I have an endometrial biopsy soon. What can I expect in terms of pain?

Hi @lexcampanella, I wanted to ask if your gynecologist can provide sedation for the biopsy. It's quite painful, and some doctors only recommend taking Tylenol, which often isn’t sufficient. In my opinion, you wouldn’t want to be awake during this procedure.

@lexcampanella Welcome to Mayo Clinic Connect and to our Gynecological Cancers Support Group.

There is an ongoing discussion about endometrial biopsies in our support group. If you haven't reviewed this Discussion already I think you will find a lot of information from our members:
https://connect.mayoclinic.org/discussion/biopsy-3/?pg=3#chv4-comment-stream-header
From everything I have read and the learned here in our support group there is a range of pain levels that women experience when they have an endometrial biopsy. No one in the Discussion I copied above wrote that they were offered sedation. I think it would be wise to discuss this ahead of time with your doctor who will be performed the endometrial biopsy.

If a phone call is not immediately successful does your doctor use a patient portal for communication?

Hello, @lexcampanella, @heather2025 and @naturegirl5, Helen,

I agree with Helen that the discussion she referenced is quite in-depth and worth referring to if you have the time and energy. Everyone's experience of pain is unique, so it's a bit difficult to imagine what your experience might be, although you already know that a colposcopy has been painful enough that you might have wanted sedation. That might be enough information for you to let your medical team know that your previous experience informs you that you want to explore further options for pain management during the procedure.

I am not sure I can separate out pain due to the colposcopy from any additional pain due to the biopsy, but will try in case it's useful to someone. A sister had recommended ibuprofen half an hour prior to the procedure, but I forgot to take it until I was in the exam room, so popped it then. The procedure happened right after, so I am sure that was not in my system by then. I remember clearly that the clamp they use to stabilize the cervix while inserting the vacuum tube for the biopsy, called a tenaculum, was VERY uncomfortable for me, especially at first, but I tolerated it (what else are you going to do when flipped like a turtle on its back and someone has your cervix in a clamp?!). I also remember sensing the scraping of the inside of my uterus, gasping, (then attempting to make my outbreath longer than my inbreath so my body would relax a bit, which DID help a bit) and grabbing the sides of the exam table to brace myself. The sensation was "gritty" and somewhat intensely painful, but in a diffuse way that I couldn't specifically locate. Time seemed to stretch out, such that what was a blip to those others in the room felt like a long time to me. I can't say whether my perception of that as painful was due to the cutting away of tissue or just the deeply unfamiliar sensation being alarming. The next time I had to have an endometrial biopsy a year later, my doctor recommended and scheduled it for in the hospital, where I was anaesthetized. Much more complicated, understandably, and costly, but TOTALLY easier on my system from the standpoint of any pain of the actual procedure. All of my discomfort surrounded the search for my vein after being NPO since midnight and driving there in cold weather so my blood vessels had retreated from the surface of my arms. I had the most minimal cramping afterward, took it easy the rest of the day, and returned to work the next morning.

There was an article/opinion piece in the New York Times entitled, What Women Endure, published 7/30/23. I can't easily access it to share a link, but you may be able to find it. It talks about a significant proportion of medical providers underestimating the pain that may be associated with GYN-related procedures, dismissing their patients' reports of higher levels of pain by saying something to the effect that "most women feel a bit of discomfort that OTC pain relievers can address," or denying their requests for additional pain management. The bottom line for me in reading that back then (only months after I'd gone through each of these) was that women need to be strong self-advocates and that the medical community needs to wake up, take their patients seriously when they report pain or anxiety about the possibility of pain, and work with them respectfully to find a pain management plan that allows them to enter such procedures feeling as safe as possible and confident that they will not be left to endure overwhelming pain if it occurs.

I have a sense that people become doctors because they want to heal people's pain. That does not mean that all of them can tolerate thinking about your pain talking about yours with you. If they let their empathy guide them, they might not get inured to seeing their patients' expressions of discomfort, and would be less able to focus on doing the procedure as effectively and as safely as possible. I would much prefer that the person performing the procedure (or another member of the team) were able to say, "this could be moderately to quite painful, or may be a non-issue for you...how can we support you to feel as safe and comfortable as possible during the procedure? How should we respond if you find yourself in more pain than you expected and have difficulty tolerating it?"

All this to say that I encourage you (or someone willing to advocate for you) to initiate such a discussion with your provider as soon as you can, if you are up to it.

I got through the "discomfort" of the un-medicated procedure and sailed through the sedated one. In the long run, neither endometrial biopsy was highly traumatic for me, but the experience of the painful one lingered for a while. But if I still had a uterus and an endometrial biopsy was recommended for me again, I would be having that discussion.

With my best wishes for a comfortable-enough experience and results that bring you complete relief or at least clarity and hope,

Gynasaur

Hurt like heck. I almost passed out. Threw up. Had to stay in the exam room for 30 mins afterwards in order to recuperate enough to stand up.
I had 6 weeks of cramping.
For reference, I had 2 vaginal deliveries without epidurals.
Before the procedure, they told me I would be able to drive home. Haha
I am pretty bitter about it.

BUT there are women who do not have a bad experience. I don't know why there is so much variation.
I hope yours goes well!