Endometrial Biopsy

Testing the Uterine Lining for Cause of Recurrent Miscarriage

© Kristen O'Hara

Jun 19, 2008

The endometrial biopsy is performed after ovulation and just before the onset of menstruation. A doctor will remove a small sample of tissue from the endometrium (the lining of the uterus). With the aid of a microscope, a pathologist will later examine the lining for proper thickness according to cycle dates and analyze the tissue for abnormal cells.

In association with recurrent loss, endometrial biopsy is performed to diagnose or rule out a luteal phase defect, the condition in which the endometrium is not properly prepared for implantation of the fetus. However, the test may also be performed in screening for cancer, analyzing the cause for abnormal vaginal bleeding or testing for certain infections.

Preparing for the Biopsy

The patient has few requirements in preparing for the test. The procedure is much like a pap smear. However, the patient may experience cramping during (and up to a day or two after) the biopsy. The physician may recommend a dose of over-the-counter pain medication be taken prior to the procedure and following, as needed. Additionally, due to the slight risk of disruption in a potential pregnancy, the doctor may require a pregnancy test before the biopsy. The patient may be asked to abstain from unprotected intercourse during the entire cycle prior to the test.

Procedures

The biopsy will most likely take place in the doctor’s office. The test is quick and is generally completed in under 10 minutes. The patient will be asked to disrobe from the waist down, after which she will be directed to place her feet in stirrups. The doctor may perform a brief pelvic exam and will then:

• Insert a speculum into the vagina
• Insert a small catheter through the cervix and into the uterus
• Suction out a small sample of the uterine lining
• Place the sample into a liquid preparation to send to the pathologist

After the Biopsy

The patient may experience light bleeding after the endometrial biopsy. Due to the timing of the procedure, bleeding may last until the beginning of menstruation (which generally follows a day or two after). The patient does not need to be concerned about bleeding, unless it becomes heavier than normal menstruation. Heavy bleeding or a fever over 100° F elicits a call to the practicing physician. Risks are very rare, but infection or other problems, such as damage to the uterus or cervix, can occur.

Results

Patients can expect results in about one week to one and a half weeks. Normal cells and proper development of the lining for cycle dates indicate a healthy lining. If the development of the lining is off by about two days or more (according to the actual cycle date), or if there are any abnormal cells present, treatment or further testing may be required.

Alternative Tests

A physician may request a blood draw to analyze the patient’s progesterone levels in addition to or instead of the endometrial biopsy. The doctor will test the levels during the post-ovulation time period, during which the progesterone should be elevated (10 or more ng/ml). Low levels of progesterone indicate a potential problem with the development of the endometrium. However, there is debate that the endometrium may not respond to proper progesterone levels. Thus, serum levels alone may not reveal a problem with the endometrium.

References and Additional Resources

1. Ferring Pharmaceuticals. "Endometrial Biopsy": Patient Fact Sheet. June 1998
2. Harvard Heatlh Publications. "Endometrial Biopsy." Harvard Medical School. Accessed June 17, 2008.
3. Southwestern Medical Center Website. "Endometrial Biopsy." Accessed October 17, 2008.
4. Zuber, Thomas J, M.D. "Endometrial Biopsy." American Family Physician. March 15, 2001. Website accessed October 17, 2008.

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