The work-up for persistent, heavy uterine bleeding typically includes blood work to check for anemia (low hemoglobin and hematocrit), platelet dysfunction, and thyroid dysfunction, as well as performing a Pap test, endometrial biopsy, and pelvic ultrasound. The physicians at AMIGS can perform their own ultrasounds at your visit. Thus there is no separate appointment needed. Sometimes we also need to perform an in-office diagnostic hysteroscopy to help us decide on the best management plan. A diagnostic hysteroscopy involves inserting a slender flexible hysteroscope into the uterus via the vaginal canal. Only a small amount of sterile saline is needed to expand the uterine cavity so we can see if any polyps or fibroids are visible. Since the scope is so slender usually only oral or intramuscular pain relieving medications and local anesthesia to numb the cervix are needed. The procedure only takes about 5-10 minutes. There is no significant recovery time needed and patients can resume normal activities immediately. Patients can expect some cramping and discharge for a couple days. Sometime an endometrial biopsy or diagnostic hysteroscopy cannot be performed in the office, usually due to a very narrow cervical canal that will not allow passage of the instrument. In these cases, a Hysteroscopy with Dilation and Curettage (D&C) is advised as an outpatient procedure in the operating room under anesthesia. This procedure is similar to the diagnostic hysteroscopy described above except dilation of the cervix is needed to place the hysteroscope into the uterus and a uterine specimen is collected to rule out cancer. This procedure can also help decrease abnormal bleeding since a thickened uterine lining, uterine polyps and small submucosal fibroids (fibroids that extend into the cavity) can be removed at the time of the procedure.