Dr. Herbert Goldfarb studied 300 women who had a D-and-C using the hysteroscope. He found that most patients still had their polyps after D-and-C.

Small fibroids under one or two cm in size or that have a stalk or that are protruding into the uterine cavity can be easily removed through the hysteroscope. Fibroids between 2.5 cm and five cm can be removed the same way after they have been shrunk through the use of medication (see GNRH drugs). Fibroids larger than five cm must be shrunk medically, and then removed in two steps.

In the case of removal of small fibroids causing bleeding, 50 to 87 percent of women return to normal menstruation after the hysteroscopic operation. If the uterus is larger than a 14-week pregnancy size, than hysteroscopic removal cannot be done.

ENDOMETRIAL ABLATION: This means destroying the uterine lining permanently. This treatment is sometimes used as a last resort for severe bleeding problems (see details in chapter on hysterectomy).

TO REMOVE A MISPLACED IUD: Both D-and-C and hysteroscope can be used to perform this job, but again the hysteroscope is more accurate.

Preparation For A Diagnostic Or Simple Operative Hysteroscopy With No Or Local Anesthetic

If the procedure is done in the office or in the out-patient department, a woman may be given a pain killer (like motrin) one hour before the exam to reduce cramping afterwards. There is usually no need for an anesthetic, since the cervix is not being dilated, but should a woman feel uncomfortable, the doctor should have available a local anesthetic which can be injected into the cervical area. A local anesthetic is only required about five percent of the time.

Before beginning the procedure, Dr. Taylor suggests that the doctor should have all "in readiness" before placing the woman in the awkward position required for the hysteroscopic exam. The whole procedure usually takes only between five and 15 minutes to perform. Once the procedure is completed, there may be mild cramping or light bleeding afterwards.

For simple operative procedures, no or a local anesthetic may be all that is required. These procedures last about twenty minutes. Longer procedures will usually require a general anesthetic.

Preparation For An Operative Hysteroscope Or A D-and-C Under General Anesthetic

First of all make sure you are clear about why the procedure is being done and what the doctor plans to examine, remove or treat. The night before you may shower or bath in your usual way. No douching or extra cleansing of the genital area is required. There is also no need to shave your pubic hair. And of course, a good night's sleep is recommended. After midnight the night before your operation, you should eat no food of any kind, nor drink any fluids, not even water, to minimize the risks of throwing up while under anesthetic. However, in the case of an emergency D-and-C, you may not have the chance to fast before hand, and the anesthetist will take this into account.

These days, the history, physical and blood and urine tests are often done before admission. Procedures vary at different hospitals so be sure to check with your doctor and find out exactly what preparations are necessary at your hospital.

At The Hospital

After the usual admitting procedures, you will be taken to your room. There a nurse will take a brief medical history with special emphasis on any allergies to medications or adverse effects of previous anesthetics. The nurse will also arrange for you to give urine and blood samples. Usually a complete blood test is done, including the amount of iron in your blood, as well as a fasting blood sugar. Your urine will be tested for a sugar, protein, and bacteria.