Endometrial Biopsy: Why It’s Done and What to Expect
If you’ve just been told you need an endometrial biopsy, you might be feeling a mix of confusion, anxiety, and curiosity. That’s completely normal. This procedure can sound intimidating, and for some people it’s genuinely uncomfortable. Understanding what’s happening, why it’s being done, and what to expect can help you feel a little more in control when it’s time for your appointment.
Why It’s Done
An endometrial biopsy is when a small sample of tissue is taken from the lining of your uterus (the endometrium) so it can be examined under a microscope.
It’s typically done to:
- Evaluate abnormal bleeding and make sure it isn’t caused by precancerous changes (hyperplasia) or cancer
- Assess how the uterine lining responds to hormones as part of treatment or follow-up care
- Help investigate infertility issues
- Rarely, to check for infection or inflammation inside the uterus
You can think of it like taking a tiny sample of the wallpaper inside your uterus to see what pattern is forming there. It’s quick, but it can give your doctor valuable information about what’s really going on.
What Actually Happens
1. Pregnancy test: If you’re still in your reproductive years, you’ll usually have a quick urine pregnancy test before the procedure.
2. Positioning: You’ll lie on the exam table with your feet in the footrests, just like for a Pap smear.
3. Speculum: The provider gently inserts a speculum to visualize the cervix.
4. Cleaning: The cervix is cleansed with an antiseptic solution to reduce infection risk.
5. Numbing (optional but encouraged): Numbing medicine may be applied or injected into the cervix (more on this below).
6. Stabilizing the cervix: An instrument is used to hold the cervix steady while the sampling tool is passed through. This can cause a sharp cramp for some people, but numbing can help reduce this.
7. Sampling: A thin, plastic, straw-like tube called a pipelle is inserted through the cervix into the uterus (nothing metal or sharp goes inside the uterus). The provider applies suction and moves the pipelle in and out to collect tissue from the uterine lining.
*Sometimes this can be done in one pass, but other times it may need to be repeated to get enough tissue for testing*
8. Completion: After sampling, medicine may be applied to control any bleeding, and then all instruments are removed.
9. Results: The sample is sent to a pathologist for analysis. Results can take anywhere from a few days to a few weeks, depending on the facility.
How Long Will It Take
It depends on a few things. In the best-case scenario — a normal-sized uterus with a slightly open cervix — the biopsy itself can take anywhere from two to five minutes. But a few factors can stretch that timeline:
- A closed or tight cervix (cervical stenosis), which is more common after menopause, in people who’ve had prior cervical procedures, or who’ve never been pregnant
- A large or tilted uterus, especially if you have fibroids or endometriosis
- Anxious or tense pelvic muscles, which can make insertion harder (and is totally normal)
- Needing multiple passes to get enough tissue for analysis
Even with those variables, the whole procedure is usually done in under 15 minutes.
Does It Hurt?
Here’s the honest version: it depends.
Some patients describe it as minimal to mild cramps that are very tolerable. Others say it feels like more intense period cramps. And a small number find it very painful, akin to labor contractions.
For most people, the worst pain happens during the actual sampling, but for some, cramping and discomfort can linger afterward for hours to days. This wide variation makes it hard to predict how any individual person will respond. The difference often comes down to anatomy, existing uterine conditions, personal pain sensitivity, and whether - and what kind of - numbing or pain medicine is used.
And just to be clear, if it’s awful for you, that doesn’t mean you’re “bad with pain.” Your body is reacting to something invasive and intimate. You deserve comfort and control during any procedure.
How to Decrease Pain
- Take an NSAID: Use naproxen (Aleve) or ibuprofen (Advil) 30–60 minutes before your appointment. These can help reduce cramping and inflammation.
- Ask for numbing medicine: This can be applied directly to or injected into the cervix. Some providers can even use the sampling straw to place numbing gel inside the uterus.
- Ask about prescription medication: If you know ahead of time that you’re sensitive to pain or anxiety, you can request a one-time dose of narcotic pain medicine or an anxiety medication. These usually need to be prescribed in advance, picked up from your pharmacy, and taken shortly before your appointment.
- Bring comfort tools: Deep breathing, music, or having a trusted support person can also help you relax during the procedure.
- Take time afterward: Don’t be afraid to ask for the day off work. This is a medical procedure, and you deserve time to rest and recover.
Can I Get Anesthesia?
Let’s not beat around the bush. If men were getting their prostates biopsied, one hundred percent of them would be put to sleep for it.
So why isn’t that standard for women? There are a few reasons, but none that make it less valid to want pain control. For too long, women’s pain has been underestimated or brushed aside. We stand with patients and physicians who are pushing for better access to anesthesia and pain management during procedures like this.
In most clinics, sedation isn’t routinely available because it requires specialized staff - typically an anesthesiologist or specially trained nurses - to manage safety in case of an emergency. Going to the operating room is always an option, but it usually needs insurance approval and can come with a higher co-pay because it’s billed more like outpatient surgery.
Despite these barriers, you should feel completely comfortable voicing your concerns and preferences. If you want to be asleep for your biopsy, that’s a legitimate option - and one your doctor should be willing to discuss with you.
Risks
Like any medical procedure, an endometrial biopsy comes with a few possible risks. Most are minor and temporary, and serious complications are very rare.
- Cramping and light bleeding for a few days afterward are common.
- Infections are rare but can occur (look out for fever, worsening pain, or foul-smelling discharge).
- Not getting enough tissue for diagnosis sometimes happens, meaning the test may need to be repeated or done under different conditions.
- Heavier bleeding is uncommon but should be reported to your doctor.
- Fainting or dizziness can occur briefly during or after the procedure.
- Uterine perforation (a small hole made in the uterus) is extremely rare but can happen with any instrument inserted into the uterus.
Serious complications are rare, and most people recover completely within a few days.
What to Expect After
Mild cramping or light bleeding for a few days is normal. Avoid sex for 24 hours, and use pads instead of tampons if you’re still spotting.
Call your doctor if bleeding is heavy (soaking a pad in under an hour) or if you develop fever, chills, or worsening pain.
The Bottom Line
An endometrial biopsy isn’t fun, but it’s a quick and valuable way to understand what’s happening inside your uterus. Ask for comfort measures, advocate for your pain control, and give yourself permission to rest afterward. Getting answers doesn’t make you fragile — it makes you proactive.
