Good morning, @suesam

It already sounds as if you've "got" this. Good for you for reaching out for support! I'm sharing about my experience and what helped in case any of it might help you feel less afraid or more ready to cope.

I had an endometrial biopsy in 12/21 when I sought care for very light post-menopausal bleeding. I had no other symptoms, but knew this was something to ask about. My PCP sent me straight to an OB/GYN because of GYN cancer history in my immediate family.

I was a bit nervous about whether the (likely) procedure would be painful, so asked a sister for her advice, and she told me to take plenty of ibuprofen an hour before the visit. Well, I forgot to do that until I was in the exam room (and the whole thing was over before I'd even digested the capsule). A transvaginal ultrasound at the same appointment showed a 7mm thickness of the endometrial lining. The biopsy was what I would call "fairly uncomfortable" and was over in 5-10 minutes. The clamp on my cervix was uncomfortable (3-4/10), the insertion of the tube was slightly uncomfortable (1-2/10) and the 3 scrapes of the inside of my uterus made me want to squirm (4-6/10). I used long, slow out-breaths to get through that. Again, it was over quickly. I had a tiny bit of spotting after, and very, very mild cramping during a long drive home over mountains (this was the only available GYN I could locate during the pandemic and was on the other side of the state). My biggest complaint was that my husband (who had come along for support) and the GYN kept up a steady stream of conversation (thanks, dh) throughout, so I was sort of alone in managing those moments. Needless to say, we both learned a lot during that visit regarding what I need for support.

I am being very specific about the experience. I do not believe that I had any analgesia on board during the entire procedure. If I had to do it again without pain relief, I would. The information (at the time) that there was no cancer was a huge relief. It was not until a year later that I had a second experience of bleeding, after which a hysteroscopy revealed endometrial adenocarcinoma, State 1a, FIGO 1.

As you have written, the value of an earliest possible diagnosis, if there is cancer, is huge.
I like that your PCP has given you the vaginal inserts, which should make the exam much more comfortable, as your tissue will be more pliable and moist for insertion of the speculum.

I DO agree with you taking some kind of NSAID ahead of time. If you take it 1/2 hour prior to your appointment, you should be well-within the window of its maximum effectiveness when the procedure takes place.

Other, non-medicinal strategies that have helped me with pain:

-A hand to hold or squeeze would be nice.

-Asking ahead of time for quiet (or music).

-Telling the doctor what I might do to manage discomfort so they recognize that I'm in pain if I do those things.

-Long, slow outbreaths were my best friend in those moments.

-I could tell myself, "This is a moment. It will be over soon. I think I can tolerate this for a while longer."

-Another strategy that has helped me with pain is to mindfully scan my body to locate a part that is NOT experiencing pain. This could be an earlobe, a toe, a finger tip, or whatever you find. Then I shift my attention back and forth between the location of any pain and the location without pain, focusing on how my body tells me that it is not in pain...relaxed, soft to touch, cool/warm to touch, how much easier it is to breathe when I focus on that non-painful part, etc. I can go back and forth as needed. Noticing the pain and then shifting my attention away from it reduces my experience of pain.

-I can sing in my head or out loud, pray, or give my thinking brain a job that keeps it busy.

-Counting the length of my in-breaths and out-breaths helps me to focus there instead of on the painful part.

I will be keeping you in my thoughts, @suesam, hoping you get through this with a minimum of discomfort and receive good news as a result of your courage and tolerance. We're all here whatever unfolds.