Endometrial Biopsy Procedure, Uterine Biopsy Procedure, Uterine Biopsy Procedure, Uterine Biopsy Procedure, Uterine Biopsy Procedure, Endometrial Sampling
Endometrial biopsy (biopsy of the uterine wall) is the process of taking a piece from inside the uterus for diagnosis or treatment. The uterine biopsy samples taken afterwards are examined under a microscope and the presence of abnormal cells or cancer in these samples is investigated. Before we talk about why we take a biopsy to understand the cause of menstrual bleeding, which is usually irregular and abnormal, let's talk about ‘what is endometrium’.
The endometrium is a layer lining the inside of the uterus. This layer thickens and becomes more vascularised every menstrual cycle in case of a possible pregnancy in case of a possible embryo (baby) attachment. When pregnancy occurs, it attaches to this layer and grows here. If pregnancy does not occur, this nourished, blood-filled part of the endometrium, that is, the inner layer of the uterus, is expelled in the form of menstrual bleeding.
What is Endometrial Biopsy?
Endometrial biopsy is the process of taking a piece of the inner tissue of the uterus in order to diagnose the cause of bleeding and to treat bleeding in women with irregular or profuse bleeding. Endometrial curettage can also be referred to by various names such as probe curettage, fractionated curettage.
'How and to whom is endometrial biopsy performed? Why is endometrial biopsy performed? What should be considered in endometrial biopsy? Let's address the answers to the questions.
How is an endometrial biopsy performed?
We perform endometrial biopsy under local anaesthesia, sedoanalgesia or general anaesthesia, using long thin plastic cannulas, vacuum instruments (as in abortion) or sharp curettes.
We can perform endometrial biopsy in office conditions or in hospital.
We can perform fractional curettage, which is the removal of pieces from the uterus and cervix together, full curettage, which is the complete removal of the inner tissue of the uterus, and pipelle biopsy, which is the removal of pieces from the uterus with the help of a thin cannula without the need for anaesthesia.
How is Endometrial Biopsy Procedure Preparation?
Firstly, we talk to our patients in detail about the details of the procedure and all possible risks. Beforehand, we question whether our patients are allergic to any substance such as iodine, medication, latex, their history of operation, disease conditions or medications they use. In particular, we question the use of blood thinners (such as aspirin, coumadin) in detail because we recommend that these drugs be discontinued before the procedure.
Afterwards, we provide our patients with a written consent form in which we inform them about what has been explained.
We advise our patients who will undergo uterine biopsy under local anaesthesia to take analgesics (painkillers) 30 minutes before the procedure.
If the uterine biopsy procedure is to be performed under general anaesthesia or sedoanalgesia, we recommend our patients to fast for 6 hours without food and water.
Before the procedure begins, we will take you to a special room to remove your clothes and put on a gown.
Then we take you to the gynaecology table, which we call the lithotomy table, in the procedure room and ask you to put your two legs on the leg rests. After anaesthesia, we start the biopsy procedure under sterile conditions;
After applying a small instrument called speculum to the vagina and visualising the cervix, after cleaning the vagina and cervix with batikon, we hold the cervix with a tool called tenekulum. At this stage, you feel a slight cramp. Then we measure the length of the uterus with a hysterometer and take a piece of the uterus with a curettage cannula. (These small cramps are felt if the procedure is performed under local anaesthesia and are very mild).
How long does it take to take an endometrial biopsy?
It takes 5-10 minutes on average.
Why is Endometrial Biopsy Performed?
- It is the most common test to diagnose endometrial cancer.
- In case of abnormal menstrual bleeding (irregular menstruation, abnormal uterine bleeding),
- Bleeding after menopause,
- For the detection of uterine infection, endometritis,
- We can take an endometrial biopsy to check the effectiveness of hormone therapy or to detect hyperplasia, cancer cells.
In the presence of which findings do we recommend uterine biopsy?
- Intense and prolonged menstruation,
- Irregular menstruation (irregular menstrual period, irregular menstrual cycle), abnormal uterine bleeding, abnormal vaginal bleeding
- Absence of menstrual bleeding,
- The presence of intrauterine polyps,
- Bleeding after menopause,
- Abnormal bleeding in breast cancer patients on tamoxifen
- We recommend endometrial biopsy in cases of thickened uterine lining on ultrasound.
What is uterine wall thickening?
The inner tissue of the uterus is expected to be thin after menopause. The thickness of the inner layer of the uterus is expected to be below 5 millimetres by ultrasound. If it is over 5 mm, endometrial sampling is recommended. In other words, a biopsy is recommended due to thickening of the uterus. In this biopsy, the presence of underlying cancer cells is investigated.
In the pre-menopausal period, there is no fixed value that can be given in millimetres or centimetres to determine the thickening when viewed by ultrasound. The patient's complaint and the shape of the image of the inner layer of the uterus on ultrasound are important in making a biopsy decision. Here, the experience of the island physician comes into play.
Who Can Have Endometrial Biopsy?
It is generally performed on women over the age of 35. It should not be performed on pregnant women.
Sometimes we think that infertility may be due to a problem in the endometrium and we can perform the biopsy procedure we call endometrial scratching. (Endometrial scratching procedure in recurrent IVF failure)
Who should not undergo endometrial biopsy?
- Pregnant women,
- People with active or recent pelvic inflammatory disease (infection in the upper reproductive organs),
- It is not recommended for people with blood clotting disorders.
- Those with severe stenosis in the cervix should be performed with caution against the risk of perforation.
What is seen as a result of endometrial biopsy?
Abnormal tissues such as fibroids, polyps or hormone-dependent endometrial cells, hyperplasia or cancer cells can be seen.
Should routine endometrial biopsy be performed as part of infertility treatment?
No, it is not. It is no longer recommended. However, there is no harm in doing it, so it can be tried.
What are the Risks of Endometrial Biopsy?
Although this procedure is simple, it has some risks like every procedure. These are
- Bleeding, infection, uterine perforation can rarely be seen.
- There may be allergy to anaesthesia drugs.
- Endometrial biopsy is never recommended if you are pregnant because it causes miscarriage.
What Happens After Endometrial Biopsy?
If you have not received anaesthesia, you can go home after a little rest.
If you have received anaesthesia, it will be better for a relative to take you home because the anaesthesia will have an effect. We do not recommend you to drive because of the effect of anaesthesia.
Is Endometrial Biopsy Painful?
It is not painful except for a slight cramp. General anaesthesia is not required.
What should I pay attention to after endometrial biopsy?
- Use the medicines prescribed by your doctor.
- If the biopsy procedure was performed with anaesthesia, do not drive a car afterwards.
- Bring a pad with you.
- There may be mild spotting and mild cramping until a few days after the procedure. You can take painkillers prescribed by your doctor. We do not recommend aspirin.
- We do not recommend vaginal douching, vaginal tampons and intercourse for 3-4 days after the biopsy.
- If you are anaesthetised, you can eat your food with your doctor's recommendation.
When should I call my doctor after endometrial biopsy?
- Excessive bleeding or bleeding lasting more than 3 days,
- Foul-smelling discharge from the vagina,
- Fever, chills,
- If you experience severe groin pain, I recommend that you call your doctor without waiting for your follow-up appointment.
How long does it take for endometrial biopsy results?
In our clinic, the results are available within 2-3 days.
What Do Endometrial Biopsy Results Mean?
Normal biopsy results indicate that there are probably no polyps, fibroids, infections, hyperplasia, abnormal cells or cancer in the inner tissue of the uterus.
Istanbul Endometrial Biopsy Prices
Istanbul endometrial biopsy fees, which can be performed under local anaesthesia in office conditions without interrupting your daily work, vary according to the characteristics of the patient, the type of anaesthesia and the clinic. If the biopsy is performed by an experienced physician, adequate cell sampling is performed and the risk of complications is reduced.
For more information and appointment, you can contact Assoc Dr Cigdem Yayla Abide.
