Gynaecological biopsies at Tunbridge Wells Hospital

Why might I need a gynaecological biopsy?

You might be offered a womb (endometrial) biopsy if:

• you have abnormal vaginal bleeding, such as heavy, prolonged or irregular periods, or bleeding between periods
• you have bleeding after the menopause
• a scan has shown the lining of your womb looks thickened or abnormal.

What are the benefits of a gynaecological biopsy?

Taking a biopsy lets a specialist check directly for abnormal cells, pre-cancerous changes or cancer in the lining of your womb, so that treatment can be started sooner if it's needed. Without a biopsy, these causes for your symptoms cannot be ruled out with the same confidence.

Are there different types of gynaecological biopsy?

• Aspiration (pipelle) biopsy: a thin, straw-like tube is passed through the cervix to gently draw a sample of cells from the womb lining using suction. This is usually done at an outpatient appointment without anaesthetic.
• Outpatient hysteroscopy: a thin telescope (hysteroscope) is passed through the vagina and cervix to look directly inside the womb, and a biopsy is taken at the same time. This can be done with a local anaesthetic injected into the cervix.
• Hysteroscopy with dilatation and curettage (D&C): carried out under general anaesthetic. The cervix is gently opened and a small instrument (a curette) is used to remove tissue from the womb lining.

If an aspiration biopsy isn't possible, for example if you haven't had children or have had previous treatment to your cervix, you may be offered a hysteroscopy instead, sometimes under general anaesthetic in an operating theatre on a different day.

How do I prepare for a gynaecological biopsy?

• There's no special preparation needed for an aspiration (pipelle) biopsy; you can have it even if you're on your period or have postmenopausal bleeding.
• The biopsy isn't suitable if you're pregnant or have an infection in your vagina or pelvis, so tell your doctor if either of these applies.
• If you're having a hysteroscopy without a general anaesthetic, you may be advised to take painkillers about an hour beforehand.
• You'll be asked to sign a consent form once your doctor or nurse has explained the procedure and you've had the chance to ask questions.
• A chaperone, another staff member, is normally in the room with you throughout; ask for one if you'd like this and it hasn't been offered.

What happens during a gynaecological biopsy?

1. You lie on a couch on your back, with your knees up and feet apart, and you're given a sheet to cover yourself.
2. Your doctor or nurse gently opens your vagina using an instrument called a speculum, the same as for a cervical screening test.
3. A thin, straw-like tube (a pipelle) is passed through your cervix into your womb.
4. Using gentle suction, cells are drawn from the womb lining into the tube. This can cause period-like cramping, which usually settles once the procedure is finished.
5. Sometimes this is repeated to make sure enough tissue is collected.
6. The tube and speculum are removed, and the sample is sent to a laboratory for testing.

The whole procedure usually takes only a few minutes, and you can normally go home straight afterwards.

What happens after a gynaecological biopsy?

You can get dressed and go home straight away. Most people are able to return to work or their normal activities the same day if they're feeling well, and you can continue with normal activities such as bathing, exercise and driving.

You may have some light vaginal bleeding or period-like cramping for a day or two. Mild painkillers such as paracetamol or ibuprofen can help. It's recommended you avoid having sex until any bleeding has stopped completely, to help reduce the risk of infection. If you had the biopsy because of heavy or postmenopausal bleeding, this bleeding is likely to continue until you've been diagnosed and, if needed, treated.

Your doctor will write to you and your GP with the results, which usually takes between 1 and 4 weeks, though this can vary between hospitals.

What are the risks of a gynaecological biopsy?

• Cramping or discomfort: common, and usually settles quickly. Mild painkillers such as paracetamol can help.
• Vaginal bleeding: common for a day or two afterwards, sometimes longer if that's why the biopsy was done.
• Feeling faint: possible, particularly during the procedure.
• Infection: uncommon.
• Prolonged bleeding: rare.
• Uterine perforation, a small hole in the womb: extremely rare.