Management of abnormal uterine bleeding – focus on ambulatory hysteroscopy

Abstract

The rapid evolution in ambulatory hysteroscopy (AH) has transformed the approach to diagnose and manage abnormal uterine bleeding (AUB). The medical management in primary care remains the mainstay for initial treatment of this common presentation; however, many women are referred to secondary care for further evaluation. To confirm the diagnosis of suspected intrauterine pathology, the traditional diagnostic tool of day case hysteroscopy and dilatation and curettage in a hospital setting under general anesthesia is now no longer required. The combination of ultrasound diagnostics and modern AH now allows thorough evaluation of uterine cavity in an outpatient setting. Advent of miniature hysteroscopic operative systems has revolutionized the ways in which clinicians can not only diagnose but also treat menstrual disorders such as heavy menstrual bleeding, intermenstrual bleeding and postmenopausal bleeding in most women predominantly in a one-stop clinic. This review discussed the approach to manage women presenting with AUB with a focus on the role of AH in the diagnosis and treatment of this common condition in an outpatient setting.

Efficacy and Safety of Remimazolam Besylate Versus Propofol during Hysteroscopy: Single‐centre Randomized Controlled Trial

“…The procedure has many advantages, but the main disadvantage is the strong pain due to cervical dilatation. Therefore, we believe that pain and anxiety must be decreased while providing effective sedation and analgesia during surgery to maximize patient comfort and cooperation [1][2][3]. To improve the comfort of patients, widely used anaesthetic methods in hysteroscopic surgery include propofol combined with opioids, propofol combined with dexmedetomidine, paracervical block, topical anaesthesia and so on [4][5][6].…”

A two-year study on postmenopausal bleeding at a tertiary institute

“…Hysteroscopic guided biopsy may be performed wherever available as it has more diagnostic value to the final diagnosis. 8 Simultaneously, it enables therapeutic removal of polyps, small submucous myomas in the same sitting in a single step. The office vaginoscopic hysteroscopy is replacing the traditional ones as it no longer requires vaginal speculum, tenaculum, cervical dilatation and sedation.…”

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“…The patient requires no systemic sedatives or medications as the procedure is usual painlessly, no injury to vaginal outlet. 8,9 Women with PMB has a 10% risk of having genital malignancies such as cervical cancer, endometrial cancer, vaginal, ovarian, and vulval cancers along with a 10% risk of significant pathology 10 . Although PMB is often associated with benign pathologies, the possibility of having an underlying malignancy makes it a sinister complaint requiring thorough clinical work up.…”