A tissue sample obtained through biopsy permits diagnosis of cel-lular changes in the endometrium. Endometrial biopsy, a method of obtaining endometrial tissue, is performed during the pelvic examination when indicated as an outpatient procedure.
Women undergoing this procedure may
experience slight discomfort. Usu-ally, the procedure can be performed without
anesthesia; however, a paracervical block or a small injection of lidocaine
into the uterus is effective if required. The examiner may apply a tenaculum (a
clamp-like instrument that stabilizes the uterus) after the pelvic examination
and then inserts a thin, hollow, flexible suction tube (pipelle or sampler)
through the cervix into the uterus.
biopsy is usually indicated in cases of midlife irregular bleeding,
postmenopausal bleeding, and infertility (to identify changes in the uterine
lining after ovulation). Women who are bleeding irregularly while receiving
hormone replacement therapy or who experience any bleeding while taking
tamoxifen are usually advised to undergo endometrial biopsy.
on aspiration may include normal endometrial tis-sue, hyperplasia, or
endometrial cancer. Simple hyperplasia is an overgrowth of the uterine lining
and is usually treated with pro-gesterone. Complex hyperplasia is a risk factor
for uterine cancer and is treated with progesterone and careful follow-up.
Women who are overweight, who are over 45, who have a history of nul-liparity
and infertility, and who have a family history of colon cancer seem to be at
higher risk for hyperplasia (Farquhar, Lethaby, Sowter et al., 1999).