Endometrial biopsy
The sample taken from your uterus lining is looked at under a microscope by a pathologist. This helps us understand what your hormones are doing, whether the lining is normal or abnormal, and whether there are any signs of inflammation or pre-cancerous changes.
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A thin tube (pipelle) is passed through the cervix into the uterus to take a tiny sample of the lining (endometrium). For more information see my webpage on pipelles New Paragraph
Your result is abnormal
- Could show hyperplasia (overgrowth of the lining).
- Rarely, could show endometrial cancer.
- Results guide whether medication, monitoring, or surgery is needed.
Your result is normal
- Normal cyclical changes of the endometrium, depending on timing in the cycle.
- Confirms no precancerous or cancerous changes.
- Postmenopause - cells should be 'inactive' because there shouldn't be any estrogenic activity on the endometrium anymore.
In the context of your previous results
A biopsy is compared with ultrasound findings, hormone tests, and previous biopsies if done.
Trends matter: e.g. repeated thickened lining + abnormal histology = higher concern.
A deeper dive
For those looking to delve deeper and gain a greater understanding of their results and their practical applications.
Here’s a breakdown of the common findings and what they usually mean:
✅ Normal or Hormone-Responsive Patterns
These are all reassuring and show that your body is responding to hormones (either your own or from MHT):
Secretory endometrium: this is a typical pattern after ovulation - shows that progesterone has been present.
Proliferative endometrium: a normal pattern before ovulation - it means estrogen is working to thicken the lining.
Disordered proliferative endometrium: not dangerous - but can mean your hormones are fluctuating and causing the lining to grow a bit unevenly, often seen in perimenopause.
🔄 Atrophic or Thin Endometrium
This is common after menopause or in people on continuous MHT - also reassuring. It means there's not much estrogen around and the lining is inactive.
⚠️ Hyperplasia (Thickened Lining)
This means the lining is growing too much and can be a warning sign if not treated.
There are a few types:
- Simple hyperplasia (without atypia): low risk, often settles with progesterone.
- Complex hyperplasia (without atypia): a bit more irregular growth but still low cancer risk.
- Hyperplasia with atypia: more worrying — there's a small chance it can develop into endometrial cancer if not treated, so we take this seriously.
🦠 Inflammation or Infection
Sometimes the biopsy shows signs of endometritis (inflammation in the lining), which may explain ongoing bleeding or discomfort. This might be treated with antibiotics, estrogen cream (yes, low estrogen can cause inflammation!) or further follow-up.
🧬 Cancer
Rare (in about 1% of abnormal post menopausal bleeding), but a Pipelle can detect endometrial cancer, especially if there's been postmenopausal bleeding. This is why we often recommend it - early detection can be life-saving.
