Skip to main content

Endometrial biopsy

4 steps

An office sample of the endometrium with a flexible suction cannula, for abnormal bleeding when hyperplasia or cancer is the question.

Consent and trauma-informed practice

  • Explain what the examination involves, why it is proposed, and what the alternatives are, in plain language, before anyone undresses.
  • Ask for permission, and make clear the patient can stop at any point, by saying so or by raising a hand. Stopping is honoured immediately, without persuasion.
  • Offer a chaperone and record the offer and the response; a student never examines without the supervising clinician present and the patient's specific agreement to the student's involvement.
  • Privacy: a door that locks or a sign, a sheet, undressing only what is needed, time to undress and dress alone.
  • Trauma-informed: assume a history you have not been told. Explain each step before it happens, keep talking, avoid sudden touch, ask about pace, and notice dissociation or distress and pause.
  • Never examine a patient under anaesthesia for teaching without their specific prior consent to that examination.

The sequence

4 steps
  1. 01

    Speculum and cleanse

    As for IUD insertion.

  2. 02

    Pass the cannula

    Through the os to the fundus; note the depth.

  3. 03

    Sample

    Withdraw the piston to create suction and move the cannula in and out with rotation, sampling the whole cavity.

  4. 04

    Expel and label

    Into formalin; the requisition carries the clinical question.

Indications

  • Postmenopausal bleeding with an endometrium over 4 to 5 mm, or persistent bleeding
  • Abnormal uterine bleeding at 40 or over, or younger with risk factors or failed treatment
  • Surveillance of hyperplasia on progestin

Preparation

  • Consent; pregnancy excluded; NSAID an hour before
  • Speculum, antiseptic, tenaculum if needed, the pipelle, a specimen pot in formalin

Complications

  • Cramping (common), vasovagal reaction
  • Inadequate sample (common with atrophy; hysteroscopy follows if bleeding persists)
  • Perforation, infection (rare)

Watch for

  • Cervical stenosis preventing passage: dilatation under local or hysteroscopy
  • A benign result with persistent bleeding: the sample is blind; proceed to hysteroscopy

Sources

  • FIGO: The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes (PALM-COEIN), 2018 revisions (2018).

A description for learning; never a substitute for supervised training. Videos play from their publishers' official YouTube channels and are not rehosted.