An endometrial biopsy is a quick office procedure that removes a small sample of tissue from the lining of your uterus so it can be examined under a microscope. It’s one of the most common ways to check for abnormal cell changes, including cancer, in the uterine lining. The procedure typically takes less than 10 minutes and doesn’t require general anesthesia.
Why It’s Done
The most common reason for an endometrial biopsy is abnormal uterine bleeding: periods that are unusually heavy, irregular, or occurring after menopause. Any bleeding after menopause is considered abnormal and generally warrants investigation, because it can be an early sign of endometrial cancer or precancerous changes.
Beyond bleeding, your provider may recommend the procedure to evaluate unexplained thickening of the uterine lining seen on ultrasound, to check for infection in the lining, or to assess fertility issues. It’s also used to monitor the effects of hormone therapy on the uterus.
Updated guidance from the American College of Obstetricians and Gynecologists (ACOG) now recommends tissue sampling as part of the initial evaluation for most patients with postmenopausal bleeding, rather than relying on ultrasound measurements of the uterine lining alone. Previous guidelines allowed providers to skip the biopsy if the lining measured 4 mm or less on ultrasound, but ACOG found that approach had unacceptably low sensitivity for detecting cancer and precancerous changes. The updated recommendation calls for combining ultrasound with biopsy, which is particularly important for Black women, who face disproportionately higher incidence and mortality rates from endometrial cancer.
How Accurate It Is
In postmenopausal women, an endometrial biopsy detects endometrial cancer about 90% of the time and catches atypical hyperplasia (a precancerous condition) about 82% of the time. Its specificity is nearly 100% for both, meaning a positive result is almost always correct. Those numbers make it a highly reliable screening tool, though a small percentage of cancers can still be missed, which is why your provider may recommend further testing if symptoms persist despite a normal biopsy result.
What Happens During the Procedure
You’ll lie on an exam table in the same position as a pelvic exam. Your provider inserts a speculum to visualize the cervix, then cleans the cervix and passes a thin, flexible catheter (often called a Pipelle) through the cervical opening into the uterus. The catheter uses gentle suction to collect a small strip of tissue from the uterine lining. The sample is sent to a pathology lab for analysis.
Most people feel moderate to strong cramping when the catheter enters the uterus and during the suction. The sensation is similar to intense menstrual cramps and typically lasts under a minute. Evidence supports taking an over-the-counter anti-inflammatory pain reliever like ibuprofen before the procedure to help manage discomfort. ACOG also notes that good pre-procedure education and counseling about what to expect reduces both anxiety and the perception of pain.
No fasting or special preparation is required. If you’re premenopausal, the biopsy is sometimes scheduled during a specific point in your menstrual cycle depending on the reason for the test. Pregnancy is a contraindication, so your provider will confirm you’re not pregnant before proceeding.
Recovery After the Biopsy
You can go home immediately and most people return to normal activities the next day. Soreness and cramping are normal for about 48 hours. Light vaginal bleeding or spotting is also expected but shouldn’t last longer than a few days.
For the first seven days after the procedure, avoid placing anything in the vagina, including tampons. Sexual intercourse should also wait at least seven days, or longer if your provider advises. Skip strenuous exercise, heavy lifting, swimming, hot tubs, and baths for several days to reduce the risk of infection.
Contact your provider if bleeding lasts longer than two to three days, if cramping or pain persists beyond the first few days, if you develop a fever, or if you notice unusual or foul-smelling discharge.
Understanding Your Results
Results typically come back within one to two weeks. The pathology report will describe the tissue using specific terms that reflect where you are in your menstrual cycle and whether the cells look normal.
If you’re premenopausal, normal results will reference either “proliferative endometrium” (the building-up phase before ovulation) or “secretory endometrium” (the phase after ovulation when the lining prepares for a possible pregnancy). These are further broken down into early, mid, and late stages. Seeing these terms on your report generally means the tissue looks healthy and is responding to your hormones as expected.
Results that require more attention include “disordered proliferative endometrium,” which describes irregular but non-cancerous growth patterns, and “hyperplasia,” which means the lining is abnormally thickened. Simple hyperplasia without atypical cells carries a low risk of progressing to cancer and is often managed with hormonal treatment. Atypical hyperplasia, where the cells themselves look abnormal, carries a meaningfully higher risk and usually requires closer monitoring or further intervention. If cancer cells are found, the report will specify the type and grade, and your provider will discuss next steps for staging and treatment planning.
An “insufficient sample” result means the catheter didn’t collect enough tissue for a reliable analysis. This happens more often in postmenopausal women whose uterine lining is naturally thin. If the sample is inadequate and your symptoms continue, your provider may repeat the biopsy or recommend a more involved procedure that allows direct visualization of the uterine cavity.