Endometrial Biopsy (EMB)

 

What is an endometrial biopsy and why is it needed?

The endometrial biopsy is used to "date" the lining to see if it is out of sync hormonally. It is considered out of phase if it the lining appears to be more than 2 days off. It is common to repeat the biopsy in another cycle, if it is found to be out of phase, before a diagnosis of a luteal phase defect is made. These tests are somewhat insensitive and I was told "about as good as the pathologist reading it."

The biopsy is performed in the second half of the cycle, usually just a few days before menstruation is expected. It can be done in the same cycle as one in which you are trying to get pregnant because the risk of miscarriage from the biopsy is only about 1% (combine that with your chances of getting pregnant in a given cycle and there isn't much to worry about at all).

The biopsy is done by inserting a narrow catheter through the cervix and into the uterus. A small sample of tissue is sucked into the tube and sent to the lab for analysis. Expect a bit of discomfort with this test -- about the same as a bad menstrual cramp. The biopsy doesn't take long, and the pain usually subsides when the procedure ends. You may have some spotting afterward.

Some suggest taking Advil or Aleve about a half hour before the test to relieve discomfort. Check with your doctor first, since this may not be recommended during a cycle in which you are trying to get pregnant. My own experience is that the pain relievers didn't make any difference.

What should I expect when I have an endometrial biopsy? How will it feel?

I've had an EMB at the end of each of my last two cycles.

The first one was OK. It hurt about the same as a bad menstrual cramp while the tissue was being taken, but it was over very quickly. Afterward I felt back to normal pretty much immediately, other than sort of a heightened sensation of my cervix. That may sound strange, but that's the best way I can think of describing it. I didn't take any painkillers. A few hours later I did get about 4-5 rapid twinges, but that's about it. I spotted for maybe 6 hours. The blood you see is often from the clamp, not the biopsy.

For the one I had two weeks ago, I took 800 mg of Advil. It didn't work because this biopsy was more painful. I think it was worse because it took a little longer -- the doctor was on vacation and came in just to do this test, sans nurse, so no one handing him tools. Again the cramps ended immediately after the catheter was removed and I got up and went out to lunch with my DH. The only spotting I had was wiped away after my first urination. The next day I was driving back roads and bumping around a lot and noticed lower back pains and a little heaviness in my abdomen. I was sort of blaming it on the EMB, but it retrospect it seems like PMS. I got my period 4 days early, and the doctor felt it was probably because of the EMB and all my activity. I also had a little brown spotting before each period which I have never done before, nor since.

I'm in Chesapeake, had my biopsy done in the office. The whole procedure took about as long as a normal vaginal exam. Depending on if your doctor numbs your cervix or not with some spray Lidocaine and depending on how bad you feel when you cramp are going to be big factors. I cramp like a son of a gun, but I took some of my cramping medicine about an hour before the test. The test was not comfortable, but it was quick and just gave me a mild crampy feeling on the way home. I took a nap and took it easy that day, because it felt like I could feel a sore inside near my cervix...from where he held onto it with the clamp. I spotted a little from where the biopsy was taken, but felt completely normal by the next day. All and all, I put a lot more worry into it than I needed too. I'm a wuss when it comes to pain. I'm a nurse but I hate needles...now I'm on day 6 of my IVF cycle and getting three needles a day. Ack! I can't believe I'm not totally freaked out yet.

At least I haven't passed out!

I have had a few of those EMB's done too. And I wanted to suggest that when they tell you to stay on the table and relax for a couple of minutes to take their suggestion! On my first I tried to get up too quick and felt "lightheaded" but before I scare everyone I want to let you know that I also get faint when they take blood, some of us are just blessed with this "reflex", I am not afraid of needles or anything (you get over a lot of this during infertility treatment don't you?). My RE said it is not that uncommon, maybe he was just trying to make me feel better :)

By the way they have never particularly hurt me, one quick cramp and it is over.

I had mine today. No painkillers, very nervous, but it was an unpleasant minute when the doctor put the catheter in, and after that it was all right. I sat with a hot bottle on my belly for two hours after, but that was more because I liked it than because I needed it. I had worse periods!

(The Netherlands)

My test was very painful. I was told that it wouldn't be too bad and that I should take a painkiller ahead of time. I forgot and really paid for it. It was all over fairly quickly and I thought I was fine (though I felt pain and I could feel that I was bleeding). I went to sit up and got really sick. I threw up and was very near fainting. I have a huge problem with needles and this was my reaction to this test was just as bad. The next day I was still feeling a bit of pain but the bleeding eventually stopped on that day. I would highly suggest the painkillers ahead of time and take someone with you to drive home just in case.

How does an endometrial biopsy compare to a hysterosalpingogram?
Which one is more uncomfortable?

I understood that it is different for each woman (both EMB and HSG). For some EMB is very painful and HSG is hardly felt, for others it is the other way around. For me, the EMB felt like one cramp (short, not nice but not to bad either) and I was fine afterwards.

For the HSG I took a painkiller (I asked my RE for one). They use a different sort of speculum, a tiny bit more uncomfortable than the normal one (it is more like a circle than a duck's beak). Than they put a plastic cub on your uterusmouth. That is a rather nasty feeling, and you will keep feeling that as long as it is there. Attached to it is a tube, and the send the dye true that one. Since that can be painful for some they will try to do it as slowly as possible. To me they said that if I felt a real pain I should warn them and they would stop a minute or go more slowly. This part will take approximately 10 minute (It took less for me, it can take a bit more for others).

Afterwards they told me to walk, to make sure that the dye wouldn't linger. I had to come back after 15 minutes and they would take a final picture to check.

I had mine done around three in the afternoon, and felt like I had a bad period the rest of the day. The next day I felt sort-of "bruised" inside, so I didn't want to hop around to much. Today (2 days later) I feel nothing anymore.

All in all it wasn't a ball, but I could do it again. I hope this gives you sort of a feel of what it can be like, but you shouldn't forget that it is different for each individual.

(The Netherlands)

I also experienced very bad pain with the HSG. I was really worried about the EMB as well, but it was definitely not as painful as the HSG. I've heard you should take a couple of Advils before the procedure since you will experience minor cramping and spotting. Also, my gyno didn't get back to me for a week with the results (just so you're not expecting anything right away)

The HSG is a hundred times worse. For me, the biopsy was painful for just a minute (and not nearly intense as HSG).

If you take three Aleve or four Motrin one hour before the biopsy it helps a lot. I just did it and it was way better than the first time without. It is uncomfortable, more for some and less for others.

Ah, but for me the endo biopsy was the absolute worst thing as far as testing goes, and my first HSG went so well, I asked for the second one (one year later, a miscarriage and a laparotomy happened in that year). The endo biopsy however caused me to pass out on the table, and I bled pretty good for about a day, and the cramping was so bad on the way home, I almost called my husband to come get me, but since my Doctor was an hour and a half away from home at that point, I figured I would be better off getting home as soon as possible. But the good news, is that is very rare, and has to do with some people having more sensitive nerves than other and I tend to get dizzy from just about anything that causes a nerve to be hit, even if it didn't hurt that much (quite similar to the funny bone effect - but in my whole body).

Now I can actually compare the two because I had my HSG on Wednesday. I see that most of the posts come down on the side of the HSG being worse, but it wasn't for me. I think they are different, for one thing, so a bit hard to compare.

My experience was a very bad pain for a very short time with and EMB, but a milder, longer-lasting pain with the HSG that was pretty unpleasant but not as "painful". I think it took a little longer to get over the HSG too, in that standing up for me brought on renewed cramping, but still nothing that bad. To me it felt more like the beginning of a period, while an EMB is probably more like the worst cramp of a period, but probably somewhat more painful than that.