Endometrial biospy is an outpatient test to examine the endometrium (lining of the uterus)

What is an endometrial biopsy?

An endometrial biopsy involves taking a small sample of tissue from the endometrium (lining of the uterus) usually to ensure that there is no serious disease.

At one time, a D&C operation was one of the most commonly performed of all operations. It was undertaken as a check to exclude pre-malignant or malignant conditions of the lining of the uterus when there was abnormal bleeding, most commonly heavy periods - menorrhagia. It could also be done during investigations of other problems such as infertility.

To enhance the information provided by the D&C, hysteroscopy was added when it became available in the mid 1980s.

We now know that an endometrial biopsy can provide virtually as much information as the D&C and in combination with pelvic ultrasound, it is about as accurate as hysteroscopy and D&C.

Endometrial biopsy has been shown to accurately identify endometrial cancer.⁰³⁰¹Outpatient endometrial biopsy has a high overall accuracy in diagnosing endometrial cancer when an adequate specimen is obtained. A positive test result is more accurate for ruling in disease than a negative test result is for ruling it out. When abnormal uterine bleeding symptoms persist despite negative biopsy, further evaluation is warranted.⁰²⁰¹

The Endocell by Wallach is popular with many gynaecologists - including myself.

Sampling catheter in the uterine cavity - the catheter has a small diameter - 3mm

The Endocell has an internal plunger. When the catheter has been gently introduced into the uterine cavity, the plunger is pulled back creating a negative pressure. The endometrial sample is obtined with this suction - no "cutting" is required.

The Endocell is associated with less discomfort than older methods.⁹⁸⁰¹Theoretically, It may be advantageous to take an analgesic such as nurofen or paracetamol before the procedure although there is no proof yet that this effective.

Older techniques used suction provided either by a pump or a syringe.

What are the indications for endometrial biopsy?

Endometrial biopsy should be considered in the following women:

All women aged >40 years with abnormal bleeding.
Younger women with abnormal bleeding and with risk factors, including for endometrial cancer:
- Nulliparity. Pregnancy protects from endometrial carcinoma by interrupting the continued stimulation of the endometrium by oestrogen.
- Family history of endometrial or colonic cancer.
- Obesity.
- Polycystic ovary syndrome.
- Tamoxifen therapy for breast cancer.
- Unopposed oestrogen therapy.
Younger women in whom abnormal bleeding does not resolve with medical treatment

What is meant by a hysteroscopy and D and C?

D and C involves the dilatation of the cervix (neck of the womb) and curettage (a curette is a surgical spoon) to "scrape" representative samples of the lining of the womb. These "curettings" are sent to the laboratory and examined under the microscope. These days most gynaecologists combine the D and C with hysteroscopy (Q 24.8). Polyps or fibroids distorting the cavity of the womb may be diagnosed or excluded. The D and C is generally recommended to ensure that the lining of the womb is not seriously abnormal (for women aged 40 or more) before commencing medical treatment.

For many years it was believed that the D and C had a therapeutic effect. It is now recognised that the first period after a D and C may be lighter but there is no long-term improvement. It should be emphasised that the D and C, like a blood test or an x-ray, is a diagnostic procedure and not a treatment.

Women's Health

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Women's Health

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This is the personal website of David A Viniker MD FRCOG, Consultant Obstetrician and Gynaecologist at Whipps Cross University Hospital, London - Specialist Interests - Reproductive Medicine including Infertility, PCOS, PMS, Menopause and HRT.

I do hope that you find the answers to your women's health questions in the patient information and medical advice provided.

Answers to FAQs on women's health, patient information and medical advice by David A Viniker MD FRCOG, Consultant Obstetrician and Gynaecologist (Gynecologist - OBGYN), Department of Obstetrics and Gynaecology, Whipps Cross University Hospital, London