Design: Video case presentation.

Setting: Procedures were performed in an operating room with the first patient under sedation and second patient under general anesthesia due to concurrent videolaparoscopy, both in gynecologic position.

Patients or Participants: Two women with abnormal uterine bleeding despite use of progesterone only pill. First one 41 years-old with two previous cesarean sections and second one 39 years-old nulliparous with associated endometriosis and infertility.

Interventions: Saline solution was used as the distension media and different tools and techniques were utilized across cases. In the first patient was identified diffusely thickened glandular endometrium with hypervascularization and was performed endometrial ablation using a 16-Fr mini-resectoscope. In the second one was observed an adenomyoma in the right cornual region measuring 2.5cm with a softened appearance with free myometrium on MRI of 0.3cm and was performed adenomyomectomy by slicing technique utilizing 26-Fr resectoscope.

Measurements and Main Results: Despite being challenging, procedures were successful and patients were discharged on the same day. In second patient, due to gestational desire, a second look showed only a small synechiae on the right cornual region which were approached with scissors, without energy use. In addition LNG-IUD was inserted for symptoms control. Both patients had substantial improvement in pain, bleeding and hematimetric levels.

Conclusion: Hysteroscopy is used in some selective cases of patients with adenomyosis. It is not the first line of treatment, but it can be beneficial in some cases of superficial lesions with intra-cavitary involvement. Conservative treatments have a recurrence rate, but studies show an improvement in the clinical picture after the procedure.