Question re endometrial biopsy

[slolegd]

I'm writing to ask about endometrial biopsy.  I am postmenopausal, 53 and have been on HRT x2 years or so, but  I have only been taking Estrogen for six months or so because it seemed like the progesterone made me bleed.  My Gyn said this was very wrong of me to dc my own progesterone and needed an ultrasound to determine the lining thickness.  Came back 1.0 cm thick and she said .5 was WNL, so she needs to do a biopsy.  I have a tight closed cervical os so it has to be a hospital procedure.  My question is this:  the d&c procedure she said can be done with LEEP or
the other way, actually dilating the os, apparently, takes longer.  How can it be called a D&C with LEEP which seems only a biopsy?  Is the sample taken with LEEP representative of the entire uterine lining?  Thank you.

[Machelle Seibel, MD]

LEEP stands for loop electrosurgical excision procedure. It uses a wire loop to peal off a layer of the cervix (neck of the womb). It is usually used for abnormal pap smears, not abnormal uterine lining, so it isn't clear to me why you are getting a LEEP procedure here.

Estrogen makes the uterine lining build up. The progesterone is added the last two weeks of the month to stop it from building up further and then when the progesterone is stopped, the lining sheds. So progesterone taken for two weeks then off two weeks typically does cause bleeding, but only when it is stopped.

If estrogen only is used, it can lead to abnormal uterine lining cells but that usually takes up to 10 years. It usually isn't a problem in 6 months. However, many doctors might do a biopsy of the uterine lining (endometrial biopsy). If the cervix is tight, it might need to be stretched slightly. This is called a dilation and is the "D" in D&C. Sometimes that can be done in the office. If not, it sometimes is done in the operating room so the person can have more anesthesia. The doctor doesn't usually use LEEP to open the cervix; they just use a dilator to open it up a little so the scraping instrument (currette which is the "C" in D&C) can be placed inside to remove a little tissue from the uterine lining. Neither takes very long in most instances.
Machelle M. Seibel, MD