What is an endometrial aspiration biopsy
An endometrial pipelle biopsy is a modern method of collecting endometrial tissue using a thin, flexible tube known as a pipelle. Inside the instrument is a piston that creates negative pressure. This draws a small number of cells from the lining of the womb into the tube, which are then sent to the laboratory.
The main aim of the procedure is to obtain material for endometrial analysis and to determine whether there are any changes that require treatment or monitoring. Unlike diagnostic curettage, a Pipelle biopsy does not usually require dilation of the cervix or general anaesthesia. The procedure takes a few minutes, and afterwards the woman can usually resume her normal activities.
Indications for endometrial pipelle biopsy
A pipelle biopsy is prescribed by a gynaecologist following an examination, an ultrasound scan and an assessment of the patient’s symptoms. The test may be recommended for the following conditions: The procedure helps the doctor obtain accurate information about the condition of the uterine lining and decide on the next course of action: observation, medication, further investigations or surgery.
- irregular menstrual cycle;
- abnormal uterine bleeding;
- excessively heavy or scanty periods;
- bloody discharge after the menopause;
- suspected endometrial hyperplasia;
- signs of chronic endometritis;
- suspected polyps, fibroids or endometriosis;
- infertility or recurrent pregnancy loss;
- preparation for assisted reproductive technology programmes;
- monitoring the outcome of hormone treatment;
- the need to rule out precancerous or malignant changes.
Contraindications to aspiration biopsy
Endometrial aspiration biopsy is not performed during pregnancy or if pregnancy is suspected. Before the procedure, the doctor will always clarify this point and, if necessary, order a hCG test.
Temporary contraindications may also include: If there are any contraindications, the gynaecologist will first prescribe treatment or select an alternative diagnostic method. It is advisable to book a gynaecological consultation prior to the procedure to determine the indications, rule out risks and select the correct day of the cycle.
- acute inflammatory conditions of the vagina, cervix, uterus or adnexa;
- active infections of the genitourinary system;
- severe uterine bleeding;
- a woman’s poor general health;
- anatomical features of the cervix that prevent the safe insertion of the pipelle.
Advantages of the procedure
Endometrial aspiration is a minimally invasive diagnostic method. It is often chosen when a doctor needs to obtain endometrial tissue without resorting to more traumatic procedures.
Key advantages: A common question from patients is whether a pipelle biopsy is painful. During the procedure, patients may experience a pulling sensation in the lower abdomen, a brief spasm, or discomfort as the instrument passes through the cervix. For most women, these sensations are mild and pass quickly. If a patient is sensitive to pain, it is best to discuss the option of pain relief with the doctor in advance.
- carried out on an outpatient basis;
- takes very little time;
- does not usually require general anaesthesia;
- does not require hospitalisation;
- provides material for histological examination;
- helps to confirm the diagnosis quickly;
- has a short recovery period.
Preparing for an endometrial aspiration biopsy
Preparation depends on the purpose of the examination and the woman’s state of health. Before the procedure, the following may be required: It is usually recommended to refrain from sexual intercourse, douching, vaginal suppositories, creams and tampons for 2–3 days prior to the procedure, unless otherwise advised by your doctor. It is also important to inform your gynaecologist about any medication that affects blood clotting, any allergies, chronic conditions and a possible pregnancy.
- gynaecological examination;
- ultrasound scan of the pelvic organs;
- vaginal swab for bacterial flora;
- cytological smear from the cervix;
- pregnancy test or blood test for hCG;
- tests for infections — where indicated;
- colposcopy — if there are changes to the cervix.
The day of the cycle on which an endometrial pipelle biopsy is performed depends on the purpose of the examination. In cases of infertility, suspected chronic endometritis, menstrual cycle irregularities or monitoring of hormone therapy, the day may vary. Therefore, the date of the procedure is determined by the doctor, not by the patient herself.
How an aspiration pipelle biopsy is performed
The technique for performing an endometrial pipelle biopsy involves several stages. The woman is positioned in a gynaecological chair. The doctor prepares the area, inserts the speculum and carefully guides a thin pipelle through the cervical canal into the uterine cavity.
The doctor then creates negative pressure inside the instrument and obtains a small sample of endometrial tissue. The sample is placed in a special container and sent for histological examination. The entire procedure usually takes a few minutes.
What does an endometrial biopsy reveal?
A biopsy helps to assess the structure of the endometrial cells and identify changes that cannot be accurately determined by ultrasound alone. Histological examination may reveal: The doctor evaluates the results of the endometrial pipelle biopsy alongside the patient’s symptoms, examination findings, ultrasound results and other tests. If no abnormalities are found, observation may be recommended. If an abnormality is detected, the gynaecologist will select a course of treatment or refer the patient for further investigations.
- whether the endometrium corresponds to the phase of the menstrual cycle;
- whether there are signs of hyperplasia;
- whether there is chronic inflammation;
- whether atrophic changes are present;
- whether polypoid changes are suspected;
- whether atypical cells have been detected;
- are there signs of a precancerous or malignant process?
After-effects and recovery following the procedure
The after-effects of an endometrial pipelle biopsy are usually minimal. In the first few days, the following may occur: It is advisable to avoid sexual intercourse, douching, tampons, hot baths, swimming pools and strenuous physical activity for a few days. It is best to shower for personal hygiene.
- light bloody discharge;
- a dull ache in the lower abdomen;
- mild cramping;
- discomfort similar to the onset of menstruation.
You should see a doctor if you experience severe pain, heavy bleeding, a fever, weakness, discharge with an unpleasant odour, or a sudden deterioration in your well-being. Such symptoms are rare but require medical assessment.
