Hysteroscopy: The Risks and B... Video Transcript

Participants

, Linda Bradley MD, Steve Cohen MD, Keith Isaacson MD, Grace Janik MD, Mary Lou Smith , Dean S. Cunningham MD

Summary

For many women, any gynecologic procedure is an unattractive prospect, and something with a name like "hysteroscopy" sounds downright frightening. In fact, hysteroscopy is a quick and comfortable procedure for treating various uterine conditions, and has many advantages over traditional gynecologic techniques. What is hysteroscopy, and when should it be used? Join our panel of experts as they discuss this important

Webcast Transcript

MARY WAGNER: Welcome to our webcast. I'm Mary Wagner. Every minute of every hour of every day at least one American woman undergoes a hysterectomy. Necessary or unnecessary? Almost half of those hysterectomies are performed for a condition known as abnormal uterine bleeding.

With us today are Dr. Linda Bradley, Director of Hysteroscopic Services at the Cleveland Clinic; Dr. Steven Cohen, Director for the Center of the Women's Minimal Access Surgery at Columbia University; Dr. Keith Isaacson, Director of Reproductive Endocrinology and Infertility at Massachusetts General Hospital and Harvard Medical School, and Dr. Grace Janik, Associate Clinical Professor at the Medical College of Wisconsin and Director of Reproductive Endocrinology at St. Mary's Hospital in Milwaukee, Wisconsin.

Dr. Cohen, can you give us a brief overview of hysteroscopy?

STEVE COHEN, MD: Absolutely. Hysteroscopy is a technique that's been used for 150 years but only recently has come into the forefront of gynecological care. Basically in a very simplified term it's taking a tiny telescope, slipping it through the cervical canal of a woman's uterus, without an incision and being able to explore and look inside the uterus and within minutes, know exactly what's going on inside the uterus without having to do scans or anything -- get a bird's eye, direct view of the inside of the uterus.

MARY WAGNER: So this is a non-incisional, a non-invasive procedure.

STEVE COHEN, MD: No incision. No knife. Slips in through a natural opening in the body cavity.

MARY WAGNER: Dr. Isaacson, it's performed fairly quickly, correct?

KEITH ISAACSON, MD: In the office, we can perform the hysteroscopy in less than one minute on average.

MARY WAGNER: So it's just about the time that a woman would expect for a Paps smear.

KEITH ISAACSON, MD: Exactly. Exactly. It's very similar to a speculum exam. You would go in for an annual exam with a Pap smear, but either a rigid or a flexible scope can be used to look inside the uterine cavity in a very short period of time, and make an instant diagnosis of what's causing the abnormal bleeding.

MARY WAGNER: Now hysteroscopy is used in many cases to diagnose and to treat abnormal uterine bleeding which affects hundreds of thousands of women in the United States. But it's also used for other matters, correct, Dr. Isaacson?

KEITH ISAACSON, MD: It is. I mean hysteroscopy is used to diagnose conditions that can lead to infertility to recurrent miscarriages and to actually a condition in which some women have no period whatsoever, which is called Asherman syndrome, in which the cavity is filled with scar tissue.

MARY WAGNER: What about pelvic pain? Because some women, in fact many women complain about pain in their pelvis. They have either associated with their periods or non-period associated pain. Can hysteroscopy be used to pinpoint causes of pelvic pain for some of these women?

STEVE COHEN, MD: It certainly can be used as part of the diagnostic workup. For example, patients may have a fibroid which is a soft tissue of the uterus sitting inside the uterus. During menstruation the contraction against that fibroid may cause pain. There could be a big polyp that almost acts as a ball valve. Sometimes we can make the diagnosis of the condition known as adenomyosis, which is an endometriosis in the wall of the uterus. Sometimes on hysteroscopy you can see almost openings or channels and give the idea -- not conclusively, but the idea or the impression that this patient has adenomyosis.