Outpatient Hysteroscopy in the Management of Abnormal Vaginal Bleeding

We performed outpatient hysteroscopy with endometrial biopsy in approximately 1000 women under local anesthesia. A definitive management plan was made at the single appointment. The combined results were analyzed by age, symptoms, findings at hysteroscopy, and pathology. Ninety percent of women had abnormal bleeding, 50% of whom had a normal hysteroscopy. Patient acceptability was evaluated by questionnaire. Over 90% of women found the procedure acceptable, with minimal discomfort. The failure rate was approximately 5%. Less than 30% of women required a second surgical procedure. Outpatient hysteroscopy is a safe, effective, and well tolerated alternative to dilatation and curettage under general anesthesia, and has the possibility of a definitive diagnosis and management plan at the patient's first visit. It has clear savings, not only in outpatient and inpatient costs, but also in operating room time.