The advantages of having procedures done in the office rather than in the hospital include greater privacy, less time required and lower cost. However, those women desiring sedation and the promise of a completely discomfort-free procedure may be better served in the hospital. It is your choice.
When a screening pap smear of the cervix reveals certain kinds of abnormal cells, a diagnostic study called colposcopy is the next step in the recommended evaluation. The colposcope is a device with a bright light and binocular type lenses that greatly magnify the view of the cervix. After a speculum is placed, the cervix is soaked with vinegar for several minutes. This makes abnormal areas visible so that a biopsy of the correct area may be done. The biopsy tissue will be examined by a pathologist under a microscope to determine the true severity of any precancerous changes. The cervical canal may also be sampled using an instrument called an endocervical curette. Colposcopy should be scheduled when you are not having your period.
An untreated high grade pre-cancer of the cervix can progress to an invasive cancer of the cervix. Thanks to pap smears and colposcopy, these pre-cancers can be found when they are curable using a simple surgical procedure called a LEEP (Loop Electrosurgical Excision Procedure). An electric current is passed through a semi-circular wire or loop. The loop is used to remove the abnormal cervical tissue, and at the same time to coagulate blood vessels to minimize bleeding. A local anesthetic is given to numb the cervix and the LEEP is performed using the colposcope to magnify the view. LEEP should be scheduled when you are not having your period.
Low grade changes to the cervix will often get better without treatment and can be followed with more frequent pap smears.
Hysteroscopy means looking into the uterus. The procedure involves a speculum exam and the insertion of a small diameter fiberoptic instrument through the cervix. A slow, low pressure infusion of sterile saline is given to slightly expand the uterine cavity and a camera sends the images onto a screen. This enables your physician (and you, if desired) to see the inside of the uterus and the cervical canal. This is the best way to diagnose polyps and fibroids that may be the cause of abnormal bleeding. Hysteroscopy is best done when you are not having your period.
Endometrial biopsy is a method of sampling the uterine lining tissue (endometrium) using a small flexible plastic catheter. It is most often done for patients with abnormal bleeding. The most important purpose of the procedure is to look for any evidence of uterine cancer. It cannot be used to diagnose uterine fibroids but sometimes the appearance of the tissue suggests the presence of a polyp. Although it is not as thorough as having a D&C (dilatation and curettage), it is quick and well tolerated by most women. The reliability of the results can be increased by doing hysteroscopy to look inside the uterus. Endometrial biopsy is best done when you are not having your period.
NovaSure endometrial ablation is a minimally invasive procedure for treating heavy periods. Ablation is done to minimize the ability of the uterine lining to thicken in response to the normal estrogen produced by the ovaries. The less lining that builds up, the less there is to shed during a period. 90% of women who have had this procedure have significantly less bleeding and some stop having their periods completely. Ablation does not affect your ovaries so you will continue to have the cyclical symptoms you usually get with your periods, even if you are not bleeding, until you are post-menopausal. Ablation does not provide birth control, and is only for women who do not desire future pregnancy. Use of a reliable method of contraception after ablation is strongly encouraged.
For more information, go to NovaSure or speak with your doctor.
Essure is a minimally invasive method of permanent, irreversible sterilization that can be done with just a local anesthetic. Using a hysteroscopic device, the physician places small flexible titanium coils into both fallopian tubes where they open into the uterine cavity. Over the course of several months, scar tissue will form around the coils, blocking the tubes so that sperm and eggs cannot meet. It is over 99% effective. Pre-procedure treatment is often given to thin the uterine lining and allow easy identification of the fallopian tube openings. Three months after the procedure, an x-ray study called a hysterosalpingogram (HSG) is recommended to confirm that the tubes are completely blocked. A small percentage of patients require as long as 6 months after placement of the coils to achieve reliable contraception. An alternative birth control method should be used in the meantime.
For more information go to Essure or speak with your doctor.
IUDs may be placed at any time in the menstrual cycle. They should only be placed in non-pregnant women but may be used as emergency contraception. We often ask that placement be scheduled when the patient is having her period. The copper IUD (Paragard) is immediately effective. Progesterone IUDs (Mirena and Skyla) are effective immediately if placed during the first 5 days of the menstrual cycle. Otherwise, use of condoms for back-up is recommended for 7 days after insertion.
Insertion generally takes only a few minutes but does involve some crampy pain, especially if the cervical opening is small and needs to be dilated to allow for placement. We recommend the use of Ibuprofen or Naprosen (acetaminophen may also be taken at the same time) before placement. Occasionally women will feel lightheaded during or shortly after insertion. A small amount of bleeding may occur. There are no restrictions afterwards.
We also do all of the other routine minor gynecological procedures done by specialists in our field. These include but are not limited to excisional biopsies, cryotherapy of skin lesions, hymenotomy and treatment of labial/vaginal abscesses by incision and drainage.