Indications for endometrial biopsy

Question 1

Indications for endometrial biopsy

Answer 1

1. Sinister symptoms
   a. Intermenstrual bleeding
   - Woman > 40yo
   - Persistent (in woman <40yo)
   b. Postmenopausal bleeding
2. Risk factors for endometrial ca
   - >45yo
   - PCOS
   - Obesity
   - Unopposed estrogen treatment
   - Treatment failure with hormones
3. Abnormal U/S findings
   a. Thickened endometrium lining
   - Post-menopausal: >5mm
   - Pre-menopausal: >15mm during all times of menstrual cycle
   b. Polyp >1.5mm (Big) or symptomatic (AUB) –> Consider D&C to remove for biopsy
4. Abnormal PAP smear
   - Endometrial cells
   - Glandular cells

Question 1

Advantages of endometrial biopsy

Answer 1

Avoids risk of GA, fairly accurate representation

Question 2

Disadvantages of endometrial biopsy

Answer 2

Blind procedure
Focal lesions can be missed
Inadequate sampling may result in need for re-sampling
Painful for nulliparous patients

Question 3

Complications of endometrial biopsy

Answer 3

Endometritis, uterine perforation, bleeding

Question 4

Contraindications of endometrial biopsy

Answer 4

Active pelvic inflammation, pregnancy