Endometrial pipelle biopsy
Information for patients from Women's Health
You have been referred to the hospital for an endometrial pipelle biopsy. This leaflet will explain the following.
What an endometrial pipelle biopsy is
What the benefits, risks and alternatives are to this procedure
What happens during and after the biopsy
Who to contact if you have any questions
We hope this leaflet answers some of the questions you may have. If you have any further questions or concerns, please speak to a member of your healthcare team.
What is an endometrial pipelle biopsy?
An endometrial pipelle biopsy takes a small sample of tissue from the lining of the womb (endometrium). The sample is then sent to a laboratory to check if there is any cancer or other abnormal cells in the lining of the womb.
The biopsy may give you answers to the following.
Why you are having abnormal vaginal bleeding. This could be heavy, prolonged or irregular periods, or bleeding in between periods.
Why you are having bleeding after the menopause.
Why an ultrasound scan shows you have a thickened lining of your womb.
If you need one, a doctor or nurse will take the biopsy as part of your outpatient appointment.
Who is the biopsy not suitable for?
The biopsy is not suitable for patients who:
are pregnant
have an infection in their vagina or pelvis
What is the benefit of having a biopsy?
A biopsy allows your doctor to check for any abnormal cells or signs of cancer, so they can offer you treatment for your condition.
What are the risks?
The procedure is usually very safe. In rare cases, patients may be at risk of:
prolonged bleeding
infection
feeling faint
uterine perforation (making a hole in the womb); this is very rare as the device used to take the biopsy can easily be shaped as it is not a metal
Will the procedure hurt?
Some patients experience period-type pain during the procedure. Some may need to take simple painkillers (such as paracetamol) after the biopsy.
What are the risks of not having the biopsy?
If you do not have the biopsy, we cannot check for any abnormal cells or signs of cancer.
Are there any alternatives?
Sometimes it can be difficult to take the biopsy. This is more common for patients who have not had children or have had previous treatment to their cervix. If this happens, you may need to go to theatre to have the biopsy taken under a general anaesthetic (where you are asleep). We would make an appointment for you to come back on a different day for this.
As an alternative you may be suitable for an outpatient hysteroscopy. We will discuss your options with you at the end of your outpatient appointment.
How do I prepare for the biopsy?
You do not need to do anything to prepare for your pipelle biopsy. You can still have the procedure if you are on your period or experiencing postmenopausal bleeding.
What happens during the biopsy?
During your outpatient appointment you will discuss with the doctor or nurse whether you need to have the biopsy taken.
If they need to take a biopsy, the doctor or nurse will do this as part of your examination.
The doctor or nurse will explain to you what examinations they are going to do. Please ask any questions you may have. Before they proceed, they will ask for your consent to take the biopsy.
A chaperone nurse will also be in the room. They will help you get undressed and help you get positioned on the examination couch, where you will lie down for the examination. This nurse will be with you throughout the examination and procedure.
The doctor or nurse will tell you when they are going to start the examination.
First, they will insert a speculum into your vagina. The speculum is used to open the vagina, and is similar to the device used for smear tests. The speculum allows the doctor or nurse to examine the walls of your vagina and cervix, to see if they appear healthy.
The doctor or nurse will tell you when they are about to take the pipelle biopsy. They pass a thin plastic straw through the cervix and into the womb. The biopsy is taken using slight suction, as the inside of the straw is pulled out. This part of the procedure can cause period-type pain; it generally settles once the procedure is finished.
The doctor or nurse may need to take more than one biopsy. This is to make sure we take enough tissue for testing.
Occasionally a patient's cervix is at an angle which makes it difficult to take the biopsy; this is normal. If this happens we may use an instrument to hold open your cervix, making it easier to take the biopsy.
The doctor or nurse will remove the speculum after the pipelle biopsy is complete.
Once the speculum has been removed, the chaperone nurse will help you:
get off the examination couch; and
get dressed, if you need help.
We will send the biopsy sample to the laboratory for examination and testing.
What happens after the biopsy?
If you have any period-type discomfort after the biopsy, please take paracetamol or ibuprofen.
Once dressed you can leave the clinic. You can carry on with whatever you have planned for the rest of the day. You can return to work if you are feeling well. You can also drive after your procedure.
You may have some vaginal bleeding for the next day or so; this is normal. Please wear a sanitary towel just in case this happens. The nurse will offer you a sanitary towel after the biopsy.
You can continue with your normal activities, such as having a bath or shower, or exercising. Do not have sex until the bleeding has stopped completely.
How do I get my results?
Your biopsy sample is sent to the Pathology Department's laboratory for testing. We will write to you and your GP with the results. It could take between one to four weeks before you receive the letter with the results.
Will I have a follow-up appointment?
If you need further treatment or a follow-up appointment, we will send you an appointment letter. In some cases, we may phone patients instead of writing a letter.
What if I have any worries once I return home?
Contact your GP, if you have heavy vaginal bleeding, especially with offensive smelling discharge. You may have an infection and need some medication.
Contact details
Monday to Friday 8am to 4pm, phone one of the following for advice.
Gynaecology Assessment Unit (GAU), Queen Elizabeth the Queen Mother (QEQM) Hospital, Margate
Telephone: 01843 235009Women’s Health Suite, William Harvey Hospital, Ashford
Telephone: 01233 651987
References
Demirkiran, F., Yavuz, E., et al. (2012). Which is the best technique for endometrial sampling? Aspiration (pipelle) versus dilatation and curettage (D&C). Archives of gynecology and obstetrics, 286(5), 1277-1282.
Rutherford, T. J., & Auerbach, R. D. (2012) Endometrial Biopsy. Cooper Surgical: product bulletin.
Du, J., Li, Y., Lv, S., Wang, Q., Sun, C., et al. (2016). Endometrial sampling devices for early diagnosis of endometrial lesions. Journal of cancer research and clinical oncology, 142(12), pp.2515-2522.
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