood or urine pregnancy tests)

What are some Questions for your Physician?

Some of the questions that you may consider asking your physician are as follows:

• What is an Endometrial Biopsy procedure?
• Why is this procedure necessary? How will it help?
• How soon should I get it done? Is it an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed? 
• What are the risks while performing the procedure?
• What are the complications that might take place, during recovery?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
• What are the costs involved?

During the Endometrial Biopsy surgical procedure:

What kind of Anesthesia is given, during the Procedure?

The procedure may be performed under intravenous sedation, or using a spinal or general anesthesia.

How much Blood will you lose, during the Procedure?

Since an Endometrial Biopsy is a less invasive procedure, the blood loss involved is minimal.

What are the possible Risks and Complications during the Endometrial Biopsy surgical procedure?

There are usually no surgical risks or complications associated with an Endometrial Biopsy. However, there are general factors that increase the risk of getting complications during the procedure, which include:

• Obesity: Generally greater the degree of obesity, greater is the surgical risk
• Smoking: Longer the smoking history (in pack years smoked), greater the surgical risk
• Advancing age
• Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
• Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
• Poorly functioning liver, as evidenced by increased blood liver function tests
• Hypertension (increased blood pressure), especially if it is poorly controlled
• Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
• Poor lung function, as evidenced by abnormal lung function tests
• History of bleeding disorders
• Longstanding illness, such as autoimmune disorders, chronic infections
• Poor immune system due to a variety of causes

What Post-Operative Care is needed at the Healthcare Facility after the Endometrial Biopsy surgical procedure?

At the healthcare facility, generally there is no requirement for any post-procedure care, unless any complications arise. 

After the Endometrial Biopsy surgical procedure:

What are the possible Risks and Complications after the Endometrial Biopsy surgical procedure?

Post Endometrial Biopsy, the following complications may arise:

• Excessive bleeding
• Infection within the lining of the uterine (endometritis)
• In rare cases, unintentional injury of the uterus

What is the Prognosis after the Surgery?

The prognosis is usually good with a complete recovery expected in about 3 weeks.

When do you need to call your Physician?

• Do contact your physician if you notice any of the following symptoms:
• Foul odor of vaginal discharge
• Increase in pain
• Abnormal vaginal bleeding or swelling
• Signs of an infection
• Fever
• Dizziness
• Feeling sick
• Muscle aches
• Headaches
• Complications associated with prescription medications used for the treatment

What Post-Operative Care is needed at Home after the Endometrial Biopsy surgical procedure?

At home, the following post-operative care is recommended, after an Endometrial Biopsy procedure:

• Resume regular/daily activities, as early as possible (under advice by the physician). This aids in a faster recovery
• Keep the wound clean and dry
• Wear cotton underwear
• It may be required to use sanitary napkins (for bleeding) for about a week (or more)
• Avoid douching, unless advised by your physician
• Avoid sex till complete healing has taken place (under advise by the physician)
• The physician may prescribe hormonal medications, if there is a hormone imbalance
• Avoid taking nonprescription medications, such as aspirin. However, individuals may take acetaminophen to relieve pain, if necessary

How long does it normally take to fully recover, from the Procedure?

A complete recovery from this procedure usually takes about 2-3 weeks.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The tissue is taken for further examination and later disposed, as per the standard medical procedure.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

• The tissue removed is processed in the laboratory under a pathologist's supervision
• Slide(s) are prepared once the tissue is processed and is examined by a pathologist and a pathology report issued
• Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time

Who will you receive a Bill from, after the Endometrial Biopsy surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The outpatient facility or a physician’s office
• An anesthesiologist (if anesthesia was administered)
• A pathologist (if the tissue was sent for analysis)
• An obstetrician, a gynecologist, a family physician or a general surgeon

The patient is advised to inquire and confirm the type of billing, before an Endometrial Biopsy procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA