In Office Procedures

Endometrial Ablation

Usually an office based, minimally invasive, quick global endometrial ablation to treat the lining of the uterus (endometrium) in women experiencing heavy menstrual periods. Your physician may recommend a procedure when birth control pills, Mirena intrauterine device, or another procedure have been ineffective and/or have produced undesirable effects such as weight gain, moodiness, continued bleeding, etc. These procedures are for women who have completed chilbearing.

NovaSure®

Novasure is a safe procedure using radio frequency energy (radio waves) to permanently remove the uterine lining (endometrium). The procedure is performed by your physician, after a diagnostic hysteroscopy. She gently inserts a thin wand, with a mesh array, into the uterus. Once the mesh has conformed to the uterine wall, a radio frequency is generated for about 90 seconds and the wand with the array is then removed. The uterine lining will be shed over the next week to 10 days. Results have included a significant reduction in menstrual bleeding, stopped periods,  and reduced pain and cramping. From studies, 94% of women have their heavy bleeding resolved and 70% experience no further periods.

Note: Pregnancy after any form of endometrial ablation is a rare but possible event and the risk of complications is increased. Ablation is not birth control.

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Hysteroscopy

Hysteroscopy is an office or hospital based procedure that is used to look inside the uterus. It utilizes a hysterscope, a slender camera telescope-like device, which is inserted through the cervix into the uterus. The procedure is commonly used to:

• diagnose or treat uterine problems associated with abnormal bleeding
• to help with the diagnosis of frequent miscarriages
• to locate an lost or imbedded intrauterine device
• remove adhesions caused by infection or past surgeries
• perform sterilization procedures

Women who are pregnant should not have the procedure.

Adiana

Adiana Permanent Contraception is a safe, minimally invasive procedure providing permanent protection from pregnancy. Adiana works by stimulating a patient’s body to grow tissue in and around extremely small and soft inserts that have been placed into a patient’s fallopian tubes. Once the tubes are closed or blocked fertilization cannot take place because sperm can no longer reach an egg.

The office-based procedure is performed without anesthesia and involves making small openings in the fallopian tubes via a catheter that is inserted into the vagina, through the cervix and into the uterus to reach the fallopian tubes. The catheter delivers radio-frequency energy to make the openings in the fallopian tubes. Adiana plugs, which are made from medical grade silicone and are approximately the size of rice grains, are then inserted into the openings. Recovery is swift and patients can return to normal activities usually within a day. Over the next three months, tissue forms around the plugs permanently blocking them. At this time a hysterosalpingogram, or HSG test, is performed to make sure the tubes are completely blocked.

Besides being permanent, the procedure uses no hormones or drugs and does not leave anything in the uterus that may limit future gynecological procedures. Prior to having the procedure, patients should carefully discuss all of their options with their physician since it is not reversible.

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LEEP

Persistent abnormal pap smears which represent cervical cells or pre-cancer results, an in office procedure is performed which shaves off the tip of the cervix for diagnosis and treatment. Loop Electrical Excision Procedure provides some tissue for the pathologist to definitively check on the type of cells present and to make sure that they are all present in the specimen. The cervix does heal and grow back over the next few months with usually healthy tissue. We will continue to follow you with pap smears periodically to make sure that the cervix is healthy. We will also follow you in pregnancy for the small possibility of preterm labor due to a weakened cervix that occurs in a few patients who have had LEEP.

Dilation and Currettage = D&C

Abnormal bleeding, especially if the bleeding is heavy, thinning the uterine lining is necessary to stop the source of the bloodflow. The cervix may need to be dilated to allow a small  instrument in that is used to thin down this lining in the uterus.

Neuromodulation

An office test is performed to help diagnose a signal problem to the bladder for the problems of urinary frequency,urgency, incontinence, urinary retention and pelvic pain. This test is soon to be FDA approved for bowel issues involving incontinence or constipation. Since the nerves that supply the pelvic organs form a neural network, sometimes a crossover of improvement is seen for patients who are experiencing a combination of these problems.

Urodynamic Testing

A variety of testing is available in the office in order to help diagnose why someone may be having urinary urge,frequency, leaking or retention.

Cystoscopy

Like hysteroscopy, a small camera on a thin telescope like want is placed into the bladder to help diagnose bladder pathology.

Pelvic Floor Therapy: Physical Therapy, Electronic Stimulation, Biofeedback, Bladder Retraining

A variety of services are available in office to help patients with urinary frequency, urgency, incontinence, or retention.