Paypel endometrial biopsy - how and why an aspirate is taken from the uterus. Aspiration and paypel biopsy of the endometrial layer Paypel biopsy with histological examination of the endometrium

Women, due to the structure of their body, often have to undergo a variety of studies. A representative of the weaker sex should visit a gynecologist regularly. Doctors talk about annual visits to the doctor in the absence of any complaints. If there are symptoms of a pathology, then you need to contact a specialist as soon as possible.

Gynecologists often prescribe to patients such studies as hysteroscopy, colposcopy, ultrasound diagnostics, and so on. Endometrial biopsy has become very popular in recent years. Consequences, reviews of diagnostic manipulation will be presented to your attention in the article. You will learn the features of the procedure. You can also find out why a pipel biopsy of the endometrium is done.

What it is

Endometrial biopsy is a diagnostic operation that allows you to examine the inner lining of the uterus without the need to expand the cervical canal. The patient practically does not feel any discomfort at the time of sampling. This allows you to refuse the use of anesthetics and narcotic drugs.

The endometrial aspiration pipel biopsy bears the name of the person who discovered it. It is carried out using the thinnest tube, which has a diameter of 2.3 or 4 millimeters. Inside this tool is hollow, which allows you to take the material.

When to Diagnose

In recent years, this type of diagnosis has been increasingly prescribed to patients. The main indications of such a study include:

infertility of an unclear nature;
irregular cycle of menstruation;
bleeding due to the use of hormonal drugs;
suspicion of acute or chronic endometritis;
lack of menstruation at the right time;
period of menopause;
polyps and fibroids in the cavity of the reproductive organ;
preparation for surgery and so on.

Sometimes a pipel biopsy of the endometrium is prescribed before IVF. This type of study eliminates possible difficulties during the implantation of the fetal egg and increases the likelihood of a positive result.

Contraindications for surgery

Like any intervention in the patient's body, endometrial biopsy has its limitations and contraindications. These include:

the presence of pregnancy, including the development outside the uterine cavity;
inflammatory diseases of the pelvic organs;
infection in the vagina;
low pain threshold (need anesthesia);
defects in the development of the uterus (partitions, adhesions, and so on).

In each individual case, there may be additional contraindications. Before manipulation, the patient is always examined by specialists and they make their conclusion.

Study preparation

The sampling of material is always carried out within the walls of the hospital. Before manipulation, the patient is offered to take an anesthetic and a sedative. However, in most cases this is not necessary. Anesthesia is required only with a low pain threshold and the use of a pipe with a diameter of more than four millimeters.

Are there any special conditions for a procedure called an endometrial biopsy? On what day of the cycle should the sample be taken? It all depends on the purpose of the research. If a woman is of reproductive age and has a relatively stable cycle, then the procedure is performed from 20 to 25 days from the start of menstruation. Representatives of the weaker sex during menopause can be assigned a study at absolutely any time.

In preparation for the in vitro fertilization procedure, manipulation is prescribed one cycle before the use of hormonal drugs. It is worth noting that you need to cancel all medications that can affect the condition of the endometrium. These include hormones, antibiotics, chemotherapy drugs, and so on. In exceptional cases, the study is carried out directly during treatment.

How is an endometrial biopsy performed?

The material is taken by an experienced doctor on a gynecological chair. Before the procedure, the woman must carry out hygiene procedures and undress. Further, the patient is located on the chair, and the doctor begins the manipulation.

A dilator with a mirror is inserted into the vagina of the fairer sex. With it, the cervix is fixed in a fixed position. After that, the specialist needs to know the size of the reproductive organ. For this, a special measuring device is used. It is carefully inserted into the cervical canal until it stops. After that, the doctor selects a suitable size pipel and proceeds to the procedure.

The doctor takes a suction tube and gently inserts it into the cervical canal. It is worth noting that the device should not rest against the bottom of the uterus. Otherwise, it may be damaged. When the tube is inserted to the desired depth, the doctor pulls the piston from the outer end of the device. At this point, negative pressure is created in the uterus. Particles of the endometrium with some areas enter the tube and remain there even after extraction. The next step, the doctor must carefully remove the pipel from the patient's cervical canal. After that, the resulting material is applied to sterile glass and sent for research.

Opinions of doctors and patients about manipulation

Paypel endometrial biopsy reviews are positive. Patients say that the manipulation is absolutely painless. It lasts no more than one minute. It takes much longer to prepare for it. Within a few minutes after taking the material, the patient can go home. Only in some special cases, doctors leave a woman in the hospital for several hours.

Doctors say that endometrial biopsy results are very accurate. If a conventional biopsy examines a specific area that was taken with the help of curettage, then the paypel takes the endometrium from all the walls of the reproductive organ. Also, experts report on the safety of manipulation. Gynecologists do not have to expand the patient's cervical canal. After all, this often leads to the development of complications.

Pipel biopsy of the endometrium is also a safe procedure due to the use of sterile materials. The straws are made of high quality plastic and can only be used once. During curettage, reusable metal devices are used. This often leads to infection and the development of an infection. That is why a pipel biopsy is the preferred method for examining the state of the internal cavity of the reproductive organ.

Patients talk about the relatively expensive cost of the procedure. The average price category of a pipel biopsy is in the range of two to five thousand rubles. However, in public institutions, this study is performed absolutely free of charge if certain documents are available.

Duration of diagnostics and obtaining results

As you already know, material sampling is carried out no longer than one minute. The tissue is then sent to a laboratory for analysis. Diagnosis lasts no more than one week. The result is usually issued within ten days.

Only a qualified specialist can decrypt the received data. You shouldn't try to do it yourself. Your guesses may be wrong. If necessary, after a pipel biopsy of the endometrium, any medications are prescribed to correct the condition.

Endometrial biopsy is an effective and informative diagnostic procedure widely used in the gynecological field. This technique allows you to conduct a laboratory study of the tissues of the uterine mucosa in order to identify its condition, possible atypical cells. A biopsy of the endometrial layer is one of the most accurate ways to diagnose oncological processes, even at the initial stages of development.

What is an endometrial biopsy? This procedure is a curettage of the uterine cavity and tissue sampling for subsequent histological examination. The peculiarity of this technique lies in the fact that under the influence of certain hormones and with the development of pathological processes, the endometrium changes, and only a laboratory analysis of the tissue can determine its transformation and assess the danger.

The endometrial biopsy procedure is minimally invasive. If earlier, quite traumatic and fraught with numerous adverse effects procedures (curettage) were used for diagnostics, then modern specialists use the most gentle and safe biopsy methods.

For these purposes, the following methods are used:

Aspiration- a minimally invasive procedure characterized by painlessness and a minimal recovery period. The procedure is performed on an outpatient basis. In the process of diagnosis, a special tip is inserted into the uterine cavity of the patient, connected to an electric suction apparatus.

Paypel- the safest, improved aspiration technique. During the procedure, a special catheter is inserted into the patient's uterus, which allows both cells and tissues to be obtained for examination. Diagnosis in this way is usually done before the onset of menstruation. considered one of the preferred methods for taking a biopsy (material sample).
Hysteroscopy- the most informative method to identify oncology, polyposis, cystic neoplasms, uterine fibroids, adenomyosis. Hysteroscopy with diagnostic biopsy also allows the specialist to assess the stage of development of the pathological process and the degree of its malignancy, to develop the most effective treatment program. The study is carried out under intravenous anesthesia using a special device - a hysteroscope.

The optimal method for conducting a biopsy of the endometrial layer is determined by the doctor on an individual basis.

Indications

An endometrial biopsy is indicated for women in the following cases:

hyperplastic processes of the endometrium;

polyps localized in the uterus;

endometritis occurring in a chronic form;

endometriosis;

suspicion of the presence of a tumor neoplasm of a benign or malignant nature (fibroids, cysts, cancerous tumors);

menstrual irregularities;

painful and excessively heavy menstruation;

problems with conception;

uterine bleeding in menopause;

adenomyosis.

Gynecological diagnostics by biopsy is prescribed in the period of preparation for IVF artificial insemination, after early termination of pregnancy, miscarriages, spontaneous abortions.

Contraindications

Endometrial biopsy has a number of absolute contraindications and time limits.

This diagnostic procedure is not recommended if:

inflammatory processes of the genitourinary system, occurring in an acute form;

decreased blood clotting, thrombocytopenia;

severe anemia;

pregnancy;

acute form of purulent cervicitis;

sexually transmitted infectious diseases.

The study is prescribed with great caution to patients suffering from blood diseases, taking anticoagulant drugs, due to the high risk of bleeding.

Preparing for diagnostics

Before an endometrial biopsy, in order to identify possible contraindications and limitations, patients are prescribed laboratory and instrumental methods of diagnostic examination:

taking a smear for cytology and flora;
blood analysis;
colposcopy;
ultrasound examination of the pelvic organs.

To obtain the most accurate and reliable diagnostic results, it is important to correctly determine the day of the procedure.

In most cases, this happens according to the following scheme:

Identification of the phase of the cycle - 18-24 days of the menstrual cycle.
Pathological uterine bleeding - 1 day.
Abundant menstruation - on the 5-10th day of the menstrual cycle.
Suspicion of infertility - the first day of the cycle or a day before the onset of menstruation.
Monitoring the effectiveness of the course of hormonal therapy - from 17 to 25 days of the menstrual cycle.

If a malignant neoplasm is suspected, the diagnosis is carried out urgently, regardless of the day of the cycle.

For several days before the procedure, the patient must follow certain rules:

Refuse to use anticoagulants and drugs that reduce blood clotting.
Refrain from intimate contact.
Eliminate foods that promote increased gas formation from the diet.
Refrain from douching.

Features of the

How is the procedure carried out? A biopsy of the endometrial uterine layer is carried out in a clinic, under the influence of local anesthesia or even without anesthesia at all. Diagnosis is carried out in a gynecological chair. The specialist introduces a tool for sampling endometrial tissues into the patient's uterine cavity, after which the resulting biological material is sent to the laboratory for further histological examination.

The duration of the procedure is on average about 2-3 minutes. A biopsy does not require recovery, rehabilitation. After the session is completed, the patient can leave the clinic and return to the usual rhythm of life.

The results of the study will be ready 1-2 weeks after the sampling of biological material. Deciphering the results is a complex process that the gynecologist is directly involved in. Based on the information received, the doctor diagnoses the patient and develops an optimal treatment course for a particular clinical case.

Recovery after a biopsy

A biopsy of the mucous membrane of the uterine layer does not affect the woman's ability to work. According to the reviews of most patients, the procedure is tolerated very well, without any adverse reactions. But during the first few days, a woman may experience aching, painful sensations in the lower abdomen. Taking pain relievers can help relieve pain.

It is also possible the appearance of vaginal discharge of a bloody nature, which is considered one of the manifestations of the norm. When such a symptom appears, it is recommended to refrain from intimate contact until the bleeding stops.

In the first few days after taking a biopsy, the patient must follow medical recommendations:

refrain from taking hot baths, visiting baths and saunas;
refuse to use hygienic tampons;
do not lift weights;
avoid excessive physical activity.

Compliance with these simple rules significantly reduces the risk of complications and adverse reactions.

Consequences and complications

In rare cases, when diagnosing the endometrium by biopsy, complications may develop. Seek help immediately if you experience any of the following symptoms:

feverish condition, increase in body temperature above 38;
uterine bleeding;
pronounced pain syndrome;

fainting states;
convulsive syndrome;
bouts of dizziness.

Interpretation of results

What does an endometrial biopsy show? In the absence of pathological processes, it will be established that the endometrium is normal, without atypical manifestations.

In the presence of pathological changes, diagnostics will determine:

adenomatosis;

endometrial hyperplasia;

hypoplastic processes;

atrophy of the mucous membrane of the uterine layer;

endometritis;

discrepancy between the indicators of the thickness of the mucous layer of the current phase of the menstrual cycle;

malignant degeneration of endometrial tissues.

Based on the results obtained, additional examinations are prescribed or therapeutic measures are developed.

Endometrial biopsy is an important diagnostic procedure that allows you to identify a number of gynecological diseases, pathological changes in the mucous membrane of the uterine layer. This diagnostic method has high rates of informativeness, and the use of modern techniques makes it possible to make the procedure as painless as possible and safe for women's health.

Previously, for some gynecological diseases, only traumatic methods of biopsy of the uterine mucosa were used to collect endometrial samples, which involved its curettage (i.e., a procedure similar to a classic surgical abortion). However, thanks to the advent of aspiration biopsy (or Pipel biopsy), such a study has become more painless and safer.

This minimally invasive surgical technique for collecting endometrial tissue is carried out using a special plastic tube called a pipel. The thickness of this device is 3 mm, and the principle of its operation is similar to the syringe mechanism. There is a piston inside the tube, and at one end there is a side hole for admission by aspiration of the endometrium into the tip of the pipel.

In this article, we will acquaint you with the indications, contraindications, how to prepare the patient for the procedure, the benefits and methodology for performing endometrial aspiration biopsy. This information will help you understand the essence of this diagnostic technique, and you can ask your doctor if you have any questions.

Unlike the classic surgical technique for collecting endometrial tissue, aspiration biopsy does not require dilatation of the cervical canal. The tip of a disposable tube is inserted into the uterine cavity without the use of additional devices. The doctor pulls back on the plunger, creating negative pressure to aspirate a small area of the endometrium as needed. At the same time, extensive wound surfaces are not formed on the inner layer of the uterus, the cervix does not suffer from mechanical stress, and the patient does not experience pronounced discomfort.

Indications

Indications for this study are pathological processes localized in the endometrium - the inner layer of the uterus.

An aspiration biopsy is prescribed in cases where, after a gynecological examination and ultrasound, the doctor suspects that the patient has pathological changes in the state of the inner layer of the uterus - the endometrium. The resulting tissue samples allow for a histological analysis of the mucous layer of the uterus and make a correct diagnosis.

Endometrial aspiration biopsy is prescribed in the following clinical cases:

endometrial hyperplasia;
disorders (acyclic scanty spotting, menometrorrhagia, scanty menstruation, of unknown origin);
chronic endometritis;
suspicion of infertility;
heavy bleeding in women in the period;
suspicion of the presence of a benign or malignant tumor (, endometrial cancer).

A pipel biopsy can be performed not only to diagnose endometrial pathologies, but also to evaluate the effectiveness of hormone therapy.

Contraindications

Endometrial aspiration biopsy cannot be performed in the following cases:

in the acute phase;
pregnancy.

Possible limitations for performing a Pipel biopsy include the following clinical cases:

disorders of the blood coagulation system;
severe forms;
constant reception and (Clexane, Warfarin, Trental, etc.);
individual intolerance to the applied.

If such conditions are identified, an aspiration biopsy can be performed after special preparation of the patient or replaced by another study.

How to properly prepare for the procedure

Aspiration biopsy of the endometrium, although it is a minimally invasive procedure, but during its implementation, instruments are inserted into the uterine cavity and, albeit insignificant, damage to the integrity of the inner layer of this organ occurs. That is why, in order to exclude possible complications of such a study, the patient needs to properly prepare for the material sampling.

To exclude possible contraindications to performing endometrial aspiration biopsy, it is necessary to carry out the following diagnostic studies:

gynecological examination;
smear on microflora;
cytological smear from the cervix (PAP test);
Ultrasound of the pelvic organs;
blood test for hCG;
blood test for hepatitis B and C, syphilis and HIV;
(preferably).

When prescribing a Paypel biopsy, the doctor must obtain from the patient all the information about the medications she is taking. Particular attention is paid to taking blood-thinning agents (Clopidogrel, Aspirin, Warfarin, etc.). If necessary, the doctor can change the order of taking them a few days before the procedure.

When prescribing an endometrial aspiration biopsy, special attention is paid to the choice of the date of the study. If a woman has not yet entered the menopause period, then the duration of the procedure depends on the day of the menstrual cycle. If the patient is no longer menstruating, then tissue sampling is performed depending on the onset of pathological uterine bleeding.

Typically, an endometrial aspiration biopsy is performed on these days:

18-24 days - to establish the phase of the cycle;
on the first day with pathological bleeding - to identify the cause of bleeding;
on the 5th-10th day of the cycle - with excessively heavy periods (polymenorrhea);
on the first day of the cycle or the day before menstruation - if infertility is suspected;
once a week - if pregnancy does not occur and menstruation is absent;
on days 17-25 - to monitor the effectiveness of hormone therapy;
any day of the cycle - if a malignant neoplasm is suspected.

Direct preparation for the Pipel biopsy is carried out 3 days before the study. These days, a woman needs to follow the following doctor's recommendations:

Refuse sexual intercourse.
Do not douche, do not insert suppositories, ointments and creams into the vagina.
Exclude from the menu products that contribute to increased gas formation.
In the evening before the study, conduct a cleansing enema.

The endometrial aspiration biopsy procedure can be performed in a specially equipped room in a polyclinic. As a rule, it does not require the use of local anesthesia, but sometimes this method of pain relief is performed for particularly sensitive patients. In such cases, before conducting the study, the doctor must make sure that there is no allergic reaction to the drug used (according to the history or the performed test).

How is the procedure carried out

During the procedure, the patient is on the gynecological chair.

On the appointed day, the patient with a referral comes to the room for an aspiration biopsy. The procedure for sampling endometrial tissue is as follows:

The woman lies down on a gynecological chair, and the doctor inserts a speculum into the vagina. If necessary, local anesthesia of the cervix is performed by irrigating it with a local anesthetic solution.
The tip of the pipel is inserted into the uterine cavity through the cervical canal.
The gynecologist pulls back the plunger and negative pressure is created in the tube. As a result of this effect, part of the endometrium enters the pipel cavity. The doctor takes material from different areas.
After receiving a sufficient amount of material, tissue samples are sent to the laboratory for histological analysis.
The pipel is removed from the uterine cavity. The duration of the procedure is 1-3 minutes.

The results of histological analysis of endometrial tissues are obtained 7-14 days after the biopsy. After their assessment, the gynecologist makes a diagnosis and draws up a plan for further examination and treatment.

After the procedure

After performing an aspiration biopsy of the endometrium, the patient feels satisfactory and can go home. Her performance is not disturbed in any way, and the need for hospitalization does not arise.

In the next 1-2 days, the patient may feel slight painful sensations of a pulling nature in the lower abdomen. To eliminate spasmodic pains that cause significant inconvenience, a woman can take antispasmodics (No-shpa, Papaverine, Spasmalgon). As a rule, such discomfort does not last more than 1 day.

In the first few days after the aspiration biopsy procedure, women have mild bloody discharge from the genital tract. Most experts recommend that their patients refrain from sexual intercourse these days. After the cessation of bleeding, a woman can resume sexual activity and use barrier contraceptives to prevent pregnancy.

After the study, menstruation may occur on time or with some delay (up to 10 days). In such cases, the woman is advised to take a pregnancy test and visit a doctor.

After an aspiration biopsy, pregnancy may occur already in the current or subsequent cycle. This method of sampling the endometrium does not affect the functioning of the ovaries and the remaining area of the uterine mucosa is sufficient for implantation of the fetal egg.

Possible Complications

The endometrial aspiration biopsy procedure is minimally invasive and, in rare cases, leads to complications. After the examination, the gynecologist necessarily acquaints the patient with symptoms, in the event of which she should immediately consult a doctor:

increase in body temperature;
bleeding from the vagina (thick, bright red discharge);
persistent pain in the lower abdomen;
dizziness or fainting;
convulsions.

Benefits of endometrial aspiration biopsy

Pipel biopsy has a number of significant advantages:

low risk of injury to the walls of the uterus;
there is no need to expand the cervical canal for the introduction of instruments;
the possibility of obtaining endometrial tissue from inaccessible areas of the uterine cavity;
minimal risk of infection;
minimal risk of complications;
no pain during the procedure;
rapid recovery of the patient after the biopsy;
the possibility of performing the study on an outpatient basis and the absence of the need for hospitalization of the patient;
high information content;
no negative impact on the body of a woman preparing for pregnancy (for example, before IVF);
simple preparation for the procedure;
low research cost.

What will the result of histological analysis after aspiration biopsy show?

In the absence of pathological abnormalities in the structure of the mucous layer of the uterus, the analysis will indicate that the endometrium corresponds to the age norm and the phase of the menstrual cycle, and there were no signs of atypia.

If abnormalities in the structure of the mucous layer of the uterus are detected, the following pathological changes can be indicated in the results of the analysis:

adenomatosis (or complex endometrial hyperplasia);
simple diffuse (or glandular, glandular-cystic) endometrial hyperplasia;
local endometrial hyperplasia with or without atypia (or polyposis, single polyps);
simple or complex atypical endometrial hyperplasia;
hypoplasia or atrophy of the endometrium;
endometritis;
discrepancy between the thickness of the endometrium and the phase of the menstrual cycle;
malignant transformation of the endometrium.

Endometrial aspiration biopsy is often used as a screening method for examining patients with questionable ultrasound results. However, this method of sampling the tissues of the inner layer of the uterus does not always make it possible to obtain a sufficient amount of material to completely exclude the presence of malignant tumors. That is why, if a cancerous process is suspected, the examination of the patient is supplemented by a more informative diagnostic curettage.

What to do after an endometrial aspiration biopsy

After the Pipel biopsy is performed, the doctor sets the date for the next visit to the patient. Usually, histological examination analyzes are ready 7-14 days after the procedure, and based on their results, the gynecologist can determine further tactics for diagnostic and therapeutic measures.

If signs of atypia or cancerous processes are detected, the doctor decides on the need for additional studies and surgical treatment. If the results of histological analysis indicate the presence of inflammation, then the patient is prescribed antibiotic therapy and anti-inflammatory drugs.

When determining signs of hyperplasia or insufficient response of the endometrium to hormonal changes during the menstrual cycle, the doctor conducts additional diagnostic studies to identify endocrine disorders. After that, the patient may be prescribed hormone therapy that improves the condition of the endometrium and restores reproductive function, taking other drugs and physiotherapy.

Paypel endometrial biopsy- this is a procedure in which a doctor, using an instrument of the same name (a pipel is something like a very thin plastic syringe with a diameter of 3 mm without a needle), takes endometrial cells (the inner mucous layer of the uterus) from the patient for analysis. Histological, more precisely, cytological analysis of a sample of the obtained tissue can show cancerous and precancerous changes in uterine cells, a chronic inflammatory process (endometrium), and reveal dyshormonal changes.

The material is taken in the gynecologist's office without the use of anesthesia. As a rule, this takes about 10 minutes.

The effectiveness of this method of taking cellular material from the uterus is quite high. However, it is significantly lower than with curettage (curettage) of the uterus, when the entire endometrium is taken for analysis. Nevertheless, the pipel method allows diagnosing endometrial cancer and hormonal disorders at an early stage. It is recommended for young and nulliparous women in non-difficult situations when there is no oncological alertness, for example, before removal of uterine fibroids. During the procedure, the doctor does not expand the cervix with the help of medical instruments, which means that it does not injure it. This is a big plus.

If we compare the pipel biopsy and hysteroscopy, then each method has its own advantages. With a conventional hysteroscopy, the doctor can visually examine the uterine cavity and remove tumors in it. Take material from a specific area for analysis. Paypel - the procedure is simpler, faster and does not require general anesthesia, but is carried out "blindly".

At the same time, there is a method of office (mini) hysteroscopy, which is performed without cervical dilation and without anesthesia, but the doctor sees everything and can take tissue for histology. This study is deeper and more effective.

Indications and contraindications for endometrial aspiration

Analysis of endometrial cells is performed to diagnose uterine abnormalities and rule out various diseases.

Your doctor may take a biopsy to:

find the cause of postmenopausal bleeding or abnormal uterine bleeding;
identify or rule out endometrial cancer;
assess fertility (ability to conceive a child);
test the response of the endometrium to hormone therapy.

Do not take aspirate from the uterus under the following conditions:

pregnancy;
inflammation of the pelvic organs;
cervical or vaginal infection;
cervical cancer;
cervical stenosis (strong narrowing of the cervix).

What painkillers to take before the procedure

Whether or not it hurts to take a pipel biopsy depends on the woman's pain threshold, the doctor's skill, and the presence or absence of pain relief. Since the procedure is performed on an outpatient basis, in any antenatal clinic, it is not advisable to do intravenous anesthesia.

It is recommended to take a non-steroidal anti-inflammatory drug 30-60 minutes before the procedure, for example, "Ibuprofen". It will provide an analgesic effect. Some women take before "No-shpu", since it is a good antispasmodic, the uterus will not contract too much and painfully and will open more easily for the introduction of the pipel.

In addition, the physician may use lidocaine spray, sprinkle them with the cervix, this will also somewhat reduce pain.

Sometimes there is a need to take a mild sedative. It can cause drowsiness, so you should not drive until the effect has completely worn off. Ask a friend or family member to drive you home after your procedure.

The most severe pain is felt at the time of taking the material for research. The uterus reacts to the actions of the doctor with a spasm. The pain is similar to that which happens shortly before the critical days. Some women feel dizzy and have stomach pain. This is called a vasovagal reaction.

How to prepare for an endometrial biopsy and what day it is performed

Biopsy of the endometrium during pregnancy can lead to miscarriage. Tell your doctor if you are, or likely to be, pregnant. Your gynecologist will ask you to take a pregnancy test before the biopsy to make sure you don't have one.

Sometimes it is necessary to keep a record of menstrual cycles before the biopsy so that the doctor schedules the procedure for the most suitable day.

If this is a woman of reproductive age, then most often prescribe an intrauterine biopsy on the 25-26th day of the cycle, that is, 2-3 days before the critical days.

In case of infertility, when luteal phase anomalies are considered the culprit, the procedure is recommended for the second half of the cycle. With this pathology, a woman ovulates, but by the time the fertilized egg enters the uterus, the endometrium is too thin and cannot “accept” it. This feature is successfully detected by histological analysis.

After the onset of menopause, the analysis is taken on any day.

24 hours before the diagnosis, you can not:

use hygienic tampons;
insert vaginal suppositories and tablets;
douche;
have sex.

Before starting the manipulation, you will be asked to sign a consent form stating that you understand the risks and agree to this.

Talk to your doctor about the need for a biopsy, the risks involved, what results may be obtained, and how useful they are for you.

How it all goes

You will be asked to lie down on a gynecological chair. The doctor will perform a manual examination of the uterus. Then he will insert a mirror into the vagina to straighten its walls and open access to the cervix. It will be fixed in a comfortable position with the help of a clamp. Everything will be treated with an antiseptic. After fixing the neck, you will feel discomfort, pressure on the rectum is normal.

Your doctor will insert a thin, flexible tube into your cervical canal. It will go a few millimeters into the uterus. It will then pull the piston towards itself to create a suction effect. The entire procedure usually takes about 10 minutes.

The tissue sample will be placed in a liquid and sent to a laboratory for analysis. Results will be ready in approximately 7-10 days.

After the procedure, you will have bloody discharge from your vagina. Don't forget to bring a sanitary napkin with you. Blood may appear within a few days, until the very beginning of menstruation, if the biopsy was taken shortly before its expected start.

Within a few hours, pulling sensations in the uterus, spasms are considered normal. Painkillers are allowed.

Consequences and complications of the procedure

Sometimes a woman does not wait for the result of a histological examination, because too few endometrial cells were transferred for analysis. This happens with a thin endometrium or a violation of the material sampling technique. In this case, you will have to agree to curettage of the uterine cavity.

Rarely, but there is an inflammatory process provoked by taking an aspirate. It can be avoided if you take a healthy test and before that get a good result of a gynecological smear on the flora. A very rare complication is perforation of the uterus with an instrument.

Signs of trouble are:

increase in body temperature;
increased bleeding;
severe pain in the abdomen;
discharge from the vagina with a putrid odor.

Taking a biopsy does not affect the duration of the menstrual cycle. Does not lead to delays in menstruation and infertility. It will be possible to get pregnant almost immediately after the procedure, unless the attending physician has a different opinion on this matter.

On the day of the aspiration biopsy, you should not expose yourself to heavy physical exertion, play sports, or lift weights. Until the complete disappearance of bloody and spotting discharge, you should avoid taking a bath. At the same time, you should stop having sex.

Endometrial aspiration biopsy results - transcript

We give here some of the terms that doctors write in their conclusion.

Normal endometrium in the proliferation phase- corresponds to the first phase of the menstrual cycle.

Normal endometrium in the secretion phase- corresponds to the second half of the cycle.

Endometrial atrophy- thin endometrium due to age-related changes (decrease in the production of sex hormones) or injury to the germ layer as a result of rough.

Hyperplasia without atypia- excessive growth of the uterine mucosa (normally, its maximum thickness in women of reproductive age on the 19-23rd day of the cycle is 21 mm), there is no risk of oncology at this time.

endometritis- acute or chronic inflammation of the uterine cavity, one of the causes of infertility.

Hyperplasia with atypia- not cancer yet, but there is a bad trend, treatment and further observation are required.

Adenocarcinoma- malignant tumor, cancer.

Real reviews

A pipel biopsy of the endometrium is the collection of a small fragment of the mucous membrane from the uterine cavity for further analysis. Manipulation is carried out using a special catheter, a small flexible plastic tube with a diameter of about 3 mm. Compared to traditional aspiration biopsy, which is performed using a special syringe or vacuum instrument, the pipel procedure is more gentle, does not require anesthesia and takes 7-10 minutes.

Indications for appointment

The indications for the study are:

bleeding during menopause;
lack of menstruation (amenorrhea);
scanty periods (dysmenorrhea);
long heavy periods;
acyclic uterine bleeding;
infertility;
habitual miscarriage;
endometrial polyps;
myoma;
endometrial hyperplasia;
endometrial tumors to determine their malignancy;
suspected endometriosis;
suspicion of an inflammatory disease of the uterine mucosa (endometritis);
evaluation of the effectiveness of ongoing hormonal treatment.

Contraindications for carrying out

Pipel biopsy is not performed under the following conditions:

pregnancy due to a high risk of miscarriage;
inflammatory processes of the small pelvis in an acute form, as they can cause the spread of infection;
pathology of hemostasis;
severe anemia.

Preparation for the procedure

During the last menstrual cycle before the biopsy, it is necessary to protect against pregnancy, as it is a contraindication to the study.

Since the research method is a surgical intervention, you will need to pass the following tests:

On the eve of the procedure, it is necessary to observe sexual rest, do not use candles, tampons, douching. The doctor may recommend taking No-Shpu 40 minutes before the study to relieve a possible spasm of the cervix of the uterus. The dosage of the drug is selected individually. Immediately before the procedure, it is necessary to empty the bladder.

How the study is done

The doctor appoints the day of the procedure in accordance with the indications. For example, to assess the state of the endometrium and detect insufficiency of the second phase of the cycle, a biopsy is performed on the 21-23rd day from the start of the last menstruation, and to exclude chronic endometritis, it is necessary to carry out the procedure on the 9-13th day of the cycle - during this period, there are no inflammatory cells in the endometrium.

Manipulation is carried out on an outpatient basis and almost always without anesthesia. At the first stage, a gynecological examination is performed on a chair and the vagina and cervix are sanitized with special drugs, while the latter is fixed with bullet forceps.

The biopsy technique consists in the fact that a sterile disposable instrument is inserted into the uterine cavity through the vagina and cervix, which is a flexible plastic tube with a piston, as in a syringe. When the piston is pulled, negative pressure is created, as a result of which the catheter sticks to the wall of the uterus and endometrial particles are aspirated through the side hole in the tube. Tissue sampling is carried out in three different parts of the mucosa. The resulting material is placed in a formalin solution and sent for histological examination.

After the procedure

Bloody discharge may be present after the biopsy, but should not be clotted, pus, or foul-smelling. If these symptoms still appear, you should immediately consult a doctor. Normally, minor bleeding stops quickly, as it is a reaction to mechanical stress. Uterine contractions are also possible, but they disappear during the day or after taking antispasmodics.

In the recovery period, which lasts 2 weeks, you can not:

to have sex until the bleeding stops;
take a bath, you should limit yourself to a shower;
lift weights;
visit the bath and sauna;
douching;
use tampons.

Deciphering the results

The results of the endometrial biopsy will be ready in 7-14 days, it all depends on the clinic where the studies are carried out and the overall workload of the laboratory. The conclusion, which is issued after the histological examination of the biopsy, consists of 4 parts.

Informativeness of the sample:

an uninformative, inadequate sample is determined by the fact that the material obtained does not contain a sufficient number of endometrial cells, blood cells, stratified squamous epithelium of the vagina, cylindrical epithelium of the cervical canal may be present;
an informative, adequate sample is characterized by the presence of a sufficient number of mucosal cells in the biopsy.

Macroscopic description of the biopsy:

the weight of the submitted samples;
fragment size (large, small);
color (from gray to bright red);
consistency (loose, dense);
blood clots, blood clots;
slime.

Microscopic description of the biopsy:

type of epithelium (cylindrical, cubic, flat, indifferent), its size, number of layers;
stroma (its presence, density, uniformity);
size and shape of stromal cells;
fibroplasticity of the stroma, that is, the number of connective fibers;
decidual-like stroma, that is, the accumulation of fluid and nutrients;
uterine glands, their shape, description of the epithelium lining them;
the shape and size of the lumen of the glands, the presence of a secret inside the glands, branching;
lymphoid accumulations as signs of inflammation;
chorion cells, the presence of edema or dystrophic changes in them, indicating that the woman had a missed pregnancy or an incomplete spontaneous abortion occurred.

Making a diagnosis after receiving the results

Often there is only one phrase in the conclusion: "Normal endometrium in the phase of proliferation / secretion / menstruation." It means that the endometrium is normal, no signs of disease and changes in the structure of cells were found, there are no polyps and hyperplasia. It is important that the state of the endometrium correspond to the phase of the woman's menstrual cycle and the period of her life.

The results of the study reveal:

After receiving the conclusion, you can contact your doctor to prescribe a therapy regimen or other methods of treatment.

Possible Complications

As after any surgical intervention, after a pipel biopsy, complications are possible:

prolonged bleeding;
accession or activation of a latent infection;
prolonged pain;
damage to the uterine wall.

The following symptoms indicate their development and the need to see a doctor:

heavy bleeding (more than 3 pads in 2 hours);
severe pain in the lower abdomen and lower back that does not subside after taking painkillers;
spotting for more than 5 days;
discharge with an unpleasant odor;
rise in temperature above 37.5ºС.

The most dangerous complication of a biopsy is endometritis. It is characterized by pain in the abdomen and the appearance of fetid uterine discharge with signs of suppuration. Its development is associated with hypothermia or non-compliance with the regimen after the procedure and the doctor's recommendations.