Hysteroscopy with endometrial biopsy – what is it?
Hysteroscopy is a diagnostic procedure that is performed to detect diseases of the uterus. In addition to the inspection of the uterine cavity, the study allows for small operations in its cavity and take tissue for diagnosis. Quite often carried out hysteroscopy with endometrial biopsy? To determine this study?
The purpose of the biopsy
Biopsy endometrial is the study of the mucous layer of the uterus to identify the reasons for the formation of infertility, hormonal disorders, hyperplasia of the mucous membrane, cancer, causes of uterine bleeding. Currently the fence of this layer in the biopsy shown in the preparation of the patient for in vitro fertilization.
What is the endometrium and what value this fabric has in a woman’s body? The endometrium is the tissue lining the uterine cavity. The fabric ensures the fixation of the ovum in the uterus and creates favorable conditions for normal development of pregnancy. He has the ability to cut off, if the period of the menstrual cycle is fertilization not come. The result of this process leads to menstrual bleeding.
During the menstrual cycle the endometrium undergoes several phases:
- Stage of proliferation. In this phase, under the action of the hormone estrogen is the formation of the functional layer. That is, the layer of cells that were rejected as a result of menstruation, begins to recover and becomes completely full to 14 day cycle.
- The secretory phase begins with the 15th day of the menstrual cycle and continues until the 27th.In the period of the secretory phase the glands secreted a secret that creates a «fertile ground» for implantation of the ovum in the uterus. This phase regulates the female sex hormone progesterone.
- Bleeding phase. It decreases the level of progesterone in the blood. As a result of hormonal deficiency in the endometrium occur vascular changes leading to cell death. Phase starts with a 28 day cycle and lasts about 4 days.
Indications for biopsy
Biopsy of the mucus layer has clear indications for use. These include:
- Prolonged and heavy menstrual bleeding.
- Absence of menstruation for no apparent reason.
- A complication of contraceptive therapy.
- Evaluation of the effectiveness of treatment with hormones.
- Uterine bleeding outside the cycle or after menopause.
- The presence of polyps in the uterus.
- The failure or low efficiency of infertility treatment.
- Examination of the female reproductive system in the polyps of the uterus, ovarian cysts, endometriosis and other diseases.
- Postpartum bleeding or bleeding after abortion.
- The presence of tumors in the uterus and the ovaries.
- Examination prior to in vitro fertilization.
The timing of the study
The endometrial biopsy is performed in certain period of time. Definition of day of the cycle, which is the material for research depends on the purpose of a biopsy:
- 2-3 days before the onset of menstruation – infertility as a result of the failure of the corpus luteum;
- 8-10 days of menstruation – in heavy and prolonged bleeding;
- 1-2 days after the start of acyclic bleeding to determine the cause of krivomazova;
- immediately after the end of menstruation – when polyps of the uterus;
- in the period from 17 to 24 day menstrual cycle research is being conducted to identify the sensitivity of this layer to the hormones.
Contraindications to biopsy
In some cases, a biopsy is not carried out? Diagnostic hysteroscopy with material sampling for endometrial biopsy can be carried out at:
- pregnancy at any time;
- acute inflammatory diseases of small pelvis organs;
- disorders of blood clotting;
- serious condition of the patient in infectious and somatic diseases.
Preparation for hysteroscopy
Before the diagnostic procedure, a woman needs to prepare. To do this, the doctor assigns the patient laboratory tests: urinalysis and blood biochemical analysis of blood, analysis of blood, determination of microflora in the genital tract, blood for HIV, blood-contact hepatitis (b and C), syphilis.
In addition, you must give the woman the following recommendations:
- 3-4 days before the hysteroscopy to exclude sexual contact.
- During the week before the study not to use vaginal douching.
- Do not use creams, ointments, suppositories and solutions for vaginal use without the advice of a gynecologist.
- If you plan to use General anesthesia during the procedure, the day of the test is necessary to exclude the intake of any food or liquid.
How is the fence of the endometrium with hysteroscopy?
- First, conduct a gynecological examination of the patient with the tools and by manual examination.
- Then spend the anesthesia which may be General, local or regional. The choice of anesthesia in each case is individual and is determined by the doctor.
- After anesthesia spend processing the genital tract and cervix.
- Expand the cervix to the desired size with the help of special tools.
- The uterus is injected with sterile solution of sodium chloride.
- Then insert the hysteroscope to examine the uterine cavity by determining the parts of the fence material.
- Are sampling tissue samples are placed in a special container.
- Output solution from the cavity of the uterus and the hysteroscope is removed.
After the procedure the material is sent for analysis to the laboratory.
To realize a sample of the mucosa, hysteroscopy can be performed with an endoscope with a microscopic surgical tip. Mucosal samples were then sent to the laboratory, where they dehydrate, put in a fat soluble form to form paraffin cubes containing endometrial cells. Then the cube is cut into very thin plates, which are fixed on slides. Doctors with special qualifications, conduct inspection of finished samples with the help of special equipment.
The study takes up to 10 days.
The report will be sent to the gynecologist, which is based on clinical data and other studies puts the final diagnosis.
What diseases are diagnosed by biopsy of the endometrium?
All of the pathology that can be identified in the study are divided into several groups:
- Hyperplastic disorders. This group of diseases include: endometrial polyps, hyperplastic process of the glandular, glandular-cystic hyperplasia, atypical hyperplasia, or a precancerous condition in the tissue of the uterus.
- Hypoplastic condition: atrophic processes in the endometrium, endometritis on the background of hypoplasia (not performing its function sufficiently).
- Inflammatory disease – acute and chronic endometritis.
- Cancer is a glandular cancer of the endometrium, squamous cell and undifferentiated carcinoma.
Biopsy of the mucous layer of the uterus to date is quite informative study of the female reproductive system. Timely diagnosis can prevent many illnesses or to prevent their development at an early stage.