a few comments

[Guest guest]

I thought I would add a few comments about some of the issues recently

discussed on the message board.

Endo biopsy/hysteroscopy:

The most commonly used device for an endometrial biopsy is called a Pipelle

and is 3mm (1/8 inch) in diameter. Most diagnostic hysteroscopes are also

3mm. Operative hysteroscopes, which are used for resectoscope myomectomies,

polypectomies and endometrial ablations are about 8mm (1/3 inch) in

diameter, so the cervix only needs to be dilated less than 1 centimeter or

about 1/2 inch for these procedures. A D&C usually requires the cervix to be

dilated to about 1 centimeter, as well.

Even a small amount of cervical dilation can cause cramping in some women. I

have been amazed during my 25 years of practice at how differently women

actually feel during cervical dilation - some women have no discomfort at

all and others find it very uncomfortable.

Fibroids and Fertility:

I just read the article in the March, 2004 issue of Fertility and Sterility,

mentioned by Ann. The conclusion that fertility is not reduced by fibroids

smaller than 4 cm (about 2 inches) and in the wall of the uterus (but not

bulging into the uterine cavity) is consistent with the large analysis of

4,900 patients published by Dr. Pritts a few years ago.

The conclusion that fertility may be reduced by fibroids larger than 4 cm in

the wall of the uterus is not supported by the statistics presented. In

fact, the Results Section says that there was only a " trend " towards lower

pregnancy rates and that the DELIVERY RATES (of babies) WERE THE SAME

compared to women with no fibroids.

There were only 41 women in the fibroid > 4 cm group - a very small study.

Also, neither confidence intervals nor power calculations (sophisticated

methods to determine whether statistics are truly meaningful) were

performed, making me question the conclusions.

I don't mean to burden everyone with these details, but before this article

gets into the public domain, I think it is important to understand that its

conclusions, I believe, are misstated.

Bill , MD