Does Uterus Biopsy Hurt and Fibroids: What to Know

If you’ve been told you need a uterine (endometrial) biopsy and you also have fibroids, it’s natural to wonder how much it will hurt, why it’s being done, and what to expect. Below, we explain the procedure, pain control options, how fibroids factor into the decision to biopsy, and how to prepare and recover—drawing on guidance from trusted health sources.

What is a uterine (endometrial) biopsy?

An endometrial biopsy is a brief office procedure that takes a small sample of the lining of the uterus (the endometrium) so it can be examined under a microscope. Clinicians use it to evaluate abnormal uterine bleeding, check for endometrial hyperplasia (pre-cancer), or diagnose endometrial cancer. It’s different from a cervical biopsy (which samples the cervix) and is not typically used to diagnose fibroids themselves.

For many people with fibroids, a biopsy is ordered to make sure there isn’t another cause of bleeding—especially if you’re 45 or older, have bleeding after menopause, or have risk factors such as obesity, polycystic ovary syndrome, or a history of estrogen-only therapy. Imaging (usually transvaginal ultrasound) is the main way fibroids are diagnosed; biopsy is about assessing the lining, not the fibroid tissue.

Does an endometrial biopsy hurt?

Pain experience varies. Most people describe brief, strong menstrual-like cramps that last seconds to a couple of minutes during the sampling. Here’s what to expect:

• During the procedure: A speculum is placed (like during a Pap test). The cervix may be cleaned and gently steadied. A narrow, flexible tube (often a “Pipelle”) passes through the cervix to the uterus, a quick measurement is taken, and suction is applied to collect tissue. The sampling portion typically lasts less than one minute; the entire visit is often 5–10 minutes.
• What the cramps feel like: Many feel a sharp cramp when the instrument passes the cervix or when suction begins. For others, discomfort is mild. Anxiety, cervical tightness, and not having had a vaginal delivery can increase discomfort.
• Pain control options: Taking an over-the-counter NSAID (such as ibuprofen) 30–60 minutes before can lessen cramping—ask your clinician and follow the label. Some clinics offer a local anesthetic to the cervix (a paracervical block) to reduce pain. Guided breathing, music, and having a support person can help.

Afterward, mild cramping or spotting for a day or two is common and usually responds to NSAIDs and rest.

How do fibroids affect the need for, or experience of, biopsy?

Fibroids (uterine leiomyomas) are benign growths in or on the uterus that can cause heavy or prolonged periods, pelvic pressure, and anemia. Because fibroids and endometrial problems can both cause abnormal bleeding, clinicians often use biopsy to rule out endometrial hyperplasia or cancer—especially in higher-risk situations. Important points:

• Biopsy doesn’t diagnose fibroids: Fibroids are usually diagnosed with ultrasound or MRI. Biopsy evaluates the uterine lining.
• Sampling challenges: Submucosal fibroids (bulging into the cavity) or a distorted uterus can make office sampling more difficult or yield an insufficient sample. If that happens, your clinician may recommend hysteroscopy (a tiny camera inside the uterus) with targeted biopsy or a dilation and curettage (D&C) in the operating room for a more complete sample.
• Rarely is a fibroid biopsied directly: Suspicion for malignancy within a fibroid (such as leiomyosarcoma) is uncommon. When concern exists, evaluation relies on imaging patterns and clinical factors; definitive diagnosis typically comes from surgical pathology after removal.

Preparing for your biopsy

• Medication: Ask if you should take an NSAID beforehand (if safe for you). Tell your clinician about blood thinners or bleeding disorders.
• Timing: Some providers avoid heavy-flow days unless bleeding itself is being evaluated. A pregnancy test is usually done beforehand because endometrial biopsy is not performed during pregnancy.
• Comfort: Eat lightly, wear comfortable clothes, and consider bringing a pad. Ask in advance about local anesthesia options if you’re concerned about pain.
• Consent and questions: Discuss why the biopsy is needed, alternatives (such as ultrasound or hysteroscopy), and how you’ll receive results.

What recovery looks like

• Common effects: Mild cramping and light spotting for 24–48 hours.
• Activity: Most people return to normal activity the same day. Many clinicians advise avoiding intercourse, tampons, and douching for 24–48 hours or as instructed.
• Pain relief: NSAIDs (if appropriate for you) and a heating pad usually help.
• Results: Pathology results often return in about 1–2 weeks; ask your clinic about their timeline.

Risks and safety

Endometrial biopsy is generally safe. Risks are uncommon but can include:

• Heavy bleeding (rare)
• Infection (rare)
• Uterine perforation (very rare)

Do not have a biopsy if you’re pregnant or have an active pelvic infection. Call your clinician urgently if you have any of the following after the procedure: soaking a pad every hour, fever or chills, foul-smelling discharge, severe pain not improving with medication, dizziness or fainting.

Alternatives and complementary tests

• Transvaginal ultrasound: First-line imaging for fibroids and to assess uterine lining thickness.
• Saline-infusion sonohysterography: Saline distends the uterus during ultrasound to better visualize submucosal fibroids or polyps.
• MRI: Useful for mapping fibroids before treatment.
• Hysteroscopy with directed biopsy: Allows the clinician to see and sample specific areas if an office biopsy is inconclusive or difficult.
• D&C: A more comprehensive sampling done in an operating room when needed.
• Note: A Pap test screens for cervical problems and does not evaluate the uterine lining.

FAQs

• Will a biopsy affect my fertility? An office endometrial biopsy samples a small portion of lining and does not typically affect fertility.
• Can I drive myself home? Most people can, unless you received sedation (which is uncommon). Expect mild cramping.
• How can I reduce pain? Ask about taking an NSAID before the visit, discuss local anesthesia, practice slow breathing, and schedule when you’re less anxious or cramping.
• Do fibroids make the biopsy more painful? Not necessarily, but fibroids that distort the cavity can make the procedure technically trickier. Discuss options like local anesthesia or hysteroscopic sampling if prior attempts were painful or inadequate.

Bottom line

A uterine (endometrial) biopsy is a quick test that can provide crucial answers about abnormal bleeding, including in people who have fibroids. Most experience brief, manageable cramping. Preparing with pain-relief strategies, knowing what to expect, and understanding how fibroids factor into the decision can make the process smoother. If you’re unsure whether you need a biopsy—or you’re worried about pain—talk through alternatives and anesthesia options with your clinician.

This article is for educational purposes and is not a substitute for personalized medical advice.

Sources and further reading

• MedlinePlus, Endometrial biopsy: https://medlineplus.gov/ency/article/003916.htm
• American College of Obstetricians and Gynecologists (ACOG), Endometrial Biopsy (Patient FAQ): https://www.acog.org/womens-health/faqs/endometrial-biopsy
• U.S. Office on Women’s Health (HHS), Uterine Fibroids: https://www.womenshealth.gov/a-z-topics/uterine-fibroids
• NICHD (NIH), What are fibroids?: https://www.nichd.nih.gov/health/topics/uterine/conditioninfo/fibroids
• National Cancer Institute (NIH), Uterine (Endometrial) Cancer—Testing and Diagnosis (PDQ): https://www.cancer.gov/types/uterine/patient/endometrial-treatment-pdq