From the Research
Women with heavy abnormal bleeding should consider endometrial biopsy starting at age 45, or earlier if they have risk factors for endometrial cancer, as the risk of endometrial cancer increases with age, especially after menopause 1.
Key Considerations
- The American journal of obstetrics and gynecology study from 2020 found that the risk of endometrial cancer and endometrial intraepithelial neoplasia was higher in women aged 60+ years, and that endometrial thickness measured through transvaginal ultrasound was a useful tool for risk stratification 1.
- For women under 45, endometrial biopsy is typically recommended if they have persistent abnormal bleeding that doesn't respond to medical therapy, or if they have risk factors such as obesity, polycystic ovary syndrome, diabetes, family history of endometrial or colon cancer, or a history of unopposed estrogen exposure 2, 3.
- The procedure involves removing a small tissue sample from the uterine lining to rule out cancer or precancerous conditions, and is typically performed in an office setting, taking about 10 minutes, and may cause cramping discomfort that can be reduced by taking ibuprofen 400-600mg about an hour before the procedure.
Risk Factors
- Obesity is an important risk factor for complex endometrial hyperplasia or cancer in premenopausal women with abnormal uterine bleeding, and body mass index should be the first stratification in the decision to perform endometrial biopsy and/or to refer secondary gynecology services 3.
- Other risk factors include nulliparity, anemia, family history of endometrial or colon cancer, and a history of unopposed estrogen exposure 2, 3.
Diagnostic Approach
- Transvaginal ultrasonography and saline-infusion sonohysterography are useful tools for evaluating abnormal uterine bleeding and guiding the decision to perform endometrial biopsy 4.
- Endometrial biopsy by Pipelle is a suitable alternative to diagnostic curettage, with high agreement and cohesion coefficient between the two methods, and lower duration and cost 5.