Dr. Mohammed Al Al Qaraghouli, MD

A hysterectomy is an extremely common surgery performed to remove the uterus. Sometimes the fallopian tubes, ovaries, or cervix will be removed as well. A woman who has had a hysterectomy will no longer have periods and cannot get pregnant.

There are a variety of reasons that women have hysterectomies, including:

• Heavy bleeding or pain, such as that due to fibroids, endometriosis, or adenomyosis
• Cancer
• Prolapsed uterus, where the pelvic muscles can no longer completely hold the uterus in place

A hysteroscopy is a diagnostic procedure performed to examine the inside of the uterus. A thin tube with a camera and light at the end, called a hysteroscope, is inserted through the vagina. It allows the physician to view the cervix and uterine walls. Sometimes, gas or liquid is used to expand the uterus and allow a better view. If necessary, tiny instruments can also be passed through the tube and used for certain procedures, such as taking a biopsy or removing a polyp.

Hysteroscopy is often done to figure out the cause of abnormal menstrual bleeding. However, it can also be used to:

• Identify the cause of recurrent miscarriage
• Remove polyps or fibroids, non-cancerous growths in the uterus
• Remove adhesions, scar tissue within the uterus
• Identify uterine septums, a wall of tissue dividing the uterus
• Perform ablation, the removal of excess uterine lining

A pessary is a device that is inserted into the vagina to relieve symptoms associated with mild to moderate pelvic organ prolapse, a condition in which the womb, bladder, or rectum bulges into the vaginal canal. This device is made of either rubber or plastic and is a safe, nonsurgical way to provide support for prolapsed organs.

Pessaries come in different shapes and sizes, and finding the right one can take some trial and error. Before a pessary fitting, patients will be examined and evaluated based on prolapse-related symptoms they may be experiencing, which may include discomfort, urine leakage when sneezing or coughing, and trouble keeping tampons in.

The following tips can help guide the process of finding the right fit:

• Once in place, patients should not be able to feel the device at all. If there is even slight pressure, patients should let their healthcare provider know, and she will find a pessary of a different size or shape.
• The pessary should not fall out with sneezing, coughing, jumping, or squatting. While getting fitted, patients should try jumping or squatting to see if the device will fall out. If it does, a different pessary will be inserted until they find one that stays in place.
• Patients and their healthcare providers should make sure the device is improving symptoms by having a check-up 5 to 15 days after it is inserted. If there is no improvement, patients may have to be re-fitted with a different pessary, or patients may be asked to consider surgical options.