Menstrual Disorders - Diagnosis

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Click the icon to see an image of laparoscopy.

Endometrial Biopsy. When heavy or abnormal bleeding occurs, an endometrial (uterine) biopsy can be performed in the doctor's office. This procedure can help identify abnormal cells, which suggest that cancer may be present. It may also help the doctor decide on the best hormonal treatment to use. The procedure is done without anesthesia, or local anesthetic is injected.

• The patient lies on her back with her feet in stirrups. An instrument (speculum) is inserted into the vagina to hold it open and allow the cervix to be viewed.
• The cervix is cleaned with an antiseptic liquid and then grasped with an instrument (tenaculum) that holds the uterus steady. A device called a cervical dilator may be needed to stretch the cervical canal if there is tightness (stenosis). A small, hollow plastic tube is then gently passed into the uterine cavity.
• Gentle suction removes a sample of the lining. The tissue sample and instruments are removed. A specialist called a pathologist examines the sample under a microscope.

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Dilation and Curettage (D&C). Dilation and curettage (D&C) is a more invasive procedure:

• A D&C is usually done in an outpatient setting so that the patient can return home the same day, but it sometimes requires a general anesthetic. It may need to be performed in the operating room to rule out serious conditions or treat some minor ones that may be causing the bleeding.
• The cervix (the neck of the uterus) is dilated (opened).
• The surgeon scrapes the inside lining of the uterus and cervix.

The procedure is used to take samples of the tissue and to relieve heavy bleeding in some instances. D&C can also be effective in scraping off small endometrial polyps, but it is not useful for most fibroids, which tend to be larger and more firmly attached.

Click the icon to see an image of a D&C.

Review Date: 07/26/2010
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org).