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 biopsies of the correct areas may be done. The biopsy tissue will be examined by a pathologist under a microscope to determine the true severity of any pre-cancerous 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 and is almost always done in the office.
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. 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 allows direct visualization of the uterine cavity. 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. While hysteroscopy allows us to see the openings of the fallopian tubes in each upper corner of the uterus, it does not allow us to see into the tubes themselves or to evaluate the muscle layer or external surface of the uterus. 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.
Endometrial ablation is a minimally invasive procedure for treating heavy periods and works by minimizing 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. Ninety percent 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 needed. Although there are others, the method of ablation that has been chosen for use at the hospital and in our office is NovaSure.
Placement of Intrauterine Devices (IUDs)
An IUD may be placed at any time in the menstrual cycle but is usually put in place when patients have their periods. This limits the chances of an undetectably early pregnancy. IUDs should only be placed in non-pregnant women but may be used as emergency contraception.
The copper IUD is immediately effective. It has the disadvantage of being associated with longer, heavier, crampier menses but is a very reliable and otherwise convenient method of contraception, and one of very few that does not involve hormones. It is approved for use for up to 10 years. Progesterone IUDs 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. Progesterone IUDs usually make periods lighter and shorter, though bleeding may be unpredictable or not occur at all. The progesterone IUDs vary with regards to how long they are approved for use (up to either 3 or 5 years).
Insertion generally takes only a few minutes but does involve some crampy pain and needs to be dilated to allow for placement. Use of a prescription medication called cytotec on the night before placement can relax the cervical opening and decrease the need for mechanical widening of the cervical os. We also 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.
For more information about IUDs, see Intrauterine Devices, and/or visit the official websites for
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.
Essure is a minimally invasive method of permanent, irreversible sterilization that involved placement of a small flexible titanium coil into each fallopian tube using hysteroscopy. It did not involve any surgical incisions. However, due to an unacceptable number of complications and safety concerns, the device was taken off the market as of the end of 2018. The manufacturer has stated that “women who have had Essure coils placed and are having no problems may continue to rely on Essure to prevent pregnancy.” Please speak to us regarding any questions that you may have. Unfortunately, the only way to have the devices removed is to have a hysterectomy.