Endometrial sampling

1. Long-term unopposed estrogen stimulation in anovulatory patients can result in endometrial hyperplasia, which can progress to adenocarcinoma; therefore, in perimenopausal patients who have been anovulatory for an extended interval, the endometrium should be biopsied.

2. Biopsy is also recommended before initiation of hormonal therapy for women over age 30 and for those over age 20 who have had prolonged bleeding.

3. Hysteroscopy and endometrial biopsy with a Pipelle aspirator should be done on the first day of menstruation (to avoid an unexpected pregnancy) or anytime if bleeding is continuous. Hysterosonography with uterine saline infusion may also be used.

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