Endometrial Biopsy

I am scheduled for an endometrial biopsy tomorrow and I am nervous to say the least…for the expected pain and the results as well.

I’ve always had irregular cycles but the break through bleeding has gotten heavier the past 4 months and I will randomly pass large clots - like no bleeding and then I will feel a clump slide out onto my underwear and within the hour I am bleeding like a heavy cycle day. My gyn didn’t even want to see me for a consultation just booked me right in for the biopsy.

Obviously not looking for medical advice, I guess I’m just looking for others experiences that maybe haven’t been truly awful?

Hello, I can well understand your worries and fears. Depending on the instruments used, sedation may be necessary. The biopsy can be performed under general anesthesia or local anesthesia. Please discuss this with your doctor. Taking a pain reliever, such as Busopan (plus, Venus), can also help reduce sensitivity.

An endometrial biopsy is a short procedure performed without anesthesia, in which a doctor uses a thin catheter to take a tissue sample from the lining of the uterus. First, a speculum is used to examine the cervix. Then, the catheter is carefully inserted, and a small sample is taken for laboratory analysis. The procedure usually takes only a few minutes and may cause mild pain or cramping, similar to menstrual cramps.

Preparation

Discuss any medications you are taking, especially blood thinners, with your doctor.

Avoid douching and tampons for about 48 hours before the procedure.

Ideally, schedule the procedure within a specific timeframe of your menstrual cycle, for example, between days 19 and 21.

Procedure

Cervical preparation: The doctor inserts a speculum into the vagina to view the cervix.

Cleansing: The cervix is ​​cleaned with an antiseptic solution.

Inserting the catheter: A thin, flexible tube (catheter) is inserted through the cervix into the uterine cavity.

Taking a tissue sample: A small tissue sample is taken by suction or by removing it with small forceps.

Removing the catheter: The catheter is withdrawn.

After the procedure:

The tissue sample is sent to a laboratory for examination.

The results are usually available within a few days to a week.

You may experience mild pain or cramping, similar to period cramps.

Your doctor may advise you to take a pain reliever before the procedure to minimize discomfort.

I needed one and was too chicken to do it after reading the horror stories. I also needed another procedure that was given under general anesthesia so they did it then.

Hope everything went well. Obviously cannot go into specific medical advice on a platform like this, but, absolutely at a bare minimum take some form of NSAID 60 minutes prior to the procedure unless ill advised for your particular circumstances. Make sure you take it before, not as an afterthought. Every woman is going to have a different level of discomfort. You'll get a pelvic exam prior to the procedure so whatever discomfort you have with that is going to be the same, but the tenaculum, and use of cervical dilators is part of the additional discomfort. Most doctors are going to use a 20% benzocaine spray on the cervix as a mild anesthetic. You will feel some pressure from the pipelle/catheter while they take the samples, they are going to move it in several directions so that is normal for them to do. Cramping is going to be rather significant afterwards and expect bleeding. It's simply the reaction of the uterus to something like this. I do find it disturbing that a better method of controlling pain has never really advanced to be a mainstream part of this procedure, rather dumb. Personally I think the advice of...oh it's just a mild pinch and maybe some mild cramping is part of the problem. Doctors should advise that yes it's rather uncomfortable, it does not take a long time to perform, and yes you'll feel like crap afterward for a while. Then when all that happens instead of the ...oh it's no big deal...internet descriptions you'll find, you won't have additional anxiety around how you feel, which just adds to the discomfort and makes things worse.

@doc4u72 NSAIDs can contribute to post procedure bleeding. Use Tylenol/paracetamol instead

Disclaimer - that you should obviously consult your own doctor, this is not medical advice

As far as NSAID goes, aspirin would be one to be cautious of as far as post procedure bleeding and diclofenac has some rare but serious side effects. Then again side effects always need to be considered and every drug has its issues.

What I find odd though is that there is really good data that shows significant reduction in pain during outpatient EB and it seems like few doctors are going this route. The top 3 pain medications that are effective compared to placebo are Intrauterine lidocaine combined with either lidocaine spray, rectal diclofenac, or Naproxen. There is really no reason to ignore the reality that this procedure may be quite painful and not offer the most effective solution that the patient can tolerate. It's oddly dismissive to think that it's no big deal. All humans experience pain differently. Another big factor is the experience of the gynecologist. You really want someone who does this procedure often and also has many years of experience. The major pain point occurs during the biopsy itself so the effectiveness of tissue sampling is also impeded if a woman is in pain and an adequate specimen is not obtained as a result.

I'm curious to hear how many women were provided an abundance of information on pain management pre biopsy vs those who were left to scour the internet on their own.

My wife gets them annually due to her high risk for cancer. They’re the most painful thing she’s experienced, and she has a high pain tolerance. I hope it went well for you @Interestedmed!