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What is Pipelle Endometrial Biopsy?
Pipelle biopsy is a gentle and informative method for examining the mucous membrane of the uterus, in which the physician obtains a small fragment of the endometrium for analysis. The procedure is performed using a thin, flexible tube (the Pipelle catheter), without cervical dilation, and most often, without anesthesia. However, local anesthesia may be used in patients with a low pain threshold, especially in nulliparous women. Simply put, it is an aspiration diagnostic method that allows a small area of tissue to be "suctioned" and examined under a microscope. This examination helps to identify the presence of inflammation, atypical cells, hyperplasia, polyps, and other changes affecting women's health.
When is Pipelle Biopsy Prescribed?
The procedure is prescribed when endometrial pathologies—the inner lining of the uterus—are suspected. It helps to detect hormonal disorders, inflammation, neoplasms, and pre-cancerous changes. It is also performed as part of the follow-up after surgical interventions and hormone therapy. A physician may refer a patient for a Pipelle biopsy for:
• Irregular or painful menstruation (dysmenorrhea).
• Intermenstrual bleeding (metrorrhagia).
• Pre-conception planning and IVF (In Vitro Fertilization).
• Long-term infertility without an obvious cause.
• Suspicion of endometrial hyperplasia, polyps, or cancer.
• Chronic inflammation of the uterine mucosa (chronic endometritis).
The method is valued for its informational content, minimal invasiveness, and the possibility of being performed in an outpatient setting without general anesthesia.
In Cases of Infertility and Unsuccessful IVF
Pipelle biopsy is an important stage of examination in cases of reproductive difficulties. When a woman cannot conceive within a year or undergoes unsuccessful IVF attempts, physicians look for hidden causes. One possible factor is chronic endometritis, which often proceeds asymptomatically but hinders embryo implantation. The biopsy also allows for the exclusion or confirmation of structural mucosal changes, hyperplasia, or hormonal imbalance that may interfere with pregnancy. Based on the histology results, the physician selects a personalized treatment strategy that increases the chances of successful conception.
Bloody Discharge and Irregular Menstruation
Changes in the nature of menstruation are a reason for a detailed examination. Heavy (menorrhagia) or scanty (hypomenorrhea), irregular, or completely absent menstrual periods (amenorrhea), as well as intermenstrual spotting, can be symptoms of hormonal imbalances, the presence of polyps, hyperplasia, or endometrial atrophy. Pipelle biopsy allows for obtaining endometrial tissue for histological analysis, detecting the presence of inflammation, excessive proliferation, or other pathologies. Histology reveals pre-cancerous changes at an early stage when treatment is most effective. The method allows for avoiding unnecessary surgical intervention if the changes are benign, or for initiating therapy promptly if malignant cells are found.
Chronic Endometritis and Hyperplasia
Chronic endometritis develops after infections, curettage, childbirth, or abortion, and often goes unnoticed. It can provoke cycle irregularities, pain, spotting, and reduce the ability to conceive. Biopsy helps to establish an accurate diagnosis, which is especially important when planning a pregnancy. Hyperplasia is a thickening of the mucosa caused by hormonal imbalance. It can be simple, without atypia, or accompanied by atypical cells—precursors to cancer. Pipelle biopsy is the primary method for differentiating these conditions and initiating timely treatment. However, when focal atypical hyperplasia is suspected, the method may be insufficiently informative—in such cases, hysteroscopy with targeted biopsy is utilized.
Follow-up after Surgery and Treatment
After the removal of polyps, curettage procedures, or hormone therapy, it is important to assess how the endometrium is recovering. The Pipelle method allows this to be done without repeated trauma or hospitalization. It helps determine the effectiveness of the treatment and the need for its adjustment. Biopsy is also prescribed after therapy for hyperplasia or endometritis to ensure the absence of pathological changes and signs of inflammation. This is an important monitoring stage, especially when preparing for pregnancy or before a repeat IVF attempt.
When Pipelle Biopsy Cannot Be Performed (Contraindications)
Despite its safety and simplicity, Pipelle biopsy has several contraindications. The procedure is not performed in cases of:
• Confirmed pregnancy—intervention in the uterine cavity can lead to miscarriage or other complications.
• Acute inflammatory diseases of the pelvic organs—for example, endometritis, salpingo-oophoritis, cervicitis, as material collection can exacerbate the inflammation and lead to its spread.
• Heavy uterine bleeding—it is difficult to obtain a quality sample under these conditions, and the risk of complications increases.
• Cervical stenosis (severe narrowing of the cervix)—this hinders the passage of the catheter and makes the procedure painful or impossible.
• Cervical canal atresia in older women.
There are also a number of relative contraindications, where the decision is made individually. For example, in cases of blood coagulation disorders, after recent surgery, or while taking certain medications. The physician must assess the patient's general condition, the results of laboratory tests, and ultrasound before recommending the biopsy.
How to Prepare for the Procedure
To ensure the procedure is as safe and informative as possible, proper preparation is important. Preparation usually includes several stages:
• Diagnostics: before the biopsy, a pelvic ultrasound is mandatory to clarify the thickness and structure of the endometrium. Swabs for flora and infections (STIs, bacterial vaginosis), a Complete Blood Count (CBC), and a coagulogram are also prescribed to rule out inflammation and coagulation disorders.
• Exclusion of Vaginal Interventions: for 2–3 days prior to the procedure, sexual intercourse should be avoided, and vaginal suppositories, creams, douches, and tampons should not be used. This reduces the risk of introducing infection and does not distort the analysis results.
• Medication Adjustment: if you are taking anticoagulants (e.g., warfarin, aspirin, clopidogrel), be sure to inform your physician. It may be necessary to change the treatment regimen a few days before the biopsy.
On the day of the procedure, no adjustment to diet or medication intake is required. However, it is advisable to wear comfortable clothing and bring a sanitary pad—slight bloody discharge is possible after the manipulation.
How is the Pipelle Endometrial Biopsy Performed?
Pipelle biopsy is an outpatient procedure performed without general anesthesia, most often in the gynecologist's office. Hospitalization and subsequent rehabilitation are not required.
The woman is positioned in the gynecological chair. The physician treats the external genitalia and cervix with an antiseptic. Then, a special instrument—the Pipelle catheter—is gently inserted into the cervix. This is a thin, flexible tube with an inner plunger. Upon insertion of the catheter, the patient may experience mild discomfort or a sensation of a brief cramp, similar to menstrual pain. Anesthesia is usually not necessary, but in cases of increased sensitivity, the physician may use a local anesthetic.
After the material is collected, the catheter is withdrawn, and the patient can immediately go home. The entire procedure, from preparation to completion, takes no more than 10–15 minutes.
How the Material is Collected
The Pipelle catheter is designed like a syringe. When the physician pulls the plunger back, negative pressure (vacuum) is created, which draws microscopic fragments of the uterine mucous membrane—the endometrium—into the tube. This is an aspiration method; the tissue is not cut out but is "suctioned" into the instrument. This approach reduces the risk of trauma and infection, and does not require cervical dilation, unlike classical curettage.
The collected material is placed in a special tube with a preservative solution and sent to the laboratory for histological examination. There, a pathologist evaluates the tissue structure under a microscope, checking for cellular changes, inflammation, polyps, and other pathologies.
After the Procedure: What to Expect
Immediately after the manipulation, the woman is advised to rest briefly (15–30 minutes). The following may occur:
• Slight pulling pain in the lower abdomen.
• Spotting (bloody discharge) for 1–3 days.
These symptoms are considered normal and do not require treatment. Within the next 48 hours, it is advisable to adhere to the following recommendations:
• Abstain from sexual intercourse.
• Do not use tampons, douches, or vaginal suppositories.
• Avoid heat procedures: do not visit a bathhouse, sauna, or take a hot bath.
If the following alarming symptoms appear—heavy bleeding, fever, chills, purulent discharge—it is necessary to contact a physician immediately. This may indicate the development of complications.
What Histology Reveals
The results of the histological examination are usually ready within 5–10 working days. The report contains information about:
• The phase of the menstrual cycle (proliferative, secretory). This is particularly relevant for diagnosing luteal phase insufficiency and clarifying the causes of infertility.
• The presence of inflammatory changes (acute or chronic endometritis).
• The endometrial structure—normal or hyperplastic, with atypical cells.
• The presence of polyps or other neoplasms.
• Pre-cancerous or malignant changes.
Based on the histology, the physician can establish an accurate diagnosis and prescribe appropriate treatment or further examination.
Pros and Cons of the Method
The main advantages of Pipelle biopsy are:
• Minimal invasiveness—the mucosa is practically undamaged.
• No need for general anesthesia or hospitalization.
• Rapid performance and recovery.
• High informational value, especially when chronic endometritis, hyperplasia, or cellular atypia are suspected.
• Possibility of repeat procedures—for example, to monitor treatment effectiveness.
Disadvantages and limitations:
• Does not allow for the accurate diagnosis of focal lesions (e.g., small polyps or areas of endometriosis that were not included in the sample).
• In rare cases, the tissue volume is insufficient for a full evaluation.
• Possible pain and discomfort, especially in nulliparous women or with a narrow cervical canal.
Possible Complications
Although Pipelle biopsy is considered a safe procedure, like any intervention, it carries risks. In rare cases, the following may occur:
• Heavy bloody discharge.
• Lower abdominal pain that persists for more than 24 hours.
• Infectious complications, especially if sterility is not maintained or if there is hidden inflammation.
• Reaction to antiseptics or local anesthesia (allergy, irritation).
The risk of complications is minimal with meticulous preparation, adherence to recommendations, and the procedure being performed by an experienced specialist.
Pipelle biopsy is a gentle and informative method for examining the mucous membrane of the uterus, in which the physician obtains a small fragment of the endometrium for analysis. The procedure is performed using a thin, flexible tube (the Pipelle catheter), without cervical dilation, and most often, without anesthesia. However, local anesthesia may be used in patients with a low pain threshold, especially in nulliparous women. Simply put, it is an aspiration diagnostic method that allows a small area of tissue to be "suctioned" and examined under a microscope. This examination helps to identify the presence of inflammation, atypical cells, hyperplasia, polyps, and other changes affecting women's health.
When is Pipelle Biopsy Prescribed?
The procedure is prescribed when endometrial pathologies—the inner lining of the uterus—are suspected. It helps to detect hormonal disorders, inflammation, neoplasms, and pre-cancerous changes. It is also performed as part of the follow-up after surgical interventions and hormone therapy. A physician may refer a patient for a Pipelle biopsy for:
• Irregular or painful menstruation (dysmenorrhea).
• Intermenstrual bleeding (metrorrhagia).
• Pre-conception planning and IVF (In Vitro Fertilization).
• Long-term infertility without an obvious cause.
• Suspicion of endometrial hyperplasia, polyps, or cancer.
• Chronic inflammation of the uterine mucosa (chronic endometritis).
The method is valued for its informational content, minimal invasiveness, and the possibility of being performed in an outpatient setting without general anesthesia.
In Cases of Infertility and Unsuccessful IVF
Pipelle biopsy is an important stage of examination in cases of reproductive difficulties. When a woman cannot conceive within a year or undergoes unsuccessful IVF attempts, physicians look for hidden causes. One possible factor is chronic endometritis, which often proceeds asymptomatically but hinders embryo implantation. The biopsy also allows for the exclusion or confirmation of structural mucosal changes, hyperplasia, or hormonal imbalance that may interfere with pregnancy. Based on the histology results, the physician selects a personalized treatment strategy that increases the chances of successful conception.
Bloody Discharge and Irregular Menstruation
Changes in the nature of menstruation are a reason for a detailed examination. Heavy (menorrhagia) or scanty (hypomenorrhea), irregular, or completely absent menstrual periods (amenorrhea), as well as intermenstrual spotting, can be symptoms of hormonal imbalances, the presence of polyps, hyperplasia, or endometrial atrophy. Pipelle biopsy allows for obtaining endometrial tissue for histological analysis, detecting the presence of inflammation, excessive proliferation, or other pathologies. Histology reveals pre-cancerous changes at an early stage when treatment is most effective. The method allows for avoiding unnecessary surgical intervention if the changes are benign, or for initiating therapy promptly if malignant cells are found.
Chronic Endometritis and Hyperplasia
Chronic endometritis develops after infections, curettage, childbirth, or abortion, and often goes unnoticed. It can provoke cycle irregularities, pain, spotting, and reduce the ability to conceive. Biopsy helps to establish an accurate diagnosis, which is especially important when planning a pregnancy. Hyperplasia is a thickening of the mucosa caused by hormonal imbalance. It can be simple, without atypia, or accompanied by atypical cells—precursors to cancer. Pipelle biopsy is the primary method for differentiating these conditions and initiating timely treatment. However, when focal atypical hyperplasia is suspected, the method may be insufficiently informative—in such cases, hysteroscopy with targeted biopsy is utilized.
Follow-up after Surgery and Treatment
After the removal of polyps, curettage procedures, or hormone therapy, it is important to assess how the endometrium is recovering. The Pipelle method allows this to be done without repeated trauma or hospitalization. It helps determine the effectiveness of the treatment and the need for its adjustment. Biopsy is also prescribed after therapy for hyperplasia or endometritis to ensure the absence of pathological changes and signs of inflammation. This is an important monitoring stage, especially when preparing for pregnancy or before a repeat IVF attempt.
When Pipelle Biopsy Cannot Be Performed (Contraindications)
Despite its safety and simplicity, Pipelle biopsy has several contraindications. The procedure is not performed in cases of:
• Confirmed pregnancy—intervention in the uterine cavity can lead to miscarriage or other complications.
• Acute inflammatory diseases of the pelvic organs—for example, endometritis, salpingo-oophoritis, cervicitis, as material collection can exacerbate the inflammation and lead to its spread.
• Heavy uterine bleeding—it is difficult to obtain a quality sample under these conditions, and the risk of complications increases.
• Cervical stenosis (severe narrowing of the cervix)—this hinders the passage of the catheter and makes the procedure painful or impossible.
• Cervical canal atresia in older women.
There are also a number of relative contraindications, where the decision is made individually. For example, in cases of blood coagulation disorders, after recent surgery, or while taking certain medications. The physician must assess the patient's general condition, the results of laboratory tests, and ultrasound before recommending the biopsy.
How to Prepare for the Procedure
To ensure the procedure is as safe and informative as possible, proper preparation is important. Preparation usually includes several stages:
• Diagnostics: before the biopsy, a pelvic ultrasound is mandatory to clarify the thickness and structure of the endometrium. Swabs for flora and infections (STIs, bacterial vaginosis), a Complete Blood Count (CBC), and a coagulogram are also prescribed to rule out inflammation and coagulation disorders.
• Exclusion of Vaginal Interventions: for 2–3 days prior to the procedure, sexual intercourse should be avoided, and vaginal suppositories, creams, douches, and tampons should not be used. This reduces the risk of introducing infection and does not distort the analysis results.
• Medication Adjustment: if you are taking anticoagulants (e.g., warfarin, aspirin, clopidogrel), be sure to inform your physician. It may be necessary to change the treatment regimen a few days before the biopsy.
On the day of the procedure, no adjustment to diet or medication intake is required. However, it is advisable to wear comfortable clothing and bring a sanitary pad—slight bloody discharge is possible after the manipulation.
How is the Pipelle Endometrial Biopsy Performed?
Pipelle biopsy is an outpatient procedure performed without general anesthesia, most often in the gynecologist's office. Hospitalization and subsequent rehabilitation are not required.
The woman is positioned in the gynecological chair. The physician treats the external genitalia and cervix with an antiseptic. Then, a special instrument—the Pipelle catheter—is gently inserted into the cervix. This is a thin, flexible tube with an inner plunger. Upon insertion of the catheter, the patient may experience mild discomfort or a sensation of a brief cramp, similar to menstrual pain. Anesthesia is usually not necessary, but in cases of increased sensitivity, the physician may use a local anesthetic.
After the material is collected, the catheter is withdrawn, and the patient can immediately go home. The entire procedure, from preparation to completion, takes no more than 10–15 minutes.
How the Material is Collected
The Pipelle catheter is designed like a syringe. When the physician pulls the plunger back, negative pressure (vacuum) is created, which draws microscopic fragments of the uterine mucous membrane—the endometrium—into the tube. This is an aspiration method; the tissue is not cut out but is "suctioned" into the instrument. This approach reduces the risk of trauma and infection, and does not require cervical dilation, unlike classical curettage.
The collected material is placed in a special tube with a preservative solution and sent to the laboratory for histological examination. There, a pathologist evaluates the tissue structure under a microscope, checking for cellular changes, inflammation, polyps, and other pathologies.
After the Procedure: What to Expect
Immediately after the manipulation, the woman is advised to rest briefly (15–30 minutes). The following may occur:
• Slight pulling pain in the lower abdomen.
• Spotting (bloody discharge) for 1–3 days.
These symptoms are considered normal and do not require treatment. Within the next 48 hours, it is advisable to adhere to the following recommendations:
• Abstain from sexual intercourse.
• Do not use tampons, douches, or vaginal suppositories.
• Avoid heat procedures: do not visit a bathhouse, sauna, or take a hot bath.
If the following alarming symptoms appear—heavy bleeding, fever, chills, purulent discharge—it is necessary to contact a physician immediately. This may indicate the development of complications.
What Histology Reveals
The results of the histological examination are usually ready within 5–10 working days. The report contains information about:
• The phase of the menstrual cycle (proliferative, secretory). This is particularly relevant for diagnosing luteal phase insufficiency and clarifying the causes of infertility.
• The presence of inflammatory changes (acute or chronic endometritis).
• The endometrial structure—normal or hyperplastic, with atypical cells.
• The presence of polyps or other neoplasms.
• Pre-cancerous or malignant changes.
Based on the histology, the physician can establish an accurate diagnosis and prescribe appropriate treatment or further examination.
Pros and Cons of the Method
The main advantages of Pipelle biopsy are:
• Minimal invasiveness—the mucosa is practically undamaged.
• No need for general anesthesia or hospitalization.
• Rapid performance and recovery.
• High informational value, especially when chronic endometritis, hyperplasia, or cellular atypia are suspected.
• Possibility of repeat procedures—for example, to monitor treatment effectiveness.
Disadvantages and limitations:
• Does not allow for the accurate diagnosis of focal lesions (e.g., small polyps or areas of endometriosis that were not included in the sample).
• In rare cases, the tissue volume is insufficient for a full evaluation.
• Possible pain and discomfort, especially in nulliparous women or with a narrow cervical canal.
Possible Complications
Although Pipelle biopsy is considered a safe procedure, like any intervention, it carries risks. In rare cases, the following may occur:
• Heavy bloody discharge.
• Lower abdominal pain that persists for more than 24 hours.
• Infectious complications, especially if sterility is not maintained or if there is hidden inflammation.
• Reaction to antiseptics or local anesthesia (allergy, irritation).
The risk of complications is minimal with meticulous preparation, adherence to recommendations, and the procedure being performed by an experienced specialist.
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