After An Endometrial Biopsy and Fibroids: What to Know

If you live with uterine fibroids and just had an endometrial biopsy, you likely have questions about recovery, results, and what comes next. This guide explains what the biopsy can (and cannot) tell you, why fibroids may affect the process, and when to follow up.

Why an Endometrial Biopsy Is Done

An endometrial biopsy samples the uterine lining (endometrium) to evaluate abnormal uterine bleeding, check for endometrial hyperplasia (overgrowth) or cancer, and guide treatment decisions. It is typically performed in the office using a thin, flexible tube (often called a Pipelle). The test is brief, but cramping is common for a few minutes as the sample is obtained.

Fibroids (noncancerous growths in the uterus) are a common cause of heavy or irregular bleeding. Because fibroids can coexist with or mask other causes of bleeding, a biopsy helps rule out problems in the lining, like hyperplasia or cancer.

What to Expect After the Procedure

• Cramping: Mild to moderate menstrual-like cramps for a few hours, sometimes up to 24–48 hours.
• Spotting or light bleeding: Usually lasts a few days.
• Temporary discharge: A watery or brown discharge can occur if an antiseptic solution was used.

Activity: Most people can resume normal activities the same day. To lower infection risk, your clinician may advise avoiding vaginal intercourse, tampons, and douching for 24–48 hours or until bleeding stops. Over-the-counter pain relievers like ibuprofen can help with cramps if they are safe for you; ask your clinician if you take blood thinners or have kidney, stomach, or heart conditions.

When to Call Your Clinician

Complications are uncommon, but contact your clinician urgently or seek care if you have:

• Heavy bleeding (soaking a pad each hour for 2 or more hours)
• Severe or worsening pain not relieved by medication
• Fever (≥100.4°F/38°C), chills, or foul-smelling discharge
• Dizziness, fainting, or signs of infection

How Fibroids Can Affect Your Biopsy

Fibroids vary in size and location. Submucosal fibroids (those that bulge into the uterine cavity) and large intramural fibroids can distort the uterine cavity, which can:

• Make the procedure more technically challenging or uncomfortable
• Reduce the amount of lining obtained, leading to an “insufficient sample”
• Miss focal problems (like a small polyp or a localized area of hyperplasia) if the sample doesn’t reach that area

If your biopsy report says “insufficient tissue” or is inconclusive, your clinician may recommend additional evaluation, especially if bleeding continues. Next steps may include a transvaginal ultrasound, saline-infusion sonohysterography (ultrasound with saline to outline the cavity), hysteroscopy (a tiny camera to view the cavity and biopsy targeted areas), or a dilation and curettage (D&C).

What the Results Might Show—and What They Mean

• Normal or benign endometrium: Proliferative or secretory (hormone-related) changes are common and reassuring.
• Benign structural findings: Polyps or fragments of fibroid tissue may be noted; these can still cause bleeding and might be treated if symptoms persist.
• Endometrial hyperplasia: Overgrowth of the lining. Without atypia, it’s often treated with progestin therapy and follow-up biopsies. With atypia (also called atypical hyperplasia or endometrial intraepithelial neoplasia), the risk of or coexisting cancer is higher; management may include hysterectomy for those who have completed childbearing or fertility-sparing progestin therapy with close monitoring.
• Endometrial cancer: Uncommon but important to diagnose early. If cancer is found, you’ll be referred to a gynecologic oncologist to discuss staging and treatment.

Timing: Many practices share results within 1–2 weeks. If you don’t hear back, call your clinic. Be sure you understand your report and the plan for follow-up—even if results are normal—especially if you still have heavy or irregular bleeding.

Does a Biopsy Treat Fibroids?

No. An endometrial biopsy is diagnostic; it doesn’t remove or shrink fibroids. If fibroids are the main cause of your bleeding or pressure symptoms (pelvic pain, urinary frequency, bulk symptoms), treatment options may include:

• Watchful waiting: Appropriate if symptoms are mild.
• Medications: Hormonal options (e.g., levonorgestrel intrauterine system), tranexamic acid for heavy bleeding, and FDA-approved oral GnRH antagonist combinations that reduce fibroid-related bleeding.
• Procedures: Hysteroscopic removal for submucosal fibroids, uterine fibroid embolization, myomectomy, or hysterectomy, depending on symptoms, size, location, and fertility goals.

Your biopsy result helps your clinician rule out lining problems and focus safely on managing fibroid symptoms.

Special Considerations if You Have Fibroids

• Pain control: Cramping can be stronger if the cervix required dilation or if the cavity is more sensitive due to distortion.
• Bleeding risk: Fibroids that increase uterine blood flow may contribute to heavier post-procedure spotting. Using pads over tampons initially can help you monitor the amount.
• Fertility: A biopsy rarely affects fertility. If you’re trying to conceive, wait until bleeding has stopped and your clinician clears you. If pregnancy is possible at the time of biopsy, notify your clinician promptly.

Practical Aftercare Tips

• Use a pad for spotting; note how many you use.
• Hydrate, rest, and use a heating pad for cramps.
• Avoid intercourse, tampons, and douching for 24–48 hours or as advised.
• Resume exercise as you feel comfortable, starting light.
• Review your medication list with your clinician, especially if you take blood thinners or aspirin.

Questions to Ask at Your Follow-Up

• Was my sample adequate, and what did it show?
• Given my fibroids, is additional imaging or hysteroscopy recommended?
• What is the plan if my bleeding continues?
• Which treatment options best fit my goals (symptom relief, fertility, recovery time)?
• When should I return for re-evaluation or repeat sampling?

The Bottom Line

After an endometrial biopsy, some cramping and light bleeding are normal. Fibroids can contribute to bleeding and may sometimes make the biopsy less representative of the entire lining. Clear follow-up on your results, plus timely evaluation of ongoing symptoms, ensures that serious conditions are not missed and that you receive the most appropriate fibroid treatment for your needs.

Trusted Sources and Further Reading

• NIH MedlinePlus: Endometrial Biopsy – https://medlineplus.gov/ency/article/003916.htm
• NIH MedlinePlus: Uterine Fibroids – https://medlineplus.gov/uterinefibroids.html
• ACOG: Uterine Fibroids (Patient FAQ) – https://www.acog.org/womens-health/faqs/uterine-fibroids
• ACOG: Abnormal Uterine Bleeding – https://www.acog.org/womens-health/faqs/abnormal-uterine-bleeding
• ACOG: Endometrial Hyperplasia – https://www.acog.org/womens-health/faqs/endometrial-hyperplasia
• NCI (NIH): Uterine (Endometrial) Cancer – https://www.cancer.gov/types/uterine
• FDA: Oral therapy approved for heavy menstrual bleeding due to fibroids – https://www.fda.gov/news-events/press-announcements/fda-approves-first-oral-treatment-menstrual-bleeding-associated-uterine-fibroids
• FDA: Treatment to manage heavy menstrual bleeding associated with fibroids – https://www.fda.gov/drugs/news-events-human-drugs/fda-approves-treatment-manage-heavy-menstrual-bleeding-associated-uterine-fibroids

This article is for general information and does not replace personalized medical advice. Always follow the guidance of your healthcare professional.