An effective and minimally invasive diagnostic method used in the field of gynecology is an endometrial biopsy. During the procedure, the doctor takes a fragment of the mucous layer of the uterus, then to send the resulting material for histological examination.
A biopsy can be performed on patients of any age and of different reproductive status, including women who have not given birth. The procedure is prescribed in cases where the gynecological examination and other tests do not accurately reveal the clinical picture of the pathology. The indication for biopsy is:
- dysfunctional bleeding,
- scanty menstrual flow and menstrual irregularities (amenorrhea),
- suspected tumor development,
- suspected inflammatory processes in the uterus,
- infertility for some unknown reason
- upcoming IVF,
- spontaneous abortion,
- pathology of pregnancy in the early stages.
The absolute contraindication to biopsy is the period of carrying a child, because the doctor’s actions will result in a miscarriage. Other contraindications:
- inflammation in the urogenital system,
- bleeding disorder,
- severe anemia,
- allergic reaction to anesthetics,
- general unsatisfactory condition of the body,
- STDs (infectious).
The reason for the abolition of biopsy can be taking anticoagulants, against which the increased risk of bleeding. In such cases, the course of medication in advance interrupt or endure the study of the endometrium.
How to prepare for the procedure?
Before sampling the patient must undergo a preliminary examination by a gynecologist and pass a series of tests:
- smear on flora,
- cytology smear,
- blood tests (total, hCG, Rh, group),
- samples for hepatitis, syphilis and HIV,
- Ultrasound of the pelvic organs,
During the interview with the patient, the attending physician clarifies information about taking medications and corrects drug therapy, excluding blood thinning drugs (7–10 days before the examination).
The day of the examination is selected, focusing on the phase of the patient's menstrual cycle (if the woman has not entered the period of menopause). Aspiration research is carried out within the following terms:
- 18–24 days to determine the current phase of the cycle
- on the opening day of abnormal bleeding (to establish the cause),
- on the 10th day of the cycle - with pathologically heavy menstruation,
- on the 1st day of the cycle or the day before the onset of menstruation (with infertility),
- once in 7 days in the absence of menstruation (if the probability of pregnancy is excluded),
- for 17–28 days in the case of treatment with hormonal drugs.
If a cancer is suspected, a biopsy is performed without being linked to the cycle.
Three days before biopsy sampling, a woman should adhere to the doctor’s recommendations:
- do not enter into intimate contacts,
- stop douching and discard vaginal suppositories and creams, tampons,
- avoid the use of products that promote the formation of gases,
- on the eve of the biopsy, use an enema to cleanse the intestines.
In the morning before the study, a woman takes a hygienic shower, removes hair in the area of the external genital organs. Patients with varicose veins are shown to use elastic bandages to rule out thromboembolism.
The procedure does not require anesthesia. Local anesthesia is used only in cases when the patient has a low pain threshold. In this case, before a biopsy, the doctor on the basis of anamnesis or tests should establish the absence of an allergy to the anesthetic drug.
The technique is radical and traumatic. The cervix is opened with medical dilators to provide access to the organ cavity. When the neck is fixed with forceps, the doctor inserts a sharp curette and scrapes part of the mucosa. The procedure requires increased accuracy from a specialist, as the risk of damage to the walls of the uterus is very high.
During curettage, the patient is under general anesthesia. Therefore, on the eve of the procedure, a woman should refuse to take food and water.
Scraping can be carried out both for diagnostic and medicinal purposes, if together with the mucous membrane, abrasive tissue is scraped.
On the day of the planned study, the patient with the referral arrives at the office where the suction biopsy will be performed. For biopsy sampling use a vacuum. Cervical dilatation is not required, so the procedure does not cause pain (only minimal discomfort with the introduction of medical instruments).
The woman is located on the gynecological chair. The specialist inserts a mirror and a special tip into the cavity of the vagina, communicating with the electro-suction device. In some cases, a syringe acts as an analogue of an electric vacuum apparatus.
Biopsy removal is carried out by analogy with the aspiration technique. However, a thin tube (3 mm in diameter) is used to collect tissue. The Pipel instrument is inserted into the uterus, after which the doctor delays the plunger and creates negative pressure, thereby triggering the separation of a part of the endometrium.
The method is preferable for nonparty patients, as it is the most gentle.
A CHU biopsy is performed using a small curette, but does not require cervical dilation. Specialist scraping narrow parts of the mucous, from bottom to throat. Tissues excised in the form of small strips and from different parts of the uterus.
The method is often used to monitor the effectiveness of hormonal treatment.
The most modern and informative method of endometrial biopsy is hysteroscopy. For its implementation used hysteroscope. However, this technique is used very rarely (due to insufficient instrumental equipment of clinics).
Evaluation of results
After removal, a fragment of the endometrium is sent to the laboratory for microscopy and histological examination. For a more accurate analysis, the pathologist must have information regarding the exact day of the patient's menstrual cycle, age and the scheme of current therapy.
If there are no deviations in the course of the study, the conclusion indicates the absence of atypical signs. Among the pathological processes can be identified:
- diffuse hyperplasia of the mucous membrane (proliferation of the endometrium),
- complex hyperplasia of the mucous membrane (proliferation of the endometrium, complicated by the formation of glands inside hypertrophied tissues),
- local processes of hyperplasia (the formation of polyps in the uterus),
- atypical hyperplasia (mutation of overgrown endometrial tissue),
- malignant processes
- endometrial atrophy,
- endometritis (inflammatory processes in the mucous membrane),
- discrepancy between the status of the endometrium actual phase of the menstrual cycle.
Atrophy of the endometrium is not always a pathology. For older patients, atrophic processes may be a variant of age-related changes.
After the procedure, the patient can immediately go home. Hospitalization after endometrial biopsy is not required. The next 1-2 days may be mild pain, which are stopped by antispasmodics.
Vaginal bleeding is observed for several days after the procedure and is considered normal. After the cessation of bleeding, you can resume sex life.
Possible failure of the menstrual cycle (delay up to 10 days). If the delay exceeds this period, it is necessary to consult a doctor.
After a biopsy, patients often complain of discomfort during intercourse. The symptom is temporary.
With a minimally invasive biopsy, pregnancy can occur in the current cycle, since the intervention does not affect the reproductive functions of the ovaries.
With a radical biopsy (curettage), the recovery process takes longer and is associated with heavy bleeding.
Recommendations after the biopsy (for the first few days):
- avoid thermal effects on the body (hot showers and baths, baths and saunas),
- do not use tampons,
- avoid physical exertion
- do not lift heavy objects
- carefully observe the hygiene of the genitals.
Consequences and complications
Complications after endometrial biopsy are quite rare and are often associated with impaired biopsy sampling techniques or neglect of medical recommendations (by the patient). Contact a specialist is necessary for:
- fever and fever,
- offensive discharge with purulent infiltration,
- heavy bleeding,
- severe pain
- fainting and dizziness,
- cramps in the uterus.
The most dangerous consequence of a biopsy is endometritis. To exclude the development of endometritis (especially with previous vaginitis and abortions), the doctor prescribes a course of antibiotics to the patient.
Endometrial biopsy: what is it?
Endometrial biopsy is an in vivo collection of a sample of tissue from the uterine mucosa (endometrium) for subsequent histological and histochemical analysis. This procedure refers to minor surgical interventions in gynecology and is most often carried out as an independent study. But in some cases it is included in the protocol of the “big” operation and is carried out on an emergency basis intraoperatively.
Biopsy most often pursues diagnostic tasks only. But in some cases, it is a medical-diagnostic manipulation, allowing to obtain the necessary information to the doctor and at the same time improve the condition of the woman. The preparation process, the volume of the intervention and whether the woman will be hurt or not depends on the type of biopsy used.
Types of research
For the first time, a documented sampling of the uterine mucosa for analysis was carried out in 1937 by Batlett and Rock. Special tools were used to expand the cervix and scrape (mechanically separate) the entire endometrium.
The main objective of this study was to determine the severity of cyclic tissue changes caused by the hormonal background of the woman. Subsequently, the indications for biopsy expanded significantly, and the method itself began to be improved. This reduced the trauma and painfulness of the procedure, reduced the risk of various undesirable consequences.
Currently, in clinical practice, several types of uterine mucous membrane taking are used for research:
- the classic version of the study - therapeutic and diagnostic curettage of the uterus,
- vacuum aspiration biopsy of the endometrium, carried out with a special syringe or device (vacuum aspirator or electric suction pump),
- endometrial biopsy is a more modern version of aspiration of the mucous membrane and contents of the uterus, using a low-impact tool in the form of a flexible suction tube (pipel),
- TsUG endometrial biopsy, during which the tissue is taken in the form of stroke scrapings (tsugov).
A less common way to obtain a sample of the endometrium is to take it in the process of hysteroscopy (endoscopic examination of the uterus). Such a biopsy is targeted. The doctor has the opportunity to take a small amount of the biomaterial from several suspicious areas at once and at the same time assess the severity, location and nature of the changes.
Nevertheless, despite the high information content, hysteroscopy is not included in the list of commonly used diagnostic procedures. Not all medical institutions have the opportunity to conduct such a modern high-tech research.
A very rarely used method of obtaining a sample of the endometrium is jet douching.
What shows endometrial biopsy
Biopsy (taking the material) is only the first stage of the study, the basis of the method is microscopy and histological analysis of the obtained samples of the endometrium. What does such a diagnosis reveal?
The study may not show any deviations from the age norm. In this case, the conclusion will indicate that the uterine mucosa corresponds to the phase of the cycle and has no signs of atypia. But more often research allows to reveal various deviations. It can be:
- simple diffuse hyperplasia of the endometrium (growth of the mucous membrane), also called glandular or glandular-cystic,
- complex endometrial hyperplasia (with the formation of the similarity of the glands inside the hypertrophied mucous membrane), this condition can also be described as adenomatosis,
- local endometrial hyperplasia (with or without atypia), which is regarded as single polyps or polyposis,
- atypical hyperplasia (simple or complex), in which the cells of the overgrown mucous membrane do not correspond in their morphofunctional characteristics to normal endometrial cells,
- malignant tissue degeneration,
- atrophy or hypoplasia of the uterine lining,
- endometritis - inflammation of the endometrium,
- discrepancy between the thickness of the functional layer of the endometrium and the current phase of the ovarian-menstrual cycle.
Detection of atypia has an important predictive value. Some forms of atypical hyperplasia are referred to as precancer.
The main diagnostic features are cellular and nuclear polymorphism, impaired proliferation, changes in the structure of the endometrial glands and invasion of glandular tissue into the stroma. The key to determining precancer and cancer is a violation of tissue differentiation.
Indications, contraindications and timing
Endometrial biopsy, when indicated, can be performed by women of any age, including those who have not given birth or have gone out of reproductive age.
The basis for the purpose of this study may be:
- dysfunctional uterine bleeding,
- menometrorrhagia, acyclic scanty spotting, amenorrhea of obscure origin, scanty menstruation,
- suspected adenomyosis and the presence of tumors.
Endometrial biopsy is performed before IVF and in identifying the cause of infertility. At the same time, histological examination of the uterine mucosa is included in the program of comprehensive diagnosis of the reproductive health of women.
The study is also carried out after spontaneous abortions in the early stages and termination of pregnancy for medical reasons (with a frozen pregnancy, intrauterine fetal death, the development of a child's malformations that are incompatible with life). In such cases, biopsy specimens are taken by curettage of the uterus.
When is a biopsy done?
Endometrium is a hormone-dependent tissue. And the information content of the results of his histological examination depends largely on the day of the cycle at the time of the biopsy. This takes into account the clinical situation and the main tasks of the biopsy. And in postmenopausal patients, the presence of uterine bleeding and the time of its onset are taken into account.
On which day of the cycle is best to perform a biopsy in women of reproductive age? Currently adhere to the following basic recommendations:
- when identifying the cause of infertility, in case of insufficiency of the luteal phase and anovulatory cycles, the study is carried out one day before the expected menstruation or the first day after its onset
- with a tendency to polymenorrhea, the study is prescribed between 5 and 10 days of the cycle,
- with acyclic bloody uterine secretions, a biopsy is performed in the first 2 days after the onset of menstruation or menstrual-like bleeding,
- in the presence of a hormonal imbalance, preference is given to the TsUG-biopsy, which is carried out several times during one cycle with an interval of 7-8 days,
- to monitor the results of hormone therapy, biopsy is performed in phase 2 of the cycle, between 17 and 25 days,
- if a malignant tumor is suspected and there is no pronounced bleeding, the study can be conducted on any day of the cycle.
What can limit the use of this method?
Some conditions are relative or absolute contraindications for biopsy, if they exist, the decision on the possibility of conducting a study and its type is made by the doctor or even the medical commission on an individual basis.
Possible restrictions include:
- pregnancy - at the slightest probability of conception during the last 2 menstrual cycles, it is necessary to make sure that there is no pregnancy, because endometrial biopsy provokes rejection of the ovum,
- blood coagulation disorders,
- constant use of drugs with disaggregation and anticoagulant effects (NSAIDs, Dipyridamole, Trental, Warfarin, Clexan and others),
- severe anemia,
- active phase of infectious and inflammatory diseases of the urogenital system,
- intolerance of drugs used for anesthesia.
A biopsy is not a vital research, if it is impossible to conduct it, the doctor makes another examination program for the patient. There is also the possibility of choosing more benign methods for collecting samples of the endometrium. But scraping in some cases performs a therapeutic function and therefore can be used even with relative contraindications.
Biopsy by curettage of the uterus
This method is the most radical and historically the earliest way of obtaining biopsy. This biopsy includes 2 main stages: dilation of the cervical canal and curettage of the walls of the uterus. It uses a set of special bougie (dilators of various sizes), forceps for removing and fixing the cervix and uterine curette - a surgical spoon with a sharp edge.
Diagnostic curettage of the uterus is a painful procedure and requires the use of pain relief. Short-term general anesthesia is preferred, and inhalation or intravenous anesthesia may be used. Therefore, this method requires compliance with the same preparation rules as any “big” operation. To prevent the reflux of gastric contents and its aspiration into the respiratory tract, it is recommended to stop taking water and food for at least 8 hours before the procedure.
Modern endometrial biopsy probe
During curettage, the doctor tries to pass the curette over the entire surface of the walls of the uterus, including the corners near the mouths of the fallopian tubes. As a result, almost the entire endometrium is mechanically removed with the formation of an extensive wound surface.
Such curettage often allows removing polyps, stopping uterine bleeding and clearing the uterus cavity of the pathological contents already present at the diagnostic stage. And the remaining open cervix does not prevent the natural outflow of blood, although it can serve as a gateway for infection.
Important advantages of diagnostic curettage are the possibility of its use in cases of suspected oncologic and necological diseases, metrorrhagia and after an interrupted pregnancy.
Endometrial Biopsy Pipepel Technique
Peipel biopsy is an improved modern version of endometrial aspiration. At the same time, the main device for collecting a part of the mucous membrane is the Pipel tip - a flexible thin disposable tube with a piston. The small diameter (about 3 mm in total) and the sufficient elasticity of this device allow it to be inserted through the cervical canal without using any dilators.
By the principle of action, the tool of the Pipel resembles a syringe. After inserting its working tip into the uterine cavity, the doctor squeezes the plunger towards itself to the middle of the tube length, which creates sufficient negative pressure to aspirate a small amount of endometrium. At the same time, extensive wound surfaces are not formed, the cervix of the uterus is not injured, the patient does not experience marked physical discomfort.
Preparation for pipe biopsy does not differ from that before classical vacuum aspiration of the endometrium. The procedure is performed on an outpatient basis and usually does not require anesthesia.
Features of the ZUG biopsy
ZUG biopsy is considered to be a low-impact option for taking a sample of the endometrium. It does not provoke massive bleeding and rejection of the mucous membrane and is usually performed up to 3 times during one menstrual cycle. The main objective of this study is to determine the reaction of the endometrium to natural or artificially created changes in hormonal levels. It is not used to diagnose cancer and precancerous conditions.
For the TsUG-biopsy, use a special small curette. It is gently injected into the uterine cavity, without pre-expanding the cervical canal. Applying a little effort, the doctor scrapes a narrow strip of mucous membrane with the working surface of a curette. This is reminiscent of strokes, so this method of diagnosis is called "endometrial bar-biopsy".
It is very important to investigate not a single part of the uterus, therefore the strokes (TSUGs) are carried out from the bottom to the internal os of the cervix. For reliable diagnosis, it is enough to get 2 samples at a time.
What to expect and what to do after the study?
Any endometrial biopsy is accompanied by a violation of the integrity of the mucous membrane of the uterus and the appearance of bleeding. Their volume and duration depend on the method of research used by the doctor.
Diagnostic curettage results in copious, menstrual-like and rather painful discharge. But their duration is usually much less than during normal menstruation, because the main part of the endometrium has already been removed during the procedure. Discharge after endometrial biopsy should not be with clots, an admixture of pus or an unpleasant odor. The appearance of any of these signs or fever is a reason for an emergency visit to the doctor.
Monthly after endometrial biopsy by other methods described above may begin on time or with a slight delay. Their volume and duration are often different from the usual. Most often there is a delay in menstruation after the endometrial biopsy pipel for up to 10 days. In this case, you need to do a pregnancy test and consult a doctor.
Pregnancy after the study is possible in the next cycle. During this period there will be a complete update of the functional layer of the uterine mucosa. In addition, biopsy does not affect the functioning of the ovaries. And with gentle methods, the remaining area of the endometrium may be sufficient for the implantation of the ovum already in the current ovulatory cycle.
In most cases, doctors recommend refraining from sexual activity until the spotting completely stops. In the subsequent in the current cycle it is desirable to use barrier methods of contraception.
How long are the results being prepared?
Decoding results after endometrial biopsy can take up to 2 weeks. Histological examination of biopsy specimens conducted by a pathologist or histologist. If necessary, also performed immunohistochemical analysis.
The timing of the results depends on the specific laboratory, the load of the histologist and the urgency of the study. If it is necessary to conduct an emergency analysis, the doctor makes a note about this in the direction. Histological examination of specimens taken during surgery is sometimes carried out for 20 minutes, the result obtained may affect the amount of surgery performed.
What do after biopsy?
Further diagnostic and treatment tactics depend on the results of the biopsy. In identifying atypia and precancer, the question of the need and feasibility of surgical treatment is resolved. When signs of inflammation are detected, its nature is determined and anti-inflammatory and antibacterial drugs are prescribed.
If endometrial biopsy showed signs of hyperplasia or insufficient tissue response to cyclic hormonal changes, further diagnostic search is performed. This is necessary to determine the presence of endocrine disorders and secondary changes in other hormone-dependent tissues (primarily in the mammary glands).
Subsequently, hormone therapy may be recommended, which allows to improve the condition of the endometrium and even restore reproductive function. In addition, other drugs and physiotherapy can be used.
Possible complications and consequences
A number of women after a biopsy complain of a temporary change in the duration of the menstrual cycle, the pain of the onset of menstruation and discomfort during sexual intercourse.
The most dangerous complication of a biopsy is endometritis. It is characterized by severe growing intoxication, pain in the abdomen and the appearance of fetid uterine secretions with signs of suppuration. Fortunately, this complication is rare. Its development is usually associated with hypothermia, non-compliance with the recommendations of the doctor regarding the hygiene of the genital organs and sexual rest.
But sometimes the cause of endometritis is the aggravation of existing vaginitis. Therefore, women with chronic urogenital diseases after an endometrial biopsy need to drink antibiotics as recommended by a doctor. The same tactics are followed if the patient has undergone an abortion.
When a biopsy will be performed, what method will be chosen and how to prepare for the procedure, it is necessary to check with your doctor. Non-compliance with the recommendations may adversely affect the reliability of the study and increase the risk of complications.
You should not refuse to conduct a biopsy, because no other diagnostic methods can replace histological analysis. Only this examination allows us to diagnose endometrial cancer in its early stages, which significantly improves the long-term results of treatment.
What is a biopsy procedure
Most often, a pipe biopsy is prescribed for diagnosis - a safe and painless procedure, as a result of which no harm is done to the body. During the study, a thin plastic tube is inserted into the uterine cavity, through which a mucous particle is taken for examination. The tissues are sucked into the cavity of the tube, that is, no scraping or other traumatic actions are performed. The difference between this method and aspiration is that tissue is collected using a tube, rather than a vacuum instrument or syringe.
Various methods can be used for biopsy, including:
- classic with full scraping mucous, the most traumatic
- endometrial aspiration biopsy with a freezing of materials using a vacuum instrument,
- Pipel, which is the safest and most painless.
Paypel endometrial biopsy - what is it?
Preparing for pipe biopsy is very simple:
- the patient should undress, as in a routine examination by a gynecologist,
- the vagina expands with a special tool
- the cervix is treated with a solution, followed by treatment with an anesthetic,
- then take a sample of tissue.
How exactly the procedure takes place depends on the chosen method, but usually it does not take much time and takes a couple of minutes. The scraping may take about 10-15 minutes, after which the patient can go home. A hospital stay is not required only if the biopsy is not performed as part of a general treatment or there are indications for this.
On which day of the cycle is being done
A biopsy is usually taken on the 21-23 day of the cycle, so it is recommended to keep a personalized menstruation schedule. It is better to do some types of studies immediately before the menstrual period, approximately in 5-7 days, but for long cycles this period may be different. If the patient does not know his long cycle, the time of the study is appointed approximately, focusing on the usual duration, that is, between 21-23 days, counting from the date of completion of the last menstrual period.
How much is
The price of the endometrial biopsy pipel depends on the clinic where the procedure is performed. On average, the cost of this diagnostic manipulation ranges from 1600 to 8000 rubles. Studies are recommended only on the basis of specialized clinics that have the appropriate conditions and equipment.
Reviews of endometrial biopsy pipel
“I have had frozen pregnancies several times, for a long time they could not determine the cause. In one of the clinics they suggested biopsy of the pipe. The procedure itself did not take much time, went well, although it was painful. As a result, they discovered hyperplasia, which was the reason for the impossibility of a normal pregnancy. She has undergone treatment, now everything is fine, we are waiting for the second baby. ”
“I was prescribed an IVF procedure and was recommended to undergo a biopsy before it, in order to rule out any problems. Everything went quickly in an outpatient clinic, there were no particularly unpleasant sensations, fertilization was prescribed in a month. ”
“The observing gynecologist prescribed a biopsy, as there was a suspicion of endometriosis. She was terrified, but in vain - everything took literally about five minutes, practically there were no painful sensations. The first couple of days were disturbed by a pulling sensation in the abdomen, light discharge, but everything went without consequences. ”
Decryption usually takes 10 days, it is done only by a qualified specialist. The results of the study allow to identify:
- discrepancy between the thickness of the mucous membrane norm,
- the presence of endometritis,
- malignant neoplasms,
- atypical hyperplasia
- precancerous condition
- the presence of fibroids and other growths,
- the presence of endometriosis.
Diagnostic hysteroscopy with biopsy is used to accurately identify pathologies, the presence of fibroids, tumor processes, polyposis, hyperplasia. The material is taken under anesthesia, for which intravenous anesthesia is usually used. The biopsy is collected using a special hysteroscope, after which tissue samples are sent for research.
What to do after the procedure?
Usually, a biopsy proceeds quickly and without special consequences, but it is not prescribed in such cases:
- blood clotting disorders
- the presence of inflammatory diseases of the genitourinary system,
- severe anemia,
- taking such drugs as trental, NSAIDs, clexane and others,
- intolerance means used for anesthesia.
In addition, a number of restrictions relate to intimate relationships, the use of hygienic tampons, pregnancy can be planned only for the next cycle, especially the IVF procedure.
What not to do after a biopsy?
After the endometrial biopsy pipel, the following actions cannot be performed:
- to have sex until the spotting passes,
- lift weights, engage in work related to serious stress,
- take a bath, especially hot,
- go to sauna, bath,
- do douching
- use tampons.
Such actions are prohibited to prevent some complications, including inflammatory diseases, heavy bleeding. Such restrictions are valid for days, after which they are removed. But, if the bleeding continues or purulent discharge from the vagina is observed, it is necessary to contact an observer.
Sex life after
Intimate relationships after a biopsy is better to be postponed until the spotting is completely gone. Further, sex no longer has limitations, but if pregnancy is not planned, at first it is better to use barrier contraception, which will also protect the mucosa from infectious and bacterial lesions.
How do monthly
Immediately after the procedure, menstrual flow comes on time, there may be slight delays, but not more than 10 days, most often there are no delays at all. The discharge itself will be more scarce than usual, the presence of an unpleasant odor of discharge, the appearance of clots, the presence of pus, and fever are not allowed.
Biopsy and pregnancy
After a biopsy, some conditions are contraindicated, but pregnancy can be planned for the next cycle, when the endometrium is restored. Delay menstruation usually does not occur, although the discharge immediately after the procedure can be scanty. But for the full cycle, the functionality of the mucous is fully restored, no problems with the arrival of the menstruation does not occur, and the uterus itself will be fully prepared to accept the egg.
How much to expect results?
Endometrial biopsy results, as a rule, have to wait from 7 to 14 days, it all depends on the clinic where the tests are conducted and the total workload of the laboratory. To decipher the results usually takes no more than 10 days, after which you can contact your supervising physician to prescribe a treatment regimen or other treatment methods.
The structure of the uterus
The uterus is the main organ of the woman's reproductive system, located in the small pelvis between the bladder and the large intestine. In shape, it resembles a triangle, facing the base and hollow inside. The lower part of the uterus, passing into the vagina, is called the cervix. Inside it passes the cervical canal (cervical canal).
The walls of the uterus consist of three layers:
- The outer layer or parametrium - connective tissue covering the organ from the outside. It also forms ligaments that provide attachment of the uterus.
- The inner layer or myometrium is smooth muscle. A thick layer of muscle tissue protects the fetus and shrinks the uterus during labor.
- The inner layer or endometrium is a mucous membrane containing a large number of blood vessels. It contains the uterine glands, which secrete mucus that prevents the uterus from falling off.
Structure and function of the endometrium
Endometrium plays a key role in the female reproductive system. Он ежемесячно готовит условия для оплодотворенной яйцеклетки: обеспечивает ее прикрепление, а в дальнейшем формирование пуповины и создание условий для развития эмбриона. Если же в данном цикле беременность не наступила, верхний слой эндометрия отторгается, что проявляется в виде менструального кровотечения.
All changes that occur in the endometrium are controlled by female sex hormones, which are released according to the maturation of the ovarian follicle.
In the development of the endometrium there are three phases:
- The proliferation phase is an increase in the functional layer of the endometrium, its recovery after menstruation. Duration from the 5th to the 14th day of the cycle. Reproduction of endometrial cells, their proliferation, stimulates the hormone estrogen.
- The secretion phase is the active secretion of the secretion of the uterine glands, which creates optimal conditions for the attachment and development of the embryo. Lasts approximately from the 15th to the 27th day of the cycle. Changes are stimulated by the hormone of the yellow body - progesterone.
- The bleeding phase is the period during which the functional layer of the endometrium exfoliates and is removed from the uterus during menstruation. Duration from the 28th to the 4th day of the cycle. The rejection of the functional layer is associated with progesterone deficiency. In the absence of it, the arteries feeding the upper layer of the endometrium contract, which is why cells do not receive enough nutrients and die.
Histology of the lining of the uterus
The inner surface of the uterus is lined with cylindrical epithelium. Endometrial cells of low cylindrical shape. They are smaller in size than the cervical canal epithelium. Cells contain one nucleus and a well-pronounced cytoplasm. They may have cilia, facilitating the advancement of the egg to the site of attachment, or be seedless.
In the uterine mucosa emit several components. Their cellular structure may vary depending on the phase of the menstrual cycle.
- The basal layer is the lower layer adjacent to the muscular layer of the uterus. Its main function is to ensure the restoration of the functional layer after menstruation or other damage. Thickness is 10-15 mm. Weakly reacts to hormonal fluctuations. The nuclei of cells are oval, stained intensely. Depending on the phase of the cycle, the shape of the cells and the location of the nuclei in them change. Here there are large blister cells, which are immature cells of the ciliated epithelium.
- The functional layer is the surface layer lining the uterus. Its function is to ensure the adherence of the fertilized egg and its subsequent implantation. It is most sensitive to the effects of female sex hormones. During menstruation, he is completely rejected. In the first days after menstruation, its thickness is minimal. By the end of the cycle, it increases to 8 mm.
- Uterine glands are simple unbranched tubular glands, secreting mucous secretion that ensures the normal functioning of the uterus. The glands originate in the basal layer. Throughout the cycle, with the growth of the functional layer, the glandular tube lengthens and acquires a tortuous shape, but does not branch.
- In the basal layer of the uterine glands are narrow, densely arranged and separated by narrow strips of the stroma. Their surface in one row is lined with cylindrical epithelium, similar to that which covers the surface of the mucous membrane.
- In the functional layer are the main parts of the tubes and their excretory ducts. In the first week after menstruation, the tube of the gland has a straight shape and a narrow lumen. Further, it lengthens, acquires a convoluted shape. At this stage, the gland cells begin to produce mucus, which initially accumulates in the duct, and then excreted into the uterine cavity, moisturizing its mucosa.
- The endometrial stroma is a connective tissue that provides the strength of the mucous membrane and connects the endometrial cells.
- In the basal layer of the stroma is dense, consists of connective cells and a large, number of thin collagen fibers. Stroma cells are small, rounded, smaller than endometrial cells. They are located in loose groups between the uterine glands. They have a rounded nucleus surrounded by a thin rim of cytoplasm.
- In the functional layer after menstruation, the stroma is represented by delicate argyrophilic fibers, which coarsen by the end of the cycle. The shape of the cells is spindle-shaped, they contain large nuclei. Cells are located at a distance from one another, therefore the stroma is loose. In the secretion phase, endometrial edema occurs and water and nutrients accumulate between the stromal cells, increasing the gaps between them.
How to prepare for endometrial biopsy of the uterus?
Two days before the appointed biopsy, it is necessary to refuse:
- Sexual intercourse,
- Use of any vaginal medication without a prescription.
To exclude infections that may cause complications after a biopsy, it is necessary to pass a series of tests:
- General blood analysis,
- General urine analysis,
- Blood chemistry,
- Blood coagulation test - coagulogram,
- Blood test for HIV, syphilis - RW, hepatitis B and C,
- Smear for flora - bacteriological examination of the contents of the genital tract,
- Test for human chorionic gonadotropin in the blood or in the urine - a test for determining pregnancy.
In the morning before a biopsy, you must take a shower and remove the hair around the genitals. If a biopsy is performed under intravenous anesthesia, then food should be abandoned within 12 hours.
Depending on the method of taking the material, the procedure can be carried out in the gynecologist's office or in a small operating gynecological hospital.
At the preparatory stage, conduct:
- Treatment of the external genital organs with an antiseptic,
- Enlargement of the vagina with a gynecological mirror to gain access to the cervix,
- Cervix treatment with alcohol,
- Fixation of the cervix with bullet forceps.
Further actions of the doctor depend on the method of biopsy.
1. Diagnostic curettage of the uterus
- With the help of dilators Gegar (which are metal cylinders with a diameter of 4-13 mm) are expanding the cervical canal. Its width should correspond to the size of a curette — a surgical spoon.
- A curette of the required size is introduced into the uterine cavity.
- Having pressed the curette to the front wall of the uterus, it is carried out from the bottom to the internal pharynx, scraping the functional layer of the mucous membrane.
- A spoonful of material removed from the uterus and collect the material in a container with formalin.
- The action is repeated, successively scraping the entire mucosa from the anterior and then from the posterior wall of the uterus and the mouths of the fallopian tubes.
- In the study of the reaction of endometrium to hormones and establishing the cause of infertility, the doctor does not scrape the entire surface of the uterus, but is limited to 3 separate scrapings - tzugs.
- With full curettage, the risk of missing foci of atypia or endometrial cancer is excluded,
- It is possible to immediately remove the pathological lesions during the procedure.
- Performed in the hospital,
- Requires the introduction of intravenous anesthesia,
- Highly invasive procedures,
- Long recovery period - up to 4 weeks,
- There is a risk of complications if the procedure is carried out incorrectly.
2. Aspiration biopsy
Aspiration biopsy of the endometrium can be performed using a thin Brown syringe or a vacuum electric device.
- A catheter (thin hollow tube) with a diameter of 2-4 mm is inserted into the uterine cavity through the cervical canal. It is pressed tightly in the wall of the uterus.
- A syringe is attached to the outer edge of the catheter.
- Pulling the plunger of the syringe, get a sample of the epithelium of the uterine mucosa.
- The resulting material is applied in a thin layer on a degreased glass slide.
- Using a thin catheter and a syringe, 3 ml of saline with sodium nitrate is injected into the uterine cavity. The latter is necessary to prevent the formation of blood clots.
- Immediately after administration, the liquid is removed with a syringe.
- The resulting wash liquid is placed in a test tube and sent for 8 minutes in a centrifuge. After that, a precipitate is formed from the cells at the bottom of the tube. This method allows you to get information about the features of individual cells, but not about the structure of the mucosa as a whole.
- 30 minutes before the operation, drugs are taken to relax the cervix and reduce pain (baralgin, analgin, diphenhydramine) or make an injection of an antispasmodic in the cervix 1-2% solution of lidocaine with adrenaline. The lidocaine solution is also injected into the percutaneous tissue.
- In the uterine cavity lead probe to determine its depth.
- After extraction of the probe, an aspiration tube connected to an electric vacuum aspirator is inserted into the uterine cavity.
- The doctor, moving the catheter through the uterus, collects material from different parts of it.
- The collected material is placed in containers with formalin solution.
- The procedure is performed blindly or under ultrasound control.
- Low invasiveness I and II variants of the procedure,
- Short recovery period after I and II options.
- It is impossible to establish the structure of the endometrium.
- The recovery period after vacuum aspiration takes 3-4 weeks.
3. Pipe Biopsy
A flexible aspiration probe is used to conduct the pipe biopsy. It is a plastic cylinder with a diameter of 3 mm with a side opening at the end. Inside the cylinder is hollow and equipped with a piston.
- The gynecologist inserts the probe through the cervical canal into the uterine cavity.
- When pulling the piston in the cylinder creates a negative pressure, and it is sucked to the wall of the uterus.
- Through the hole at the end of the probe, the material enters its cavity.
- The procedure is repeated 3 times in different parts of the mucous.
- The probe is removed from the uterus.
- The contents of the probe is placed in a container filled with 10% formalin solution.
- It is possible to carry out in the gynecological office,
- No need for anesthesia
- Painless and non-traumatic,
- Rapid healing of the mucous
- Sensitivity 60-90%
- Does not cause complications with proper procedure.
- Based on small fragments of the mucous, it is difficult to establish the structure of the endometrium,
- Collection of material from limited areas of the uterus. There is a risk of missing pathological foci.
4. Biopsy during hysteroscopy
Conducted using a hysteroscope - an endoscope designed to examine the uterus. The device is a probe attached to the end of the equipment, which allows you to get an image of the uterine mucosa and take samples from suspicious areas.
- Sterile saline is injected into the uterine cavity to obtain a high quality image.
- A hysteroscope is inserted through the cervical canal into the uterine cavity.
- Inspect the mucous with the display of the image on the monitor screen.
- Determine the areas from which you want to take samples of the material.
- A curette or other surgical instrument is inserted through the hysteroscope port. With it, take particles of the endometrium by the method of scraping or aspiration.
- Mucous samples are placed in a container.
- Remove the saline from the uterus, then remove the hysteroscope.
- There is an opportunity to remove the identified pathologies - polyps, synechias,
- Short recovery period
- High diagnostic accuracy.
- The need for intravenous anesthesia
- The high cost of the procedure
- Insufficient number of clinics equipped with appropriate equipment.
The resulting material is labeled accordingly (indicate the date of biopsy, the name and year of birth of the patient) and sent to the laboratory for histological examination. After the examination, the results of endometrial biopsy come to the doctor, who has a woman. As a rule, the conclusion is necessary to wait 10-15 days.
What are the results of histology biopsy?
The conclusion that the laboratory makes after the histological study of biopsy consists of 4 parts.
- Uninformative, inadequate sample. This phrase in the histological conclusion indicates that there is not a sufficient number of endometrial cells in the resulting material. Blood cells, squamous epithelium of the vagina, cylindrical cervical canal epithelium may be present. This situation is possible with the wrong sample.
- Informative, adequate sample - a sufficient number of endometrial cells are present in the biopsy.
- Macroscopic description of the drug.
- Weight of submitted samples
- Fragment size (large, small)
- Color (from gray to bright red),
- Consistency (loose, dense),
- Blood clots, blood clots,
- Microscopic description of the drug.
- The type of epithelium (cylindrical, cubic, flat, indifferent), its size, the number of layers,
- Stroma - its presence, density, uniformity.
- Size and shape of stromal cells,
- Stroma fibroplasticity - the number of connective fibers,
- The decidability of the stroma is the accumulation of fluid and nutrients,
- Uterine glands, their shape, description of the epithelium lining them,
- The shape and size of the lumen of the glands, the presence of secretion within the glands, branching,
- Lymphoid accumulations are signs of inflammation,
- Chorion cells, the presence of edema or dystrophic changes - this option indicates that the woman had a missed abortion or an incomplete spontaneous abortion.
- It indicates which phase of the cycle the endometrium corresponds to,
- The presence of hyperplasia - the growth of the endometrium,
- The presence of polyps and the description of the tissue of which they are composed
- The presence of atrophy of the endometrium - thinning of the mucous membrane of the uterus,
- Hypoplastic mixed endometrium is a borderline state that is not a disease.
- Chorionic villi, which are particles of the fetal shell, indicate an aborted pregnancy.
- Degeneration of the epithelium or vessels of the chorionic villi - suggests that the fetus did not initially receive nutrients, which could have caused its death
- The presence of atypia - cells with signs that are not characteristic of this tissue, indicates the precancerous condition of the endometrium,
- The presence of malignant (cancerous) cells indicates endometrial cancer.
Often there is only one phrase in custody: “Normal endometrium in the proliferation / secretion / menstruation phase”. It means that the endometrium is normal, no signs of disease and changes in the structure of the cells are found, there are no polyps and hyperplasia.
It is important that the condition of the endometrium corresponds to the phase of the woman's menstrual cycle and the period of her life. So the conclusion “Normal endometrium in the proliferation phase” 3 days before the planned menstruation speaks of hormonal disorders in the body.
Description of endometrial biopsy
The purpose of endometrial biopsy is a study to identify the causes of infertility, miscarriage, menstrual disorders. Also, the procedure is applied in preparation for IVF. Allows you to get complete information about the state of the mucous membrane.
Aspirate from the uterus is taken with hormonal abnormalities, miscarriages in history, uterine bleeding, which is not associated with menstruation, hyperplasia, malignant neoplasms.
During the procedure, mucous membrane particles are surgically removed. Depending on the tactics of execution, the collection of tissues is carried out with the help of a tube, a vacuum apparatus or a syringe. With conventional curettage, a surgical curette is used for diagnostic purposes. The material for the study can also be obtained during hysteroscopy using a probe. Equipped with a video camera, the device has a small surgical instrument, which point-takes samples from the endometrium (endometrium).
Modern equipment allows you to take a sample of the mucous membrane in the desired area without damage to healthy tissues - the uterus, cervical canal. The possibility of complications and discomfort during the operation is minimized. Biopsy refers to a small surgical intervention. Usually it is carried out according to plan for diagnostic purposes, but in rare cases it is carried out as part of the main operation or on an emergency basis.
Diagnosis using an aspiration biopsy or other type of material is carried out with various defects of the uterus, the absence of menstruation, and bleeding during menopause.
If the study is carried out according to plan, operations are preceded by such diagnostic measures:
- taking a smear on cytology and flora,
- colposcopy behavior
- Ultrasound of organs located in the woman's small pelvis
- general urine and blood count.
Emergency biopsy is performed in case of suspected or accurate determination of the presence of a malignant neoplasm in the uterus or cervical cavity, while the day of the cycle is not taken into account.
Also in the framework of the training are recommended:
- refusal to take drugs that affect blood clotting, and anticoagulants,
- temporary abstinence from sexual activity (at least three days before the operation),
- rejection of douching
- exclusion from the menu of dishes that cause gas.
Improper preparation for the operation can cause various complications, such as damage to the blood vessels (as a result, bleeding), endometrial rejection, violation of the cycle.
When taking an aspirate from the uterus
Endometrial biopsy is performed according to indications that are determined by the woman observing the woman. Taking aspirate from the uterus is necessary in the following cases:
- suspicion of tumor growth,
- scanty menstruation or uterine bleeding, including dysfunctional,
- in the presence of endometrial inflammation,
- determining the cause of infertility, spontaneous abortions or missed pregnancies,
- amenorrhea without pregnancy for unknown reasons,
- preparation for the IVF procedure,
- pathology of pregnancy.
Scraping the endometrium allows you to define its structure and identify abnormal cells. Also determined by its thickness, precise localization.
The procedure is applied if, after a standard gynecological examination and an ultrasound examination, the doctor detects pathological changes in the endometrium. Always diagnosis is carried out before the removal of fibroids or fibroids, polyps, malignant neoplasms.
What is the procedure
Endometrial biopsy is performed by different methods, but it is often used aspiration option. It is less traumatic, there is absolutely no discomfort during the procedure, the risk of complications and side effects is minimized, and the information content of the study is quite high.
The analysis is taken after appropriate preparation for the procedure, which begins 3 days before the manipulation. Immediately before the examination, the intestines are cleaned with an enema.
A biopsy of the mucous membrane of the cervical canal or uterus lasts no more than 3 minutes (30–60 seconds on average, depending on the qualifications of the doctor). Rarely, a woman may need anesthesia. The absence of nerve fibers allows manipulation with minimal use of painkillers.
Biopsy during erosion involves the collection of material from the cervical or uterus canal using a vacuum / syringe / tube / curette. Additionally, the doctor can remove polyps.
Scraping of the uterus and further histological examination of the material is carried out on women of any age, including during menopause, before or after delivery and pregnancy.
Timing and technique of performing biopsy
Endometrial biopsy is performed at certain periods of the cycle, depending on the intended diagnostic objectives:
- When clarifying the factors of infertility on the background of anovulatory cycles and the minimal luteal phase, the analysis is done one day before the start of menstruation or on the first day of bleeding.
- In the case of the presence of acyclic bleeding that is not related to menstruation, mucosal curettage is prescribed on the first or second day of menstruation.
- In the diagnosis of polymenorrhea, the manipulation is carried out in time between the fifth and tenth days of the cycle.
- To determine the cause of hormonal failure, the sample is taken in the second phase of the cycle in the period between the 17th and the 25th day.
- If you suspect the presence of benign and malignant neoplasms scraping is taken regardless of the day of the cycle (extra).
Any study is the introduction into the vagina of a special device for sampling the endometrium. Techniques differ in duration, possible side effects, informativeness.
This method for diagnosis is preferable to aspiration biopsy and curettage. When diagnosing a catheter replaces a small plastic cylinder. At one end, placed in the uterine cavity, there is a small hole on the side, on the other - a piston. When removing the material, a vacuum is formed, the hole is attached to the wall of the uterus, mucous cells are literally sucked into the device.
The procedure is also carried out in certain periods of the menstrual cycle, depending on the type of study. The technique has several advantages:
- painless, no anesthetics applied,
- no side effects
- performed without cervical dilatation,
- most informative
- flexible tube allows you to control the depth of injection, which reduces the risk of injury to the inner walls of the uterus,
- hospitalization is not required,
- fewer contraindications, the possibility of use in women with serious chronic or acute diseases.
This technique also allows you to identify the causes of hormonal disorders, infertility, to assess the growth of tumors.
This technique is one of the least dangerous and less traumatic compared with endometrial aspiration biopsy or curettage. It can run a maximum of three times per cycle.
This technique is not used to diagnose cervical precancer or malignant neoplasms.
To find out the cause of uterine diseases, the cervical canal is artificially dilated; a small curette is gently inserted into the organ cavity. With its help, tissue is collected from the surface of the inner layer.
Endometrial scraping is performed from the depths outward to the inner throat of the cervix. Two samples of material are collected at one time.
The procedure is performed on the 1-2th day of menstruation or after it. Taken uterine material is also sent to the histology, which allows you to accurately identify the causes of infertility, hormonal changes, uterine bleeding, tumor localization.
Endometrial biopsy is considered one of the leading methods to clarify the factors that provoke infertility, miscarriage, spontaneous abortions, interruption of fetal viability and other violations of the reproductive female function. In addition, it is possible to establish the causes of diseases of the uterus during biopsy, to increase the chances of embryo attaching during IVF management.
The procedure helps not only to identify the factors of infertility. Even pregnancy that has arisen on the background of in vitro fertilization is more common. A high percentage of effective IVF. Positive effects were recorded when the biopsy was performed in the month preceding fertilization.
To clarify the factors of infertility, the operation is carried out according to the same pattern as the usual diagnostic procedure. The study of the material reveals the presence or absence of atypical cells, including precancerous conditions, hormonal disorders, inflammatory processes, hyperplasia, and other factors leading to the absence of conception.
Complications and consequences
Aspiration biopsy with professional behavior practically does not cause side effects. The most dangerous in terms of risk is the usual cure, because after it can develop bleeding due to trauma to the walls of the uterus and other complications. In general, such undesirable consequences are possible:
- heavy bleeding - may occur against the background of trauma to the walls of the uterus or cervix,
- dizziness and other signs of weakness,
- nagging or sharp pains
- the development of the inflammatory process after infection with the lack of sterility of the instrument (when scraping),
A woman receives biopsy results no earlier than 6–7 days after the manipulation. The histological examination of a fragment of the endometrium allows to reveal various pathological processes: oncology, diffuse and atypical hyperplasia, atrophy, endometritis, hormonal failure. Based on the results, appropriate therapy is prescribed.
Always manipulations are performed before surgery for the removal of uterine fibroids, malignant tumors.
Biopsy is the most effective way to determine the causes of endometrial abnormalities. This minimally invasive technique most accurately reflects the processes occurring inside the uterus, allows early detection of the growth of a malignant tumor or polyps, serves to clarify the hormonal status, identifies the causes of infertility and other reproductive function disorders.
Endometrial biopsy procedure: features of the technique, patient reviews
Endometrial biopsy is an effective and informative diagnostic procedure widely used in the gynecological field.
This technique allows laboratory testing of the tissues of the mucous membrane of the uterine membrane in order to identify its condition, possible atypical cells.
Endometrial biopsy is one of the most accurate ways to diagnose oncological processes even at the initial stages of development.
Features of the technique
What is endometrial biopsy? This procedure is a curettage of the uterus and the taking of tissue for subsequent histological examination.
The peculiarity of this technique is that under the influence of certain hormones and with the development of pathological processes, the endometrium changes, and only laboratory analysis of the tissue allows to determine its transformation, to assess the danger.
The endometrial biopsy procedure of the uterus is minimally invasive.
If earlier for the diagnosis were used quite traumatic and fraught with numerous adverse effects of the procedure (curettage), then modern specialists use the most gentle and safe methods of biopsy.
For these purposes, the following techniques are used:
- Aspiration is a minimally invasive procedure, characterized by painlessness and minimal recovery period. The procedure is performed on an outpatient basis. In the process of diagnosis, a special handpiece is inserted into the uterine cavity of the patient, which is connected to an electro-suction device.
- Paypel - the safest, improved aspiration technique. During the procedure, a special catheter is inserted into the patient's uterus, allowing you to receive both cells and tissues for examination. Diagnosis in this way is usually done before the beginning of the month.
- Hysteroscopy is the most informative method for detecting oncology, polyposes, cystic tumors, uterine fibroids, adenomyosis. Hysteroscopy with a diagnostic biopsy also provides an opportunity for a specialist to assess the stage of development of the pathological process and the degree of its malignancy, to develop the most effective treatment program. The study is conducted under intravenous anesthesia using a special device - a hysteroscope.
The optimal method for performing a biopsy of the endometrial layer is determined by the doctor individually.
Endometrial biopsy is indicated for women in the following cases:
- endometrial hyperplastic processes,
- polyps localized in the uterus,
- chronic endometritis
- suspicion of tumor neoplasm of benign or malignant nature (fibroids, cysts, cancers),
- menstrual disorders,
- painful and excessively heavy menstruation,
- problems with conception,
- uterine bleeding in menopause,
Gynecologists recommend endometrial biopsy to patients after a preliminary examination, an ultrasound, with the detected pathological processes occurring in the endometrium.
Gynecological diagnostics using biopsy is prescribed during the period of preparation for IVF fertilization, after early termination of pregnancy, miscarriages, and spontaneous abortions.
Preparation for diagnostics
Before endometrial biopsy, in order to identify possible contraindications and restrictions, patients are assigned laboratory and instrumental methods of diagnostic examination:
- taking a smear on cytology and flora,
- blood test,
- ultrasound examination of the pelvic organs.
To obtain the most accurate and reliable diagnostic results, it is important to correctly determine the day of the procedure.
In most cases this happens according to the following scheme:
- Detection of the cycle phase - 18-24 days of the menstrual cycle.
- Pathological uterine bleeding - 1 day.
- Abundant menstruation - 5-10 days of the menstrual cycle.
- Suspected infertility - the first day of the cycle or the day before the onset of menstruation.
- Monitoring the effectiveness of the course of hormonal therapy - from 17 to 25 days of the menstrual cycle.
If you suspect the presence of a malignant tumor, diagnostics is carried out urgently, regardless of the day of the cycle.
For several days before the procedure, the patient must observe certain rules:
- Refuse the use of anticoagulants and drugs that reduce blood clotting.
- Refrain from intimate contact.
- Exclude from the diet foods that promote increased gas formation.
- Refrain from douching.
On the eve of the study is recommended to make a cleansing enema.
Biopsy of the mucous uterine layer does not affect the working capacity of women.
According to reviews of most patients, the procedure is tolerated very well, without any unwanted reactions.
But during the first few days, a woman may experience aching, painful sensations in the lower abdomen. Analgesic drugs can help relieve pain.
It is also possible the appearance of vaginal discharge bloody nature, which is considered one of the manifestations of the norm. When this symptom occurs, it is recommended to refrain from intimate contact until the bleeding stops.
In the first few days after taking a biopsy, the patient must follow the medical recommendations:
- refrain from taking hot baths, visiting baths and saunas,
- stop using tampons,
- do not lift weights
- avoid excessive physical exertion.
Compliance with these simple rules significantly reduces the risk of complications and adverse reactions.
Interpretation of results
What does endometrial biopsy show? In the absence of pathological processes, it will be established that the endometrium is normal, without atypical manifestations.
In the presence of pathological changes, the diagnosis will allow to determine:
- endometrial hyperplasia,
- hypoplastic processes,
- atrophy of the mucous uterine layer,
- discrepancy between the thickness of the mucous layer and the current phase of the menstrual cycle,
- malignant degeneration of endometrial tissue.
Based on the results obtained, additional examinations are appointed or therapeutic measures are developed.
Endometrial biopsy is an important diagnostic procedure that allows you to identify a number of gynecological diseases, pathological changes of the uterine lining mucosa.
This diagnostic method has high informativity, and the use of modern techniques allows you to make the procedure as painless and safe as possible for women's health.
Nina, 42 years old
I had an endometrial biopsy for suspected hyperplasia. The procedure was performed by the method of Paypel. Very worried, but everything went quickly and did not even hurt. The result was ready soon, and I was able to quickly develop a treatment program.
Vladislav, 32 years
The doctor prescribed an endometrial biopsy during the preparation for IVF. I can not tell you how much I was worried and afraid.
The aspiration biopsy was completely painless, and I transferred it very well, without any consequences.
By the way, everything went well, my daughter soon turns a year!
Natalia, 39 years old
The endometrial biopsy procedure saved my life. A year ago, the monthly periods were long and very much abundant. Of course, I ran to the doctor. The doctor prescribed a biopsy after the gynecological examination and ultrasound.
Conducted the procedure without anesthesia, I myself wanted it. It was a little uncomfortable, but tolerable. Thanks to her, she was able to identify the development of oncology at the very initial stage and start treatment in a timely manner.
The effects of endometrial biopsy
After endometrial biopsy, nausea, dizziness, pain in the lower abdomen, discharge, small vaginal bleeding, and general weakness are possible.
All these symptoms usually go away within a few days.
The very process of endometrial biopsy takes from 5 to 20 minutes, and sensations during the procedure, some patients describe as strong spasms that accompany menstruation.
Doctors recommend to refrain from heavy physical labor and seek help in case of high temperature, heavy bleeding and pain, as well as the appearance of discharge with an unpleasant odor.
During endometrial biopsy, there is a certain risk of damage to the cervix, bleeding, and infection of the pelvic organs.
Endometrial Biopsy Types
In addition to the usual endometrial biopsy, which is inherently curettage of the uterus, today there are other ways to take a sample of the mucous membrane.
For example, pipe biopsy is less painless than regular curettage. The procedure is performed using a special tool, which is a flexible tube with a diameter of only 3 mm. The process itself takes less than a minute, and the results can be known after 7 days.
It is also widely used aspiration biopsy, which is usually carried out in diseases due to hormonal disorders. It uses a uterine syringe or electric suction, and the procedure itself takes place on an outpatient basis.
Endometrial biopsy is a common and, most importantly, effective way to diagnose disorders of the mucous membrane of the uterus.
Hysteroscopic examination with endometrial biopsy
Hysteroscopy is a diagnostic procedure that is performed to detect diseases of the uterus.
In addition to examining the uterine cavity, the study allows for small operations in its cavity and taking tissue for diagnosis.
Hysteroscopy with endometrial biopsy is often performed? What makes this study possible?
Purpose of biopsy
Endometrial biopsy is a study of the mucous layer of the uterus to identify the causes of infertility, hormonal disorders, mucosal hyperplasia, cancer, causes of uterine bleeding. Currently, the sampling of this layer for biopsy is indicated in preparing the patient for in vitro fertilization.
Classical scraping mucous
This type of procedure involves taking a biological sample with a surgical instrument. The specialist collects the top layer from the surface of the uterine cavity. The gynecologist can collect the material completely or make several scrapers - trains. The purpose of the event is a diagnostic study of the uterus and medical procedures.
Scraping is done in these situations:
- violation of the menstrual cycle,
- endometrial pathological changes,
- abundant or poor menstrual flow,
- the presence of intermenstrual discharge,
- diagnosis of cervical tumors,
- spontaneous abortion,
- no fetal movement.
If the procedure is carried out on time, the doctor will be able to establish the exact causes of the disease. In this case, proper treatment will be able to slow down the disease and heal the genital organ.
Aspirate biopsy with vacuum or aspirator
Aspiration biopsy is a more gentle method than scraping. It is not so traumatic, because it does not imply a strong expansion of the uterine canal. The risk of complications is significantly reduced. The event is carried out using a thin brown syringe or vacuum apparatus.
For women who have never had a child, the procedure may cause some discomfort. To reduce it, the doctor may suggest general anesthesia.
Aspirate biopsy is recommended for any uterine pathology, as well as for unreliable results of ultrasound examination, which needs to be clarified.
The advantages of the aspiration technique can be found in the video from the channel Medical Center.
The advantages and disadvantages of the research method
- the ability to diagnose endometrial cancers,
- doing scraping, the doctor can immediately eliminate the lesions of the pathological lesion.
- the procedure takes place in stationary conditions
- the introduction of anesthesia
- traumatic injuries
- the period of wound healing lasts at least a month,
- there is a risk of complications.
- fast recovery
- minimal inconvenience
- low risk of complications
- saving time and money
- patient reviews are only positive.
- a disadvantage of the procedure can be considered a smaller amount of aspirate,
- It is difficult to study the structure of the endometrium.
- can be done without anesthetic,
- harmless and painless biopsy method
- rapid healing of the fallopian tubes,
- rarely causes complications.
- it is difficult to study the constitution of the mucous membrane,
- It is possible to miss the foci of malignant diseases.
- the most harmless manipulation
- appointed for the diagnosis of hormonal disorders.
- It is not performed in the diagnosis of cancer and a precancerous condition.
- during the event, you can remove benign lesions,
- fast recovery
- high performance accuracy.
- anesthesia needed,
- high cost of operation.
Endometrial biopsy is prescribed in the following cases:
- unreasonable bleeding,
- hemorrhage after menopause,
- severe and prolonged bleeding during the cycle,
- hemorrhage after childbirth or abortion,
- bleeding after taking hormonal contraceptives,
- unreasonable absence of menstruation,
- diagnosis of infertility,
- surgical removal of various neoplasms,
- uterine fibroids,
- ovarian cyst,
- cervical occultology,
- in vitro fertilization (IVF).
Features of the biopsy:
- with concerns about cancer - any day of the menstrual cycle,
- if you suspect polyps or similar tumors - immediately after the end of the cycle,
- to establish the cause of non-cyclical bleeding - on the first menstrual day,
- with heavy monthly bleeding - a week after the completion of menstruation,
- in order to diagnose endometrial sensitivity to hormones - no earlier than two weeks later,
- with infertility - three days before the expected menstruation.
How is the procedure
The main stages of the operation:
- Treatment of external genital organs with a special antiseptic.
- Vaginal dilatation with a specialized surgical mirror.
- After access to the cervix, alcohol treatment is performed.
- The body is fixed with the help of bullet forceps.
- All further actions are carried out depending on the choice of biopsy technique.
The greatest experience in Russia in the surgical treatment of patients with chest deformities (VDGK, KDGK, Poland syndrome).
To date, the spinal surgeon Dr. Pekarsky is the most sought after in Israel. Dr. Pekarsky performed a successful spinal surgery of the figure skater Evgeny Plushenko - a video report of Channel 1.
Production of an individual implant depending on the degree of deformation. Reception is led by prof. Rudakov Sergey Sergeevich.
What is the endometrium, and what value does this tissue have in a woman's body? Endometrium is the tissue lining the uterus.
The tissue provides fixation of the ovum in the uterus and creates favorable conditions for the normal development of pregnancy.
It tends to reject, if during the period of the menstrual cycle fertilization did not occur. As a result of this process, menstrual bleeding occurs.
During the menstrual cycle, the endometrium passes through several phases:
- Stage of proliferation. At this phase, under the action of the hormone estrogen, a functional layer is formed. That is, that layer of cells, which was rejected as a result of menstruation, begins to recover and fully becomes full by the 14th day of the cycle.
- The secretory phase starts from the 15th day of the menstrual cycle and lasts until the 27th. During the secretory phase, a secret is secreted by the glands, which creates a “fertile soil” for implantation of the ovum in the uterus. This phase is regulated by the female sex hormone progesterone.
- Phase bleeding. It reduces the level of progesterone in the blood. As a result of hormonal deficiency in the endometrium, vascular changes occur, leading to cell death. The phase begins on the 28th day of the cycle and lasts about 4 days.
Cyclic changes in the endometrium
Indications for biopsy
Biopsy of the mucous layer has a clear indication of the purpose. These include:
- Prolonged and heavy menstrual bleeding.
- Lack of menstruation for no apparent reason.
- Complication of contraceptive therapy.
- Evaluation of the effectiveness of treatment with hormonal drugs.
- Uterine bleeding outside the cycle or after menopause.
- The presence of polyps in the uterus.
- Unsuccessful or low effectiveness of infertility treatment.
- Examination of the female reproductive system for polyposis of the uterus, ovarian cysts, endometriosis and other diseases.
- Postpartum hemorrhage or bleeding after abortion.
- The presence of tumors in the uterus and ovaries.
- Examination before in vitro fertilization.
Preparation for hysteroscopy
Before hysteroscopy, a woman must pass a variety of tests.
Before conducting a diagnostic procedure, a woman must be prepared.
To do this, the doctor prescribes the patient laboratory tests: a general analysis of urine and blood, biochemical examination of blood, analysis of coagulability, determination of microflora in the genital tract, blood for HIV, hemocontact hepatitis (B and C), syphilis.
In addition, the following recommendations should be made to the woman:
- 3-4 days before hysteroscopy exclude sexual contact.
- Do not use vaginal douching for a week before the test.
- Do not use creams, ointments, suppositories and solutions for vaginal use without the recommendation of a gynecologist.
- If it is planned to use general anesthesia during the procedure, it is necessary to exclude any food and liquid intake on the day of the study.
If the hysteroscopy is performed under general anesthesia, then the study should come on an empty stomach.
How is endometrial sampling performed using hysteroscopy?
- First conduct a gynecological examination of the patient with the help of tools and by manual examination.
- Anesthesia is then performed, which may be general, local or regional. The choice of anesthesia in each case is individual and is determined by the doctor.
- After anesthesia, the genital tract and cervix are treated.
- Extend the cervix to the desired size using special tools.
- A sterile solution of sodium chloride is injected into the uterus.
- After that, a hysteroscope is inserted and the uterus is inspected, determining the areas of material intake.
Women undergo hysteroscopy
- They take samples of tissue that are placed in a special container.
- Remove the solution from the uterus and remove the hysteroscope.
After the procedure, the material is sent for analysis to the laboratory.
In order to carry out a sampling of the mucous membrane, hysteroscopy is performed using an endoscope with a microscopic surgical tip.
Then the mucosal samples are sent to the laboratory, where they are dehydrated, reduced to a fat-soluble form and a paraffin cube is formed, containing endometrial cells. After that, the cube is cut into very thin plates, which are fixed on glass slides.
Doctors with special qualifications conduct an examination of the finished samples with the help of special equipment.
The study takes up to 10 days.
The conclusion is sent to the gynecologist, who, on the basis of clinical data and other studies, makes the final diagnosis.
Endometrium in the proliferation phase
What diseases are diagnosed using endometrial biopsy?
All pathologies that can be identified as a result of the study are divided into several groups:
- Hyperplastic disorders. This group of diseases includes: endometrial polyps, glandular hyperplastic process, glandular-cystic hyperplasia, atypical hyperplasia or a precancerous condition in the tissues of the uterus.
- Hypoplastic conditions: atrophic processes in the endometrium, endometritis on the background of hypoplasia (not performing its function in sufficient volume).
- Inflammatory diseases - acute and chronic endometritis.
- Cancer pathology - endometrial glandular cancer, squamous and undifferentiated cancer.
Biopsy of the mucous layer of the uterus today is a fairly informative study of the female reproductive system. Timely diagnosis helps prevent many diseases or prevent their development at an early stage.
Biopsy in gynecology
Thursday, March 3, 2016 - 12:20
Biopsy is a diagnostic method necessary in gynecology, which allows to determine the pathology at the cellular level.
Increasingly, experts refer patients to diagnostic methods such as cervical biopsy, endometrial aspiration biopsy. This is due to the spread of cancer pathology and the need for its exclusion, detection in the early stages.
The essence of the biopsy lies in the lifetime collection of cellular material (or tissue) for subsequent microscopic evaluation.
There are the following types of biopsy:
- puncture - the studied material is obtained by collecting a tissue column with a needle, can be carried out under the control of endoscopic techniques or ultrasound (targeted biopsy),
- aspiration - material is taken by an aspirator,
- incisional - a tissue site is obtained during surgery,
- excision - material sampling after surgery from the removed tissue.
Biopsy is a highly accurate diagnostic method.
It allows you to determine the cellular composition of tissues, which is necessary for the diagnosis of cancer as well as precancerous conditions.
This research method is usually complemented by others, allows you to determine the amount of necessary intervention and treatment tactics.
Indications for biopsy in gynecological practice are diagnostics, as well as differential diagnostics of the pathology of the external, internal genital organs, including diseases of the endometrium, cervix.
This method is carried out in cases of suspected precancerous conditions, malignant neoplasms of the cervix. Excision of its site is carried out with colposcopic examination. This allows you to carry out the procedure as accurately as possible.
The cervix is a narrow part of it, adjacent to the vagina.
A biopsy of the cervix consists in removing a small piece of it for subsequent histological examination.
Such a study is always carried out after a colposcopy, if the doctor suspects the presence of cervical pathology.
The cervix is distinguished by the absence of pain receptors, so the procedure is usually performed without anesthesia. The patient's pain threshold is of decisive importance, and the procedure is rather unpleasant, but not painful.
Endometrial Biopsy Species
Endometrium is the inner layer of the uterus, its mucous membrane, undergoing cyclical changes under the influence of female sex hormones. Its structure is different not only in different phases, but also on different days of the menstrual cycle. The pathology of the endocrine system, the ovaries, the uterus itself inevitably affects the structure of the mucous membrane, according to the characteristics of which the doctor judges the nature of the pathology.
"Get" endometrium can only penetrate into the uterus. In the first half of the last century, attempts to obtain a sample were accompanied by expansion of the cervical canal and scraping of the entire mucosa. Modern biopsy techniques imply low level of activity and low pain, as well as a low risk of complications, which allows to expand the indications for the study. The clinic uses several types of endometrial biopsy surgery:
- Classical scraping mucous,
- Aspirate biopsy with vacuum or aspirator,
- The endometrium biopsy is one of the least traumatic methods.
- ZUG biopsy,
- Sighting biopsy with hysteroscopy - allows you to get the tissue from the most modified areas of the endometrium, but has limited use due to the high cost of hysteroscopy itself and the lack of equipment in many hospitals.
The operation of collecting endometrial fragments is only the initial stage of the diagnostic search, because without microscopy it is impossible to determine which structural changes occur in the uterine lining. The exact answer will be given by the analysis of histological sections of the endometrium under a microscope.
Indications and contraindications for biopsy
Pathological examination of the uterine mucosa is performed on women of different ages, regardless of whether they have given birth to children or not yet. The reason for the procedure can be:
- Dysfunctional bleeding,
- Intense uterine bleeding or scanty menstruation,
- Amenorrhea (absence of menstruation) for an unknown reason (it is necessary to exclude pregnancy!)
- Possible tumor growth,
- Internal endometriosis,
- Suspected chronic inflammation in the lining of the uterus,
- Infertility to clarify the reason
- IVF planning,
- Miscarriages, the pathology of pregnancy for a small period (after medical abortion).
Contraindications for endometrial biopsy are:
- Pregnancy is an absolute contraindication to the study, since intervention into the uterus will provoke a miscarriage,
- Pathology of hemostasis due to the risk of bleeding,
- Treatment with anticoagulants and antiplatelet agents, anti-inflammatory drugs (require cancellation in advance),
- Severe anemia,
- Common infectious diseases (ARVI, intestinal infections, etc.),
- Acute or exacerbation of chronic infections of the genital tract,
- Allergy to anesthetics.
Since a biopsy is not performed for vital reasons, in the case of serious contraindications, it can be completely abandoned in favor of other, safer diagnostic methods. With relative obstacles, the doctor will try to choose the most optimal method of tissue sampling, excluding complications.
Preparation for the study
Preparing for endometrial biopsy includes general clinical tests (blood, urine), blood clotting, blood group and rhesus factor, HIV tests, hepatitis, syphilis. During a gynecological examination, the doctor takes smears from the cervix for cytology, for microflora from the vagina. If it is impossible to exclude pregnancy, a test for chorionic gonadotropin is carried out.
After passing the examinations and setting the date of the biopsy, the patient should refuse to have sex, douching, vaginal tampons 2 days before the procedure, 7–10 days the use of blood-thinning agents stops. If curettage under general anesthesia is planned, then the day before, at 6 pm, the ingestion of food and liquids stops.
On the morning of the study, the patient takes a shower, removes hair from the external genital tract, in the presence of varicose veins in the legs, the doctor may prescribe an elastic bandaging to prevent thromboembolic complications.
Biopsy during erosion
Erosion is a very common pathology of the cervix. Its detection requires caution and exclusion of oncological pathology.
Each patient must be aware that the cervical examination is not carried out "by eye", in mirrors, but only during colposcopy.
If a specialist has appointed a biopsy, you should definitely agree, because an incorrect or unspecified diagnosis can lead to ineffective treatment and development of cancer.
Biopsy allows to differentiate erosion from simple cell metaplasia and dysplasia.
After the procedure, bleeding is possible for several days, but they should not be too heavy, should not be accompanied by fever, severe abdominal pain.
Such symptoms require expert advice. In most cases, the biopsy is well tolerated by patients.
Causes of endometrial disease
The most common diseases of the endometrium are caused by the following reasons:
- The inflammatory process (endometritis) - may be due to bacterial, viral, parasitic, fungal, mycoplasmal, protozoal and other infections, and often has a chronic nature,
- Hormonal disorders - hyperplasia (excessive growth) of the endometrium or polyps (focal growths) of the endometrium,
- Endometrial injury - during curettage of the uterine cavity can lead to the formation of intrauterine adhesions or atrophic processes.
Endometrial pathologies can lead to violations of the menstrual cycle, embryo implantation process, spontaneous abortion, formation of placental insufficiency, infertility.
Timely diagnosis of endometrial diseases is necessary in the comprehensive diagnosis of menstrual disorders, reproductive problems and the treatment of infertility.
Hysteroscopy and endometrial biopsy before IVF
Histological examination - microscopy of uterine mucous membrane samples - is the main method for assessing the state of the endometrium.
In some cases, a histological examination may be accompanied by the use of immuno-histochemical methods, allowing to determine the autoimmune nature of the endometrial lesion, impaired receptor function.
To obtain endometrial specimens, a biopsy procedure is used. Endometrial biopsy can be performed during hysteroscopy or by endometrial aspiration using special instruments.
Endometrial biopsy is advisable to use:
- if you suspect endometrial hyperplasia by ultrasound,
- to assess the state of the endometrium in the presence of recurrent miscarriage and implantation failures in ART programs,
- as a control after previously performed hysteroscopy and subsequent treatment.
Diagnostic hysteroscopy and endometrial biopsy are also carried out in preparation for IVF. These procedures allow you to identify the causes of infertility, the causes of uterine bleeding, as well as eliminate cancer tumors, if there is suspicion of a tumor process.
Peipel biopsy before IVF is performed on an outpatient basis. The procedure allows you to explore the inner lining of the uterus without expanding the cervical canal. Therefore, it is painless and less traumatic for the patient, has a very low risk of complications.
Peipel endometrial biopsy before IVF helps to avoid difficulties during the period of embryo transfer.
Hysteroscopy with IVF
Endometrial hysteroscopy before IVF allows you to give additional information about the state of the endometrium, increase the effectiveness of the protocol, determine the treatment tactics and protocol scheme.
The procedure allows you to promptly identify and cure diseases that interfere with the successful attachment of the ovum and its bearing. Therefore, hysteroscopy is performed before IVF. Hysteroscopy before IVF increases the chances of a successful outcome of fertilization.
In the case of an unsuccessful protocol - hysteroscopy for IVF is not the only, but the most important procedure.
Diagnostic hysteroscopy before IVF is of a diagnostic nature and cannot cure the disease. It is carried out on the 7-10 day of the cycle.
It is these days that the walls of the uterus are the thinnest.
With the help of a special hysteroscope device, at the end of which there is a LED, you can see the walls of the uterus from the inside and assess the condition of the endometrium.
Hysteroscopy with RDV before IVF
Hysteroscopy with separate diagnostic curettage (RDV) allows you to remove polyps of the uterine mucosa, stop uterine bleeding, remove the mucous membrane with endometritis, dissect uterine synechia. Hysteroscopy with ERA before IVF improves diagnostic accuracy and is more effective than hysterosalpingography.
IVF after hysteroscopy
The timing of IVF after hysteroscopy depends on the results obtained during the survey.
Someone needs to undergo a course of hormonal treatment, someone anti-inflammatory therapy, someone just wait for the time after the operation.
It is possible to carry out an IVF program in the period from 10 days from the time of the hysteroscopy to 6 months. Sometimes, after the treatment, the procedure is repeated.
Unfortunately, not all women are helped by hysteroscopy and IVF will not bring success, because besides uterine developmental abnormalities, there are a number of pathologies leading to infertility.
Uterine Endometrial Biopsy Results
As a rule, endometrial biopsy is performed in the second phase of the menstrual cycle, approximately 21-23 days.
For an aspiration biopsy, you must have blood test results for:
- Hepatitis B and C
- smear on flora from the cervical canal without signs of inflammation.
For detection of endometrial diseases, uterine ultrasound and hysterosalpingography are used as preliminary methods.
Make a final diagnosis and, if necessary, carry out surgical treatment and remove all pathological changes, such as polyps, myoma, etc.
allows only hysteroscopy, in which the uterus and the fallopian tubes are inspected from the inside with a thin flexible or rigid hysteroscope.
During a biopsy, a thin catheter is inserted into the uterine cavity, through which a piece of endometrial tissue is taken for histological examination.
This procedure is practically painless and may be accompanied by a slight sensation of stifling in the lower abdomen or in the lower back.
After a biopsy, blood smearing from the vagina is possible for 1-2 days.
Examination of the endometrial tissue under a microscope allows you to accurately establish the diagnosis and prescribe treatment.
The main complication of endometrial biopsy may be the interruption in the early stages of an already occurring but not yet revealed pregnancy.