Endometrial Biopsy: I’m terrified, what can I expect?

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.

Perhaps you could ask for a paracervical block? I did, and other than the little pinch of the needle from the block.I felt no pain.

I had no gyne symptoms whatsoever, but urologist recommended a vaginal and pelvic ultrasound and found that my endometrial lining was 14. Then, went on to do a PAP, which was positive. D&C was scheduled right away to do the various biopsies. The gyne recommended general sedation because it is painful and the procedure would be longer than a typical biopsy of the uterus. I did not have any significant pain afterwards except for some soreness in the abdomen and spotting for about 6 days.

Thanks, Topsz. My doctor did offer to send me to a gynecologist but I'll let him give it a try. I'm much calmer now. I had landed in the ER and they found nothing suspicious in my CT scan and ultrasound except that thickness in my endometrium. I was just startled at the biopsy - since I have no symptoms and my thickness is a 6, I figured they'd just monitor it. And my doctor gave me ways to help with the pain, so I'm okay. I think I was just focused on the pain to avoid thinking of cancer, but I need to do this to rule it out. Thanks. I appreciate your thoughts and advice.

Not to get your business but an obgyn would have so much more experience doing this procedure. All I took was a couple of naproxen one hour before the procedure. Just a thought! You got this!

Hi Helen,

It's actually my family doctor, not the gynecologist, who is doing the biopsy. He offered to send me to one, but said he could do it. A friend of mine thought he was cruel to mention it would be painful but I didn't feel that at all. He was preparing me by asking me to take the vagifem tablets for a month and advil before I come in, to help me. My friend kept going on and on about how cruel my doctor was to say that, but he's always been kind and gentle with me and I just thought he was stating a reality and trying to help me. The ER was very thorough with blood work, urine testing, a CT scan and an ultrasound but couldn't find the source of the pain. There were no masses or anything in my abdomen and pelvis. My family doctor thinks it might be IBS because I've had this pain in the past when I'm stressed. The biopsy is scheduled for 1:00 on Jan. 20th. Thanks for listening.

@suesam I am tagging a few of our members who have had endometrial biopsies.
@gynosaur42 @bethmcbab @idaho1960 I am hopeful that they can fill you in on their experiences.

Thank you for your reply. It's good to know that the CT and ultrasound did not show anything other than some thickness in the endometrium. It's also great that your gynecologist is following up and then on (or after) January 20 you will have more information.

Did the visit to the ER result in a diagnosis for the abdominal pain?

Thanks, Helen. I really should know better than to do a search and see such horrendous acct's of the biopsy. I understand people feel pain in varying degrees, and I'm not knocking their experiences, but I wish I never read them. It just scared me more. I landed in the ER last week with abdominal pain, so that's why I know my CT scan and ultra sound showed nothing but a mild thickness. I need to keep my research on reliable sites like you said. I had a hysteroscopy a few years back and found it just fine. My doctor wants to do the biopsy to be safe. I guess he was telling me that it was painful to tell me the truth and he's trying to prepare me the best he can. I guess the worst case scenario is that we can't get it done and I'll be sent somewhere for some sedation. The date is on Jan 20. He wanted to wait until then to do the pap smear and biopsy all at once - to get it over with. I don't mind some pain and I know it's a fast procedure and I know I need to do this because catching endometrial cancer in an early stage is key. I just was shocked. I have no signs of bleeding and my thickness is mild - a 6 - so I wasn't prepared to have a biopsy. Anyhow, thanks for listening. And thanks for responding.

Thanks Topsz, for sharing. That is good news - that it doesn't last too long. Thank you.

@suesam Welcome to Mayo Clinic Connect. Many the members of our Gynecological Cancers support group have had endometrial biopsies. This is a good place to talk about what’s involved and get some advice and support.

I did not have an endometrial biopsy so I cannot comment on that. Based on my ultrasound and recommendations from the radiologist who read the ultrasound my gynecologist went straight to hysteroscopy and a D &C while I was under sedation.

You may have already read this. When I do research on the internet I look for and read reliable and valid information that comes from places like Mayo Clinic or Cleveland Clinic or from .gov websites that come from the National Institutes of Health. Here is what Cleveland Clinic has on endometrial biopsy:

— https://my.clevelandclinic.org/health/diagnostics/15676-endometrial-biopsy

I hope your results are negative. What is the scheduled date for the endometrial biopsy?