Endometrial Biopsies

How I Practice Video Series 
May Hsieh Blanchard, MD, FACOG
Baltimore, MD

Endometrial Biopsies - May Hsieh Blanchard, MD, FACOG from ACOG on Vimeo.

When I need to do an endometrial biopsy in the office, it’s definitely a procedure that can cause some anxiety and pain and discomfort for the patient. I think being able to explain the process and minimize the discomfort as much as possible is critical for the patient as well as to continue to do the next steps of evaluation as necessary. I found that over the past several years even as I get further away from training I continue to learn ways to improve my technique and help the patient to be more comfortable in what is understandably an uncomfortable situation. When I first learned how to do an endometrial biopsy as a resident, we used an instrument called a tenaculum.  And a lot of times we were told to have the patient cough as you place the tenaculum on the cervices as an effort to try to distract the patient or offset the discomfort of the clamp being placed on her cervices. And what I observed from my own experience as well as watching my residents when I was supervising them was that it is really hard to try to coordinate a cough as well as being able to place the clamp on the patient’s cervices. And often times it really didn’t help with the discomfort. So what I have done now, just placed the tenaculum just gently on the cervices.  I tell the patient that she might feel some cramping at this point.  And instead of trying to place to it as quickly as possible, I slowly apply the clamp across the cervices. And actually just take even ten seconds or so to apply that tenaculum and watch the tenaculum advance through the cervical tissue. The patient will have a little bit of cramping. But it’s not such a jarring effect. And then I also make sure that as I close the clamp, I avoid any kind of audible ques so that it’s not startling the patient as she is also having this cramping.

The other component that I think is very critical is that as I introduce the endometrial biopsy catheter, trying to just apply some gentle pressure as the pipel or the endometrial sampler passes through the internal os of the cervices, there can be a little bit of resistance just at that internal os and rather than try to use any abrupt motions to advance the catheter sometimes just some gentle traction on the cervices with the tenaculum and some gentle pressure of the biopsy instrument against the cervices allows that muscle to relax and then I am able to insert the catheter with minimal discomfort.  This is how I practice. 

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