The D and C technique is usually carried out under a general anaesthetic in a day hospital or general hospital setting. During dilatation, the cervix is gently stretched open by inserting progressively larger instruments. This is followed by a curette in which the endometrium is gently scraped away using an elongated instrument with a scoop attachment.

An alternative diagnostic procedure that can be used when a detailed patient history, examination and laboratory tests have failed to reveal the cause of abnormal bleeding is hysteroscopy. A hysteroscope is basically a tubular instrument with a light at one end and an optical system for transmitting an image to a display monitor. It is inserted through the vagina and cervix to observe the inside of the uterus. After obtaining ultrasound images of the uterus and introducing gas to separate the pelvic organs, the cervical canal is gently stretched to allow the hysteroscope to pass into it. It is then possible to get a good view of the uterus in about 80% of patients. (In the remaining patients, the view may be obscured by heavy bleeding.) Of women with menstrual irregularities in whom the uterus can be observed, more than 60% have no apparent uterine abnormality. These women are spared a diagnostic curettage. The others may have fibroids, polyps, endometriosis, pre-cancerous changes or endometrial cancer. If any area of abnormality is identified, a sample can be removed, checked by a pathologist and, in many cases, destroyed on the spot by an instrument inserted through the hysteroscope.

Hysteroscopy is thus a useful diagnostic test which can be used as the basis for treatment. It can be carried out without hospital admission or general anaesthesia, a considerable benefit in the eyes of many women (particularly those who are elderly and have multiple medical problems). A study by the University of Adelaide and the Royal Adelaide Hospital suggests that Australia’s health budget could be reduced by at least $30 million a year if outpatient hysteroscopy (also called office hysteroscopy) was adopted instead of performing D and C procedures in day surgery units.9 This 1994 study quoted the cost of a hysteroscopy at about $100, while a D and C cost over $500 when carried out in a day surgery unit and over $1000 if an operating theatre and overnight stay were required.

Serious complications such as bowel perforation occur in less than 1% of patients having a hysteroscopy, but about 70% experience the discomfort of menstrual-type pain, sensations of dizziness, tremor, shoulder tip pain or nausea, which is often followed by vomiting. If doctors explain possible side-effects before the procedure starts, this can help to reduce anxiety in patients when they occur. As increasing numbers of gynaecologists become familiar with the technique of hysteroscopy, it is hoped that D and C will be used more selectively.

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This is a popular herb which grows in Mediterranean countries and central Asia. It does not contain any hormones but it stimulates the function of the pituitary gland which controls and balances our hormones by producing luteinising hormone. This increases progesterone production and helps regulate a woman’s cycle. Agnus castus also helps keep prolactin secretion in check. (Excessive prolactin can prevent ovulation.)

This herb has been used by women who had established luteal phase defect (shortened second half of the cycle) and high prolactin levels. In one study 48 women diagnosed with infertility took agnus castus daily for three months. Seven of them became pregnant during that time and 25 of them regained normal progesterone levels.

Agnus castus works to restore hormonal balance and can be used where there are hormone deficits as well as excesses. It:

• regulates periods

• restarts periods which have stopped

• helps with heavy bleeding

• helps with too-frequent periods

• helps with painful periods

• increases the ratio of progesterone to oestrogen by balancing excess oestrogen

I have seen a number of women who needed to have IVF treatment” but could not do so because their levels of Follicle Stimulating Hormone (FSH) were too high. The highest FSH level for most IVF treatments is 10, and rising FSH levels can indicate a pre-menopausal condition. The use of agnus castus, sometimes with a mix of other herbs, brought down the FSH level so that the women could go for IVF treatment.

Dong Quai (Angelica Sinensis)

This is an Oriental herb frequently used for menstrual complaints. It is extensively cultivated in Asia for medicinal purposes and in traditional Chinese medicine is well-known as a tonic for the female reproductive system. It:

• tones a weak uterus

• regulates irregular periods

• alleviates period pains

• reduces spotting

• helps with absent periods

False Unicorn Root (Chamaelirium Luteum)

This North American herb is a good tonic and strengthener for the reproductive system and can be used for both men and women, as it has a balancing effect on hormones. Herbalists often give it to women after a miscarriage or an infection in the pelvic area. Mixed with other herbs, it can be given for ovarian cysts or endometriosis. It is also used to try and prevent a threatened miscarriage. It:

• balances the hormones

• regularizes delayed periods

• regularizes absent periods

Saw Palmetto (Serenoa Serrulate)

This is one of the best herbs for the male reproductive system. It acts like a tonic for the man and has traditionally been used for centuries to treat enlarged prostate.

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