Abnormal Pap Smears
Pap smears are screening tests. When we identify abnormal cells by pap smear, we proceed to a more accurate test called colposcopy. Colposcopy is done by looking at your cervix under a microscope to identify abnormal appearing cells or blood vessel changes of the cervix. When we see areas of concern, we take small pinch-biopsies of these areas and send the tissue to a pathologist who is able to more accurately evaluate the cellular abnormalities. The procedure is very well tolerated in the office. You might want to take two ibuprofen tablets 200 mg prior to the procedure, but you would return to routine activity after the procedure. We do advise pelvic rest, no tampons or intercourse for 5 days after the procedure to avoid infection of the biopsy sites.
Cryotherapy is a freezing technique using nitrous oxide (liquid nitrogen) to treat persistent abnormal cellular changes of the cervix. The procedure is usually performed in the office and requires no anesthesia. If your pap smear continues to have mild abnormal changes, we might recommend treating this by freezing the surface abnormal cells of the cervix to remove the abnormal cells and allow healthy cellular healing.
LEEP Procedure is a treatment for high grade dysplasia. It is done in the office with a local anesthetic block of the cervix. We use a wire loop electrode to remove the surface abnormal cells of the cervix. The procedure is tolerated very well and no down time is needed, however, many patients prefer to make their appointment at the end of the day and go home after the procedure. Pelvic rest, no tampons or intercourse, is recommended for two weeks after LEEP to avoid infection risk. We are removing a 5 mm depth biopsy of the surface of the cervix to remove all the abnormal cells. Due to a small preterm labor risk associated with LEEP, we do recommend cervical length ultrasounds in pregnancy.
Heavy or Irregular Menstrual Cycles
Heavy or irregular menses can be caused by uterine polyps, uterine fibroids (benign smooth muscle tumors of the uterus), and hormonal imbalance.
Hysteroscopy is the inspection of the uterine cavity to identify uterine polyps or fibroids. The hysteroscope is a small thin flexible scope introduced into the uterus. Saline is instilled into the uterus to distend the uterus and visualize the cavity with a camera attached to the hysteroscope. We utilize a small flexible endoscope called Endosee to do minor diagnostic hysteroscopy in the office to identify uterine polyps or fibroids within the uterine cavity. In office hysteroscopy is performed in our procedure room with a hysteroscope that has an operating channel that allows us to remove small polyps or take biopsies. Larger polyps or fibroids would need to be removed in the operating room as a day surgery procedure.
Endometrial biopsy is a diagnostic test to evaluate the endometrium (lining of the uterus) for cellular abnormalities that might be causing irregular or heavy bleeding. A small thin (3mm) catheter is introduced into the uterine cavity to obtain a biopsy of the lining. This procedure can be uncomfortable so you will be offered pain medication, if desired, for the procedure.