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Endometrial Biopsy

Introduction:An endometrial biopsy is a way for your doctor to take a small sample of the lining of the uterus (endometrium). The sample is looked at under a microscope for abnormal cells. An endometrial biopsy helps your doctor find any problems in the endometrium. It also lets your doctor check to see if your body’s hormone levels that affect the endometrium are in balance.

Doctors take biopsies of areas that look abnormal and use them to detect cancer, precancerous cells, infections, and other conditions. For some biopsies, the doctor inserts a needle into the skin and draws out a sample; in other cases, tissue is removed during a surgical procedure.

The lining of the uterus changes throughout a woman’s menstrual cycle. Early in the menstrual cycle, the lining grows thicker until a mature egg is released from an ovary (ovulation). If the egg is not fertilized by a sperm, the lining is shed during normal menstrual bleeding.

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There are several ways to do an endometrial biopsy. Your doctor may use:

*A soft, straw-like device (pipelle) to suction a small sample of lining from the uterus. This method is fast and is not very painful.

*A sharp-edged tool called a curette. Your doctor will scrape a small sample and collect it with a syringe or suction. This is called a dilation and curettage (D&C). A D&C may be done to control heavy uterine bleeding (hemorrhage) or to help find the cause of bleeding. This is done with general or regional anesthesia.

*An electronic suction device (Vabra aspiration). This method can be uncomfortable.

*A spray of liquid (jet irrigation) to wash off some of the tissue that lines the uterus. A brush may be used to remove some of the lining before the washing is done.

When a woman is having a hard time becoming pregnant, an endometrial biopsy may be done to see whether the lining of her uterus can support a pregnancy.

An endometrial biopsy may also be done to find the cause of abnormal uterine bleeding, to check for overgrowth of the lining (endometrial hyperplasia), or to check for cancer.

An endometrial biopsy is sometimes done at the same time as another test, called hysteroscopy, which allows your doctor to look through a small lighted tube at the lining of the uterus.

Why It Is Done
An endometrial biopsy is done to:

*Check for cancer. For example, an endometrial biopsy may be done to help determine the cause of some abnormal Pap test results.
*Find the cause of heavy, prolonged, or irregular uterine bleeding. It is often done to find the cause of uterine bleeding in women who have gone through menopause.

*See whether the lining of the uterus (endometrium) is going through the normal menstrual cycle changes.

How To Prepare
Tell your doctor if you:

*Are or might be pregnant. An endometrial biopsy is not done during pregnancy.

*Are taking any medicines.

*Are allergic to any medicines.

*Have had bleeding problems or take blood-thinners, such as aspirin or warfarin (Coumadin).

*Have been treated for a vaginal, cervical, or pelvic infection.

*Have any heart or lung problems.
Do not douche, use tampons, or use vaginal medicines for 24 hours before the biopsy. You will empty your bladder just before your biopsy.

If you are not bleeding heavily, you might want to take an NSAID medicine such as ibuprofen one to two hours before the test, to reduce the possibility of uterine cramps during the procedure. Ask your physician for a recommendation ahead of time.

You will need to sign a consent form that says you understand the risks of an endometrial biopsy and agree to have the test done. Talk to your doctor about any concerns you have regarding the need for the test, its risks, how it will be done, or what the results may mean. To help you understand the importance of this test, fill out the medical test information form (What is a PDF document?) .

If you are having a dilation and curettage (D&C) and will go to sleep (general anesthesia) for the test, do not eat or drink anything for 8 hours before the test. If you are taking any medicines, ask your doctor what medicines you can take the day of the test.

How It Is Done
An endometrial biopsy is usually done by a gynecologist, a family medicine physician, or a nurse practitioner who has been trained to do the test. The sample will be looked at by a pathologist. The biopsy can be done in your doctor’s office.

Your cervix may be numbed with a spray or injection of local anesthetic.

You will need to take off your clothes below the waist. You will be given a covering to drape around your waist. You will then lie on your back on an examination table with your feet raised and supported by foot rests (stirrups).

Your doctor will put an instrument with smooth, curved blades (speculum) into your vagina. The speculum gently spreads apart the vaginal walls so your doctor can see inside the vagina and the cervix. See a picture of a pelvic examination with a speculum. The cervix is washed with a special solution and may be grasped and held in place with a clamp called a tenaculum.

The tool to collect the sample is guided through the cervix into the uterus. The tool may be moved up and down to collect the sample. Most women have some cramping during the biopsy.

An endometrial biopsy takes 5 to 15 minutes.

Dilation and curettage (D&C)
A D&C is usually done in a hospital or clinic. Most women do not need to stay overnight but can go home the same day.

Your doctor will put an instrument with smooth, curved blades (speculum) into your vagina. The speculum gently spreads apart the vaginal walls so your doctor can see inside the vagina and the cervix. Your cervix will be gently spread open (dilated). Depending on the reason for the D&C, your doctor may use a tool called a hysteroscope to look inside the uterus. A small spoon-shaped instrument (curette) is then guided through the cervix and into the uterus. The top layer of the lining of the uterus is carefully scraped off and removed (along with any other tissue that looks abnormal) for biopsy.

If you have general anesthesia, you will be watched by a nurse in the recovery room until you are fully awake.

You can do most of your normal activities in a few days. Do not lift anything heavy for a few days after the test. Do not douche or have sex for one week after the test.

How It Feels
If you have not had any pain medicine, you may feel a sharp cramp as the tool is guided through your cervix. You may feel more cramping when the biopsy sample is collected. Most women find that the cramping feels like a really bad menstrual cramp.

Some women feel dizzy and sick to their stomachs. This is called a vasovagal reaction. This feeling will go away after the biopsy.

An endometrial biopsy usually causes some vaginal bleeding. You can use a pad for the bleeding or spotting.

Dilation and curettage (D&C)
If general anesthesia is used during a D&C, you will be asleep and feel nothing. After the test, you will feel sleepy for a few hours. You may be tired for a few days after the test. You may also have a mild sore throat if a tube (endotracheal tube, or ET) was placed in your throat to help you breathe during the test. Using throat lozenges and gargling with warm salt water may help relieve your sore throat.

Risks Factors:
You might have pelvic cramps (sometimes intense) during the procedure and sometimes for a day or two afterward; you may also experience a small amount of vaginal bleeding. It is extremely rare to have heavy bleeding or to develop an infection that needs treatment.There is also a small risk of disturbing a very early pregnancy. To guard against this, your doctor might order a pregnancy test before performing the biopsy.

After the test:
You may feel some soreness in your vagina for a day or two. Some vaginal bleeding or discharge is normal for up to a week after a biopsy. You can use a sanitary pad for the bleeding. Do not do strenuous exercise or heavy lifting for one day after your biopsy. Do not douche. You may have to avoid sex or using tampons for several days. Ask your doctor when you can have sex or use tampons again.

Follow any instructions your doctor gave you. Call your doctor if you have:

*Heavy vaginal bleeding (more than a normal menstrual period).

*A fever.

*Belly pain.

*Bad-smelling vaginal discharge.

Results:
Time to know the results:
An endometrial biopsy is a way for your doctor to take a small sample of the lining of the uterus (endometrium). Lab results from a biopsy may take several days to get back.


Endometrial biopsy  Normal
: No abnormal cells or cancer is found. For women who have menstrual cycles, the lining of the uterus is at the right stage for the time in the menstrual cycle when the biopsy was done.

Endometrial biopsy  Abnormal:

*A noncancerous (benign) growth, called a polyp, is present.

*Overgrowth of the lining of the uterus (endometrial hyperplasia) is present.

*Cell changes that may lead to cancer are present.

For women who have menstrual cycles, the lining of the uterus is not at the right stage for the time in the menstrual cycle when the biopsy was done. More tests may be needed.

Resources:
https://www.health.harvard.edu/fhg/diagnostics/endometrial-biopsy.shtml
http://women.webmd.com/endometrial-biopsy

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Black Haw

Botanical Name :Viburnum prunifolium
Family: Caprifoliaceae
Synonyms: black haw bark, sweet viburnum, stag bush, American sloe
Common Name: blackhaw viburnum
Order: : Caprifoliaceae
Parts used: Bark, root bark.

Habitat: Native to eastern and central North America

Description:
Black haw is usually grown as a large, upright, multi-stemmed, deciduous shrub with an irregular crown, but it also may be grown as a small, single trunk tree. As a shrub, it typically grows 12-15′ tall with a spread of 6-12′, but as a tree may reach a height of 30′. A Missouri native plant which commonly occurs in moist woods, thickets and on streambanks throughout the State. Non-fragrant white flowers in flat-topped cymes (to 4.5″ diameter) appear in spring.

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Flowers give way in autumn to blue-black, berry-like drupes which often persist into winter and are quite attractive to birds and wildlife. Ovate, finely toothed, glossy dark green leaves (to 4″ long) turn attractive shades of red and purple in fall. Fruits are edible and may be eaten off the bush when ripe or used in jams and preserves. Common name refers to the purported similarity of this plant to hawthorns (sometimes commonly called red haws), though hawthorns are in a different family.

Constituents : Black haw contains triterpenoids, coumarins, bitter principle, valerianic acid, salicosides, tannin.

Medicinal Uses:
The black haw has been traditionally used in a number of ways by the Native Americans, the stem of the plant were used to make baskets, while the berries were turned into a kind of jam. Fertility was believed to be boosted by the plant, and to increase a slave woman’s ability to bear more children, many Southern slave owners used to coerce their female slaves to eat the black haw berries – the idea being to make her bear more children. The supposed ability of the herb to boost fertility in women is even mentioned in the old clinical text called the Kings American Dispensatory, this 19th-century medical text was extensively used by medical doctors of that era, in this text, a group of doctors called the Eclectic movement state various uses of the herb to boost fertility and to preclude abortion in women, it is written:” It was customary for planters to compel female slaves to drink an infusion of black haw daily whilst pregnant to prevent abortion”- thus the plant was believed to control fertility and the reproductive functions of women.

It is also known that long before the colonization of North America by Europeans, in many indigenous Native American cultures, the women traditionally made use of the black haw plant for medicinal purposes – using a wide variety of herbal remedies made from different parts of the plant. In many North American cultures, the physical symptoms associated with menopause and the symptoms of menstrual cramps in women were treated by drinks of a decoction prepared from the bark of the black haw plant, the bark decoction was also used in the prevention of miscarriages and to ease the intense pains following labor during the birth of a child. Disorders of the blood and problems such as migraines were also traditionally treated using species of plants related to the black haw. As Europeans came to the continent, they learnt the value of the black haw from natives, and used it in many remedial applications; the black haw was very highly regarded as a remedy by the Eclectics, mentioned before. For example, internal irritation in the womb is alleviated by the remedies made from black haw bark, in women with a history of difficult pregnancies; the herbal remedy made from this plant is therefore a useful and very potent ally in dealing with various symptoms. The presence of a particular helpful chemical known to be a uterine relaxing agent called scopoletin confirms the validity of its traditional use in this role to some extent. Many modern herbalists still swear by the remedial properties of the black haw bark.

As an herbal remedy, the strong astringent and anti-spasmodic effects of the black haw are used specifically in the treatment of pain associated with the menstrual cycle in affected women. Many other gynecological disorders and conditions are also treated using the remedies derived from the black haw bark, thus the practices of the 19th-century are still followed by many herbalist. Some of the conditions treated using the bark include excessive bleeding during menopause in women, the prolapse of the uterus, the presence of morning sickness during pregnancy, and the threat or signs of miscarriage in pregnant women. The presence of colic or the presence of cramping pain along the bile ducts, pain along the digestive tract and the urinary tract are also typically treated using the black haw herb, the strong anti-spasmodic action of the plant comes into play and helps alleviate such physical conditions.

Collection & Harvesting:
Autumn is the usual period for harvesting of black haw root and trunk bark, this is preceded by the collection of bark from stems in the spring or summer. The normal way of collection of bark, is by uprooting the entire shrub and then carefully stripping off the bark from the roots and the trunk of the plant. During the summer or the spring the bark of the branches is collected and stored after drying – the difference in collecting time ensures optimal utilization of the plant as individual plants are dead when uprooted during autumn. Drying of the bark is carried out in shaded areas in all cases and these are then stored and processed to be used in herbal medications at a later time.

Click to see:What is the most important information one should know about black haw?

Click to see:- Black Haw Bark for Menstrual Cramp Cure

Disclaimer:The information presented herein is intended for educational purposes only. Individual results may vary, and before using any supplements, it is always advisable to consult with your own health care provider

Resources:
http://www.mobot.org/gardeninghelp/PlantFinder/plant.asp?code=G240#lbl_culture
http://www.herbs2000.com/herbs/herbs_black_haw.htm
http://www.purplesage.org.uk/profiles/blackhaw.htm