used in conjunction with laparoscopy or other methods to reduce the risk of perforation during the procedure. Endometrial polyp. Polypectomy. Abnormal uterine bleeding Adenomyosis Endometrial ablation (Some newer systems specifically developed for endometrial ablation such as the Novasure do not require hysteroscopy) Myomectomy for uterine fibroids. Congenital uterine malformations (also known as Mullerian malformations). Evacuation of retained products of conception in selected cases. Removal of embedded IUDs. The use of hysteroscopy in endometrial cancer is not established as there is concern that cancer cells could be spread into the peritoneal cavity. Hysteroscopy has the benefit of allowing direct visualization of the uterus, thereby avoiding or reducing iatrogenic trauma to delicate reproductive tissue which may result in Asherman's syndrome. Hysteroscopy allows access to the uterotubal junction for entry into the Fallopian tube; this is useful for tubal occlusion procedures for sterilization and for falloposcopy. Complications A possible problem is uterine perforation when either the hysteroscope itself or one of its operative instruments breaches the wall of the uterus. This can lead to bleeding and damage to other organs. If other organs such as bowel are injured during a perforation, the resulting peritonitis can be fatal. Furthermore, cervical laceration, intrauterine infection (especially in prolonged procedures), electrical and laser injuries, and complications caused by the distention media can be encountered. The use of insufflation (also called distending) media can lead to serious and even fatal complications due to embolism or fluid overload with electrolyte imbalances. Particularly the electrolyte-free insufflation media increase the risk of fluid overload with electrolyte imbalances, particularly hyponatremia, heart failure as well as pulmonary and cerebral edema. The main factors contributing to fluid overload in hysteroscopy are: Hydrostatic pressure of the insufflation media Amount of exposed blood vessels, such as being increased in endometrial ablation and myomectomy. Duration of the hysteroscopy procedure. Women in fertile age are at increased risk of resultant hyponatremic encephalopathy, likely because of increased level of estrogens. The overall complication rate for diagnostic and operative hysteroscopy was 2% with serious complications occurring in less than 1% of cases using older methods. Morcellation has fewer complications than electrocautery, less than 0.1%. Severe Pain The English Member of Parliament, Lyn Brown (West Ham, Labour), has spoken twice in the House of Commons on behalf of constituents who have been coerced into completing unbearably painful outpatient hysteroscopies without anaesthesia. Lyn Brown cites numerous instances of women throughout England being