What is a Hysteroscopy? Video Transcript

Participants

Martin S. Goldstein MD, Dean S. Cunningham MD

Summary

If you are suffering from abnormal bleeding, you may have submucus fibroid tumors. These tumors can cause severe cramping, fatigue, heavy menstrual periods and bleeding in between periods. Fortunately, they can be removed by your gynecologist with a hysteroscopy. Join us as gynecologist Martin Goldstein, MD and a hysteroscopy patient discuss this important procedure.

Webcast Transcript

PAUL MONIZ: I'm Paul Moniz. Thank you for being with us today. We are discussing how hysteroscopy has become an alternative to hysterectomy in treating abnormal uterine bleeding. Here to walk us through this procedure and its effectiveness is a gynecologist and one of his patients. We appreciate you being here.

Dr. Martin Goldstein is Associate Clinical Professor of Obstetrics and Gynecology at Mt. Sinai Hospital. Next to him is Valerie. She is a 50-year-old mother of two who has agreed to share her story, though because of its sensitive nature, she does not want her face shown. Thank you both for being here.

How effective is it? Will a patient notice immediate benefit and relieve of their symptoms?

MARTIN GOLDSTEIN, MD: If we remove the submucous fibroid and that is the only cause of the patient's heavy bleeding, we will get instant result. The Lupron, which we have given several weeks prior to the surgery will wear off. The average patient will have a period two to four weeks after finishing the procedure. The first menstrual period may be a little heavier than subsequent periods. But, with the second period that occurs after the procedure, the patient should then go back to a regular menstrual flow without heavy blood loss during the period.

PAUL MONIZ: Valerie, you did very well with this procedure, didn't you?

VALERIE: Quite well. I walked out of the hospital. I felt fine. I didn't need any pain medication, and I have had normal periods in the past year.

PAUL MONIZ: So you're not bleeding heavily?

VALERIE: Absolutely not. Absolutely not.

PAUL MONIZ: Patients worry about a number of things when they undergo surgery, chief among them is risk. What are the risks here?

MARTIN GOLDSTEIN, MD: The initial risk is misdiagnosis and not operating for the right reason. The second risk is making certain that there isn't a malignancy. The third risk is in stretching the cervix. There is a risk in using a rigid instrument that one could make a hole through the top of the uterus. If that occurred, no significant danger will happen to the patient, but we would have to stop the procedure.

The absorption of glycine, which is the dilating liquid. If the glycine gets into the bloodstream, it can dilute the sodium concentration. It can lead to blurred vision, possibly seizures, and significant problems.

PAUL MONIZ: This procedure will preserve fertility in women of childbearing age. Is that correct? That's one of the attractive parts of it.

MARTIN GOLDSTEIN, MD: The procedure will preserve fertility. In some cases, where people have frequent miscarriages due to submucous fibroids, it will promote the maintenance of pregnancy. The other really positive aspect of doing a myomectomy using a resectoscope is that when a patient has a child, they will be able to deliver vaginally, rather than require a cesarian section. Because we have not made an incision in the uterus and weakened the uterine wall by cutting it and sewing it, the patient who goes through this procedure will be able to carry a pregnancy to term, and go through labor and delivery without the risk of uterine rupture.

PAUL MONIZ: What is the likelihood that the fibroids will come back?

MARTIN GOLDSTEIN, MD: The fibroid that we remove will not come back. We really don't have a true understand of why fibroids develop. If a patient has a fibroid, there is a possibility that another fibroid will occur. The overall success rate of hysteroscopic myomectomy is 90-95 percent.