Re: diagnostic hysteroscopy / endo biopsy -- to Judith S

[Guest guest]

> My doctor has suggested diagnostic hysteroscopy (for reasons

> that make sense to me). He said it would be an in-hospital

> with general anesthesia procedure. Since this didn't correlate

> with what I had read about hysteroscopy - including in the very

> pamplet he gave me! - that diagnostic hysteroscopy may be

> an in-office procedure with local anesthesia, I asked why. He

> said that in his experience he couldn't get a good enough view

> with an office procedure, that the inflation necessary to hold the

> uterus open for a good view was too painful, and that, also, with

> general anesthesia, he could continue immediately with

> operative procedures like removing a polyp.

>

> While I understand this, I'm still not sure I agree with it. Have

any

> of you had the in-office procedure with just local anesthesia?

> What was it like?

>

> Am I being reasonable or being paranoid in preferring diagnosis

> first, even if it means a second operative procedure later? I'm not

> sure I want to authorize my doctor to take whatever further steps

> he deems necessary without knowing what they will be.

Judith,

I am evaluating a somewhat similar thing right now, although my dr

does do in-office diagnostic hysteroscopy. Apparently, our drs

differ in how they do the diagnostic hysteroscopy, but I'm with you

on the value of doing a diagnostic procedure first.

My dr did a saline ultrasound in office, saw " irregular edges " (not

normal looking fibroids), and suggested an in-office diagnostic

hysteroscopy to determine if there are polyps or some abnormal growth

that needs to be biopsied. Or he said, we could just schedule

operative hysteroscopy and deal with what we find at that time. I

thought it seemed best to do the diagnostic first to know ahead of

time what had to be dealt with. It still seems to me the most

logical way to proceed.

However, I am now reconsidering based on 2 things: extra cost of

having the two procedures instead of just one, and I'm trying to

decide if the risk of having an extra procedure outweighs the

benefits. I do think the risk of an in-office diagnostic

hysteroscopy is quite small. I was instructed to take 800mg of

ibuprofen 2 hours before coming in. That's it. He said I might have

a little cramping afterwards. He does a lot of these. I do believe

the amount of cramping is partially related to the skill of the

surgeon. I say this because I had an in-office endometrial biopsy

done 2 years ago by my regular gyn (a gynecological oncologist and

skilled surgeon). There was a little pinching, but no significant

pain. I took some ibuprofen afterwards, but that was it. Same with

the saline ultrasound done by this new guy - a little pinching when

the tube went in, but no significant pain. I think the better drs

can get into the uterus quickly and at the right angle and minimize

the cramping that occurs.

Anyway, now I'm thinking if money were not an issue, I would

definitely have the diagnostic first. I would love to know what all

you're thinking about and what you decide, as I'm going through a

similar thing. Feel free to email me.

Jean