An endometrial pipelle biopsy is a procedure in which a small sample of tissue is removed from the endometrium (lining of the uterus / womb) using a thin diameter plastic suction device and sent for pathology assessment. The biopsy is used to exclude any suspicious conditions and can provide information to help make a diagnosis or suggest treatment options.
There are several reasons an endometrial pipelle biopsy is required:
- irregular or abnormal vaginal bleeding (heavy menstrual bleeding)
- vaginal bleeding between periods (intermenstrual bleeding)
- vaginal bleeding after the menopause (post-menopausal bleeding)
- an ultrasound scan shows you have a thickened endometrium (biopsy not always required before the menopause)
An endometrial pipelle biopsy cannot be taken during pregnancy, or when there is evidence of vaginal or pelvic infection or pelvic inflammatory disease.
Sometimes the biopsy cannot be taken in the outpatient department and may have to be taken in theatre using a general anaesthetic, at a later date. This sometimes happens in the following cases:
- if a patient has never been pregnant
- when there is cervical scarring or stenosis (narrowing). This sometimes happens after a patient has had cervical treatment for abnormal smears, or after the menopause.
- when a patient is anxious
To obtain the pipelle biopsy a speculum is inserted into the vagina (like a cervical smear test) to allow visualisation of the cervix (neck of the uterus/womb). The biopsy is then taken by passing the pipelle through the cervical canal and into the uterine cavity. The sample is obtained by creating slight suction. This may cause a crampy period type pain, which generally settles once the biopsy has been taken. Occasionally, it may be slightly difficult to take the biopsy due to the position of the cervix. This is completely normal. An instrument might be needed to hold onto your cervix so that it can be held in a better position to make it easier to take the biopsy. Once the biopsy has been taken the speculum will be removed and the examination will have finished.
During visualisation of the cervix, a cervical polyp may be identified. This is a bud of tissue like a skin tag and is an overgrowth of cells. Occasionally an endometrial polyp is identified, where the cell overgrowth is coming from the lining (endometrium) of the womb (uterus) and protruding out through the cervical opening. A cervical polyp is an overgrowth that develops in the cervical canal and protrudes out into the vagina.
The exact cause of polyps is unknown, but they tend to grow when there is more of the hormone oestrogen in the body. Most polyps are non-cancerous (benign) growths although a minority can be cancerous or can eventually turn into cancer.
Polyps often cause no symptoms and are found coincidentally during examination. Sometimes they do cause symptoms of irregular menstrual bleeding or bleeding between periods. After the menopause they may cause vaginal bleeding.
Sometimes the cervical (or endometrial polyp) cannot be removed in the outpatient department and may have to be removed in theatre using a general anaesthetic, at a later date.
