In order to evaluate uterine fibroids, we need to know what is on the inside of the uterus. Many times ultrasound (or saline enhanced ultrasound) or MRI will provide the information we need. Many women are subjected to endometrial biopsy which is good to rule out cancer, but useless in diagnosing submucous fibroids and polyps. Fortunately it is easy to look directly into the uterus using a thin telescope called a hysteroscope.
With today’s tiny instruments, it usually only takes a few minutes to do office hysteroscopy using local anesthesia, and most women report little discomfort. First I numb the cervix, which is hardly noticeable. Saline is used to fill the uterus so we can see, and a thin flexible or regular hysteroscope is inserted through the cervix under direct vision. I encourage my patients to watch on the video monitor so they will have a better understanding of what is going on inside her own uterus. If someone is extremely anxious she can have something to help her relax during the procedure, but the vast majority of women do not need this and can go about their normal activities for the rest of the day.
Hysteroscopy compliments other diagnostic studies, so that when we decide on a treatment plan we know exactly what we are treating, and don’t wind up with any surprises.
The photo below shows an actual view from an office hysteroscopy. You can clearly see the submucous fibroids on the back wall of the uterus. This type of fibroid can easily be removed (by an gynecologist experienced in this type of surgery) in an outpatient procedure called hysteroscopic resection of fibroids.
The next photo shows a large submucous fibroid at the beginning of hysteroscopic resection of the fibroid. The loop seen is what will be used to remove (resect) the fibroids.
Comment: I feel that for a gynecologist, doing hysteroscopy in the office is as basic as an ear doctor being able to look into an ear in the office. What would you do if you saw a doctor for an earache and he or she wanted to schedule you for surgery so they could look in your ear? Yet only 10% of gynecologists in the U.S. (who are supposedly specialists in treating the uterus) do office hysteroscopy. I see too many women taken to the operating room whose surgery is abandoned because submucous myomas had not been diagnosed by surgeons not prepared to treat them. And many of these women are told that they need a hysterectomy because the gynecologist is not experienced in hysteroscopic treatment of submucous fibroids. I’ll have much more in detail about hysteroscopic treatment of submucous fibroids in upcoming posts!