Investigation of Abnormal Uterine Bleeding

For most of the 20th century, the only method available for investigating the uterine cavity in cases of abnormal uterine bleeding was the Dilatation and Curettage (D&C) procedure, which has the intrinsic characteristic of being a “blind” technique. Thus, diagnosis of the cause of the bleeding was mainly based on obtaining adequate amount of biopsied tissue from an as wide as possible area of the cavity, in order to achieve a reliable histology report. With the introduction and evolution of ultrasonography, physicians started to be able to indirectly visualize gross uterine anatomical pathology like polyps and fibroids. However, small, flat, superficial, focal lesions, often behind suspicious for malignancy cases of abnormal bleeding could be easily missed.

Hysteroscopy instead allows clear and direct visualization of the uterine cavity; views can be obtained from a distance in order to acquire an understanding of the contour and shape of the cavity, or at close and in detail by bringing the lens just millimeters above suspicious lesions. In that way, it is also feasible to obtain targeted biopsies from the exact points of specific interest, so that the histology report is definite and conclusive.

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Dr Eleftherios Meridis