A biopsy of any type is a tissue sample, and an endometrial biopsy is a tissue sample taken from the lining or inner surface of the uterus, which is also called the endometrium. The doctor will examine the biopsy for signs of cancer or other abnormalities.
When Would Somebody Undergo an Endometrial Biopsy?
A doctor might order an endometrial biopsy if any of the following are true:
- A post-menopausal patient is bleeding.
- The patient has begun bleeding after starting hormone replacement therapy.
- The patient has irregular or abnormally heavy periods.
- Ultrasound tests show an abnormally thick endometrium.
- The patient’s Pap smear had abnormal results.
- The patient began bleeding after taking tamoxifen, a drug used to treat breast cancer.
- The doctor suspects the patient may have cancer.
The endometrial biopsy can be combined with other tests if the doctor is trying to determine the cause of a patient’s infertility.
What Does the Process Involve?
An endometrial biopsy is an outpatient procedure, and the patient may or may not need anesthesia. The patient will assume the “gynecological position,” as if she were undergoing a pelvic exam. In other words, she will be on her back on an examining table with the legs bent and the feet in stirrups. The position will allow the doctor easy access to the vagina.
After examining the patient’s pelvis, the gynecologist will use a speculum to hold the vagina open and access the cervix. The doctor will use a liquid to clean the cervix and then numb it with an injection or a spray. They will use a type of forceps called a tenaculum to steady the uterus.
The gynecologist will then use a pipelle, which is a thin and hollow tube with a suction attached, to remove a tissue sample. After removing the tools, the doctor will take the tissue sample to the pathology lab and examine it. The patient should not have sex or use tampons for a specific number of days after the procedure. The doctor may provide additional instructions depending on the patient’s medical history. An endometrial biopsy generally takes just minutes to perform.
How Should the Patient Prepare?
In some cases, the doctor will need to perform the endometrial biopsy at a specific point during the patient’s menstrual cycle. They may, therefore, ask the patient to keep a journal of her menstrual cycles.
The patient may take Tylenol or Advil about an hour before the procedure to reduce any cramping. She should not take any aspirin, however, for that will increase the risk of bleeding. Similarly, she should not take any blood thinners.
If the patient believes that she is pregnant, she should tell the doctor so. She should also tell the doctor if she is allergic to iodine or latex, or if she has any bleeding disorders.
What Happens After the Biopsy?
It will take time for the lab to complete their tests. The doctor will then discuss the results with the patient. Common causes of abnormal bleeding from the uterus can include the following:
- An infection like endometritis
- Growths like fibroids or polyps
- A thyroid disorder
The doctor will then discuss appropriate treatments for the patient’s condition.
In some cases, the results of the endometrial biopsy will be inconclusive. In such a case, the doctor may recommend another procedure which will allow the doctor to take a larger tissue sample from the patient’s uterus.
What is Endometrial Hyperplasia?
Endometrial hyperplasia is a condition in which the endometrium or lining of the uterus becomes abnormally thick. It is caused by an imbalance between the female hormones estrogen and progesterone. The patient’s ovaries are either producing too much estrogen, too little progesterone, or both. Estrogen causes the lining to grow, while progesterone causes it to be shed. The imbalance between the two causes the production of an abnormally thick endometrium that may contain abnormal cells.
There are four types of endometrial hyperplasia: simple endometrial hyperplasia, complex endometrial hyperplasia, simple atypical endometrial hyperplasia, and complex atypical endometrial hyperplasia. The latter two types are characterized by the development of abnormal cells that can increase the patient’s chances of developing uterine cancer.
The most common symptom is abnormal bleeding from the uterus. In addition to uterine bleeding after menopause or unusually heavy periods, abnormal bleeding from the uterus describes the following situations:
- Bleeding in between periods
- Unusually long periods
- Menstrual cycles that are under 21 days
- Skipped periods in a patient who is not pregnant or approaching menopause
What is Endometrial Atrophy?
Endometrial atrophy is the opposite condition of endometrial hyperplasia; the endometrium is too thin rather than too thick. It is caused by too little estrogen and is most commonly seen in women who have gone through menopause.
How Do Thyroid Problems Affect Menstruation?
The thyroid is a gland at the base of the neck. It is often described as “butterfly-shaped.” The thyroid produces the thyroid hormone that regulates a variety of bodily functions, including menstruation. Thus, if the thyroid produces too much or too little hormone, it can affect the patient’s menstrual cycle and ovulation. The latter means that thyroid problems can impair a woman’s ability to get pregnant.
Hypothyroidism is the condition in which the thyroid produces too little hormone. It can cause abnormally heavy bleeding, and doctors define “heavy bleeding” as having the following characteristics:
- The blood soaks through at least one pad or tampon every hour for several hours straight
- The patient needs to change her pad or tampon in the middle of the night
- The menstrual flow produces blood clots that are quarter-sized or larger
- The patient needs to wear more than one pad at a time
Hypothyroidism can also sometimes cause the patient to skip periods or have unusually long menstrual cycles (over 35 days).
Hyperthyroidism, in which the thyroid produces too much hormone, generally causes abnormally infrequent periods or skipped periods. The excess thyroid hormone causes the pituitary gland to release a hormone called prolactin that causes the ovaries to release estrogen. The decline in estrogen production affects the patient’s menstrual cycle so she has few or no periods.
Both hypothyroidism and hyperthyroidism can cause other symptoms besides irregular periods. Symptoms of hypothyroidism can include the following:
- Increased and abnormal sensitivity to cold
- Slowed heart rate
- Weight gain
- Reduced sweating
- Dry and pale skin
- Thin and dry hair
- Pain in the muscles and joints
- Hoarse voice
- Puffy face
Symptoms of hyperthyroidism can include the following:
- Increased and abnormal sensitivity to heat
- Rapid or irregular heart rate
- Weight loss
- Increased appetite
- Increased sweating
- Bulging eyes that may also be irritated or reddened
- Trouble sleeping
- Tremors in the fingers and hands
What is Endometritis?
Endometritis is an inflammation of the lining of the uterus, and it is usually caused by an infection. An infection of the endometrium can be caused by a sexually transmitted infection like gonorrhea or chlamydia. It can also be caused by tuberculosis or certain medical procedures that bring bacteria into the uterus. Examples of such procedures include Cesarean sections, hysteroscopies, and placement of intrauterine devices (IUDs).
In addition to bleeding, endometritis can cause the following symptoms:
- Swollen abdomen
- Abnormal discharge from the vagina
- Uncomfortable bowel movements
- Pain in the lower abdomen, pelvis or rectum
- General feeling of illness
What are Benign Uterine Growths?
Benign uterine growths are non-cancerous growths that develop on or within the uterus. While small growths usually don’t cause any symptoms, larger ones can cause heavy bleeding, painful intercourse, and other problems. Benign uterine growths include adenomyosis, fibroids, and polyps.
Adenomyosis is similar to endometriosis, for it also involves the endometrium growing in the wrong place. In endometriosis, the uterine lining grows outside the uterus; in adenomyosis, it grows inside the uterine muscular layer. Researchers don’t really know what causes adenomyosis, but they have observed that it is most likely to develop after childbirth.
Fibroids are masses that grow in or on the uterus. They are categorized depending on where they develop. Polyps are benign overgrowths of the endometrium that bulge into the uterine cavity. They typically have stalks.
Depending on the growth’s size and the severity of the associated symptoms, the doctor may give the patient medications to relieve the symptoms and shrink the growth, or they may perform surgery.
What is Uterine Cancer?
Uterine cancer describes any cancer that develops in the uterus, and there are several types. Endometrial cancer, which is also called endometrial adenosarcoma, is by far the most common type. About 80 percent of uterine cancers are endometrial adenosarcomas. The cancer develops within the endometrium’s glands.
Adenosquamous carcinoma is the second-most common type and makes up about ten percent of cases. It consists of two types of abnormal cells: gland-like cells and flat, thin cells called squamous cells.
Uterine sarcoma develops in the myometrium or the muscle wall of the uterus. It makes up about five percent of cases. It is an aggressive cancer that can quickly spread to other parts of the body. Papillary serous carcinoma, another type, is aggressive and often recurs even if caught early.
When Should a Woman See a Doctor About Irregular Periods?
A woman should always call a doctor about bleeding if she has passed through menopause. In girls and younger women, however, there are situations in which erratic periods are both benign and expected. For example, after an adolescent girl has her first period, it takes time for her menstrual cycles to become regular, for she has not begun ovulating yet.
The same is true of a woman who has just had a baby, abortion, or miscarriage. Until she starts ovulating again, her first few periods will be erratic.
A middle-aged woman may start skipping periods or having erratic periods as much as eight years before entering menopause. She should still call the doctor if her periods become extremely painful or heavy.
A younger woman should call the doctor if any of the following are true:
- Her periods are painful or unusually heavy
- Her periods are over a week long
- She hasn’t had a period for over 90 days
- She has a period less often than every 35 days or more often than every 21 days
- She bleeds between periods
- Her menstrual cycle suddenly changes