Dr. Garcia has completed a fellowship in hysteroscopic techniques. Having a fellowship-trained surgeon with advanced expertise in hysteroscopy ensures precise evaluation, minimizes complications, and optimizes patient outcomes.

Hysteroscopy is a minimally invasive procedure that allows Dr. Garcia to visualize the inside of the uterus using a thin, lighted tube known as a hysteroscope. The overall experience is generally well-tolerated, with local anesthesia and mild discomfort, as the hysteroscope is inserted through the cervix to visualize the uterine cavity. Hysteroscopy is typically conducted to diagnose and treat various uterine conditions, including abnormal bleeding, postmenopausal bleeding, polyps, fibroids, and misplaced intrauterine devices (IUDs). If necessary, interventions such as an endometrial biopsy, polypectomies, fibroid removal, and correction of misplaced IUDs can then be performed.

Hysteroscopic endometrial biopsy is an office-based procedure that allows direct visualization and targeted sampling of the endometrial lining using a hysteroscope. The procedure involves distending the uterine cavity with saline or another medium to enhance visualization, followed by using small instruments to obtain tissue samples from suspicious areas. This technique is typically performed to evaluate abnormal uterine bleeding, postmenopausal bleeding, or unexplained thickening of the endometrium seen on ultrasound or other imaging of the pelvis. Unlike blind sampling methods, hysteroscopic biopsy ensures precise sampling of focal lesions, reducing the risk of missing significant pathology. Typical findings include endometrial hyperplasia, polyps, atrophy (common in menopausal patients), or, in some cases, endometrial cancer.

Hysteroscopic biopsy is superior to blind procedures like traditional endometrial biopsy (Pipelle) or dilation and curettage (D&C) because it allows direct visualization of the uterine cavity, ensuring targeted sampling of abnormal areas rather than random or incomplete tissue collection. Blind techniques can miss focal lesions such as polyps or small tumors, leading to false-negative results, particularly concerning in postmenopausal patients, where bleeding may indicate malignancy. Additionally, office hysteroscopy avoids the risks and costs associated with operating room procedures like D&C, offering a quicker recovery and greater patient convenience. For menopausal patients, hysteroscopic biopsy is especially valuable as it provides both diagnostic accuracy and the ability to immediately detect and biopsy suspicious lesions, improving early detection of endometrial cancer or precancerous conditions.

An endometrial polyp is a benign growth of the uterine lining, often attached by a thin stalk or a broad base. These polyps are composed of overgrown endometrial tissue and can vary in size from a few millimeters to several centimeters. Common symptoms include abnormal uterine bleeding, such as heavy or irregular periods, spotting between periods, or postmenopausal bleeding. Some patients may also experience infertility or recurrent pregnancy loss, as polyps can interfere with embryo implantation. While many polyps are asymptomatic and discovered incidentally, symptomatic or large polyps typically require removal to alleviate bleeding, rule out malignancy (especially in postmenopausal women), and improve fertility outcomes.

Hysteroscopic polypectomy performed in the office is a minimally invasive procedure that uses a hysteroscope to visualize and remove the polyp without the need for general anesthesia. This approach is safe, effective, and avoids the risks associated with operating room procedures. For menopausal patients, special considerations include a higher suspicion for malignancy, as postmenopausal bleeding can be a sign of endometrial cancer. Therefore, polyps in this population should always be evaluated histologically after removal.

Misplaced or embedded intrauterine devices (IUDs) can lead to complications such as pain, abnormal bleeding, expulsion, or even perforation into surrounding structures. Hysteroscopy is the gold standard for diagnosing and managing these issues, as it allows direct visualization of the uterine cavity to assess IUD position, identify embedment, or confirm proper placement at the time of insertion. Unlike ultrasound alone, which may miss subtle malpositions, hysteroscopy provides real-time, high-definition imaging, enabling immediate correction of misplacement or removal of embedded devices with precision. Additionally, confirming proper IUD placement during initial insertion via hysteroscopy reduces the risk of future complications, improving long-term patient satisfaction and device efficacy.

To ensure patient comfort, especially for those with prior traumatic experiences—whether from painful gynecologic procedures, complex IUD insertions, or medical/violent trauma—office-based hysteroscopy can be performed with local anesthesia, such as a paracervical block, to minimize discomfort. The office setting offers a more intimate and controlled environment than a hospital or surgical center, allowing personalized care, slower pacing, and a supportive atmosphere to ease anxiety. By combining the diagnostic and therapeutic advantages of hysteroscopy with a trauma-informed approach, Dr. Garcia can address IUD-related issues effectively while fostering trust and reducing distress for patients with past negative experiences.

A colposcopy is a diagnostic procedure using a specialized microscope called a colposcope to closely examine the cervix, vagina, and vulva for abnormal cells. This procedure is typically recommended after an abnormal Pap smear or a positive high-risk human papillomavirus (HPV) test, as these findings may indicate precancerous changes or early cervical cancer. During the colposcopy, Dr. Garcia applies a vinegar or iodine solution to highlight abnormal areas and may take small tissue samples (biopsies) for further testing. Local anesthesia is used before any tissue biopsies to minimize discomfort. The goal is to identify cervical dysplasia—a precancerous condition where cells on the cervix show abnormal changes—before it progresses to cervical cancer. Since high-risk HPV strains cause nearly all cervical cancers, early detection through colposcopy and biopsy is critical for preventing severe disease.

Cervical dysplasia, also called cervical intraepithelial neoplasia (CIN), is graded as mild (CIN 1), moderate (CIN 2), or severe (CIN 3), with higher grades carrying a greater risk of developing into cancer. If detected early through colposcopy and biopsy, treatment options such as cryotherapy (freezing abnormal cells), loop electrosurgical excision procedure (LEEP), or laser therapy can effectively remove precancerous tissue before it becomes invasive. Cervical cancer, when caught in its earliest stages, is highly treatable with surgery, radiation, or chemotherapy. Regular screening with Pap smears and HPV testing, followed by colposcopy when needed, plays a vital role in preventing cervical cancer by allowing for early intervention. Vaccination against HPV also significantly reduces the risk of developing cervical dysplasia and cancer, underscoring the importance of both preventive and diagnostic measures in women’s health.

The Loop Electrosurgical Excision Procedure (LEEP) is a standard in-office gynecological procedure for diagnosing and treating cervical dysplasia (precancerous cells) detected during a colposcopy. During LEEP, a thin, electrified wire loop removes abnormal tissue from the cervix while simultaneously cauterizing the area to minimize bleeding. The procedure is typically performed under local anesthesia, and patients may feel mild pressure or cramping, similar to menstrual discomfort. The entire process takes about 10–15 minutes, and while some light spotting or discharge is normal afterward, most women resume normal activities within a day or two. The removed tissue is sent to a lab for further analysis to ensure that all abnormal cells have been excised. LEEP is highly effective in preventing cervical cancer when precancerous changes are caught early, and follow-up visits ensure proper healing and monitor for recurrence. The office setting provides a comfortable, efficient experience with minimal downtime.