Endometrial Biopsy (Aspiration Method)

Before having an endometrial biopsy, you will need to attend an initial consultation with your gynaecologist. During this appointment, the consultant will review your medical history, including any symptoms such as abnormal, irregular or postmenopausal vaginal bleeding. They will also ask about any previous gynaecological conditions, surgeries or treatments you have had.

The consultation will involve a pelvic exam to assess the uterus and surrounding structures. This exam helps the gynaecologist to evaluate patient characteristics such as the size and position of the uterus, which can affect the choice of the biopsy method. The consultant will also explain the procedure in detail, including the benefits, risks and complications, so that you can give informed consent. Your doctor may also discuss the use of a local anaesthetic to manage pain during the procedure based on your individual needs and preferences. Please mention any medications you are taking, especially blood thinners, as they may need to be stopped temporarily to reduce the risk of bleeding.

This initial consultation is an opportunity to ask questions and address any concerns you may have. Understanding the procedure and what to expect can help reduce anxiety and prepare you for the biopsy. In some cases, the doctor may recommend additional tests, such as an ultrasound, to evaluate a thickened uterine lining or other abnormalities before proceeding with the biopsy.

During the endometrial biopsy procedure, you will be lying on your back, knees up and feet apart. A sheet will cover the lower half of the body for comfort and modesty. The doctor will use a speculum to open the vagina and access the cervix.

A numbing agent may be applied to the cervix before the procedure. Over-the-counter pain relievers like ibuprofen can be taken an hour before the biopsy to reduce cramping.

A thin tube is then inserted through the cervix into the uterus. The tube is gently moved up and down to collect a tissue sample from the endometrium. In an aspiration biopsy, gentle suction is applied through the tube to collect the endometrial tissue during endometrial sampling. This method is less invasive and causes less discomfort compared to other biopsy methods. The entire procedure takes less than 15 minutes. Once the tissue sample is collected, it is sent to the lab for microscopic examination, where the samples are checked for any abnormalities such as cancer cells or endometrial hyperplasia.

Pain and discomfort during an endometrial biopsy can vary. Many patients say it feels like mild to moderate period pains. This discomfort is short-lived, and cramping symptoms subside soon after the procedure is over. While severe discomfort is rare, underlying conditions like pelvic inflammatory disease can make the procedure more painful, and local or general anaesthesia may be considered for extra comfort.

Post-procedure care and recovery

After the biopsy, it’s best that you arrange for someone to drive you home. You can expect mild cramping, which can last up to 2 days. Over-the-counter pain relievers are often recommended to help with these cramps.

Do not use tampons or insert anything into the vagina for at least a week to prevent infection. You should also avoid sexual intercourse for at least a week. Monitor for complications, including prolonged bleeding beyond 3 days, severe pain or signs of infection like fever and bad-smelling discharge.

Following these post-procedure care instructions will ensure a smooth recovery. Make sure to seek medical attention if any severe symptoms occur.

Results and follow-up

You will usually receive your results within 1-2 weeks. Normal biopsy findings are a healthy uterine lining often described as ‘proliferative endometrium’ or ‘atrophic endometrium’.

If abnormal results are found, further tests such as Dilation and Curettage (D&C) may be recommended for further diagnosis.

In cases where endometrial carcinoma (womb cancer) is diagnosed, your doctor will refer you to a specialist in oncology to discuss the best treatment options tailored to your condition. Treatment may involve surgery, hormone therapy, or other interventions.

You will discuss your biopsy results during a follow-up appointment with your gynaecologist. They will make sure you understand the findings and next steps, including treatment options, if abnormal cells are found.

Complications

Like any medical procedure, an endometrial biopsy has potential risks and complications. Although rare, these can include infection, heavy vaginal bleeding, pelvic pain, fever and bad-smelling discharge. There is also a risk of uterine perforation if the biopsy instrument punctures the uterine wall, although this is very rare.

If severe symptoms like heavy bleeding, abnormal bleeding or fever develop, contact your healthcare provider immediately.