Hysteroscopy is a procedure that can be used to both diagnose and treat causes of abnormal bleeding. The procedure allows your doctor to look inside your uterus with a tool called a hysteroscope. This is a thin, lighted tube that is inserted into the vagina to examine the cervix and inside of the uterus. Hysteroscopy can be a part of the diagnosis process or an operative procedure.
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Before Hysteroscopy Procedure
What is diagnostic hysteroscopy?
Diagnostic hysteroscopy is used to diagnose problems of the uterus. Diagnostic hysteroscopy is also used to confirm results of other tests, such as hysterosalpingography (HSG). HSG is an X-ray dye test used to check the uterus and fallopian tubes. Diagnostic hysteroscopy can often be done in an office setting.
Additionally, hysteroscopy can be used with other procedures, such as laparoscopy, or before procedures such as dilation and curettage (D&C). In laparoscopy, your doctor will insert an endoscope (a slender tube fitted with a fiber optic camera) into your abdomen to view the outside of your uterus, ovaries and fallopian tubes. The endoscope is inserted through an incision made through or below your navel.
What is operative hysteroscopy?
Operative hysteroscopy is used to correct an abnormal condition that has been detected during a diagnostic hysteroscopy. If an abnormal condition was detected during the diagnostic hysteroscopy, an operative hysteroscopy can be performed at the same time, avoiding the need for a second surgery. During operative hysteroscopy, small instruments used to correct the condition are inserted through the hysteroscope.
When is operative hysteroscopy used?
Your doctor may perform hysteroscopy to correct the following uterine conditions:
. Polyps and fibroids: Hysteroscopy is used to remove these non-cancerous growths found in the uterus.
. Adhesions: Also known as Asherman’s Syndrome, uterine adhesions are bands of scar tissue that can form in the uterus and may lead to changes in menstrual flow as well as infertility. Hysteroscopy can help your doctor locate and remove the adhesions.
. Septums: Hysteroscopy can help determine whether you have a uterine septum, a malformation (defect) of the uterus that is present from birth.
. Abnormal bleeding: Hysteroscopy can help identify the cause of heavy or lengthy menstrual flow, as well as bleeding between periods or after menopause. Endometrial ablation is one procedure in which the hysteroscope, along with other instruments, is used to destroy the uterine lining in order to treat some causes of heavy bleeding.
When should hysteroscopy be performed?
Your doctor may recommend scheduling the hysteroscopy for the first week after your menstrual period. This timing will provide the doctor with the best view of the inside of your uterus. Hysteroscopy is also performed to determine the cause of unexplained bleeding or spotting in postmenopausal women.
Who is a candidate for hysteroscopy?
Although there are many benefits associated with hysteroscopy, it may not be appropriate for some patients. A doctor who specializes in this procedure will consult with your primary care physician to determine whether it is appropriate for you.
Preparation for hysteroscopy
How do I get ready for a hysteroscopy?
Your hospital will tell you how to prepare for your hysteroscopy procedure. If you’re still having periods, you need to be sure there’s no chance that you’re pregnant at the time of your procedure. For this reason, it’s important to use contraception or not have sex between your last period and the test.
Don’t worry if you’re bleeding at the time of your procedure. Your hysteroscopy can usually go ahead, unless it’s heavy, but check with your hospital.
You’ll usually have the procedure and go home on the same day.
Your hospital might tell you to take an over-the-counter painkiller such as ibuprofen (a non-steroidal anti-inflammatory medicine) an hour or two before your procedure.
You may not need an anaesthetic or you may have a local anaesthetic. You may be able to have a general anaesthetic if you prefer or if you’re having a longer and more complicated operation such as having fibroids treated. This means you’ll be asleep during the operation. A general anaesthetic can make you sick so it's important that you don't eat or drink anything for six hours before your hysteroscopy. Follow your anaesthetist or doctor or specialist nurse’s advice and if you have any questions, just ask.
Your nurse or doctor will discuss with you what will happen before, during and after your procedure, including any pain you might have. If you’re unsure about anything, ask. No question is too small. It’s important that you feel fully informed so you’re in a position to give your consent for the operation to go ahead. You’ll be asked to sign a consent form.
Side effects and Complications
Side effects of hysteroscopy
Side-effects are the unwanted but mostly temporary effects that you may get after having the procedure.
After a hysteroscopy, you may have:
. Cramping pains for a day or two, like those you get during a period
. Feeling or being sick
. Bleeding from your vagina – this usually gets better after a few days, but can last for up to a week, depending on if you’ve had any treatment
Complications of hysteroscopy
Complications are when problems occur during or after your procedure. The possible complications of a hysteroscopy include the following.
. Damage to the wall of your uterus or your cervix, caused by the instruments used to look inside. If this happens, you may need another operation to repair the damage.
. Heavy bleeding during or after your hysteroscopy. If it’s severe, your doctor or specialist nurse may put a special water-filled balloon inside your uterus to stop the bleeding.
. An infection, which means you may need antibiotics.
The risk of complications is higher if you have a hysteroscopy under general anaesthesia.
What are the benefits of hysteroscopy?
Compared with other, more invasive procedures, hysteroscopy may provide the following advantages:
. Shorter hospital stay.
. Shorter recovery time.
. Less pain medication needed after surgery.
. Avoidance of hysterectomy.
. Possible avoidance of "open" abdominal surgery.
During Hysteroscopy Procedure
During the procedure
How is hysteroscopy performed?
Prior to the procedure, your doctor may prescribe a sedative to help you relax. You will then be prepared for anesthesia. The procedure itself takes place in the following order:
. The doctor will dilate (widen) your cervix to allow the hysteroscope to be inserted.
. The hysteroscope is inserted through your vagina and cervix into the uterus.
. Carbon dioxide gas or a liquid solution is then inserted into the uterus, through the hysteroscope, to expand it and to clear away any blood or mucus.
. Next, a light shone through the hysteroscope allows your doctor to see your uterus and the openings of the fallopian tubes into the uterine cavity.
. Finally, if surgery needs to be performed, small instruments are inserted into the uterus through the hysteroscope.
The time it takes to perform hysteroscopy can range from less than five minutes to more than an hour. The length of the procedure depends on whether it is diagnostic or operative and whether an additional procedure, such as laparoscopy, is done at the same time. In general, however, diagnostic hysteroscopy takes less time than operative.
What type of anesthesia is used for hysteroscopy?
Anesthesia for hysteroscopy may be local, regional or general:
. Local anesthesia: The numbing of only a part of the body for a short time.
. Regional anesthesia: The numbing of a larger portion of the body for a few hours.
. General anesthesia: The numbing of the entire body for the entire time of the surgery.
The type of anesthesia used is determined by where the hysteroscopy is to be performed (hospital or doctor’s office) and whether other procedures will be done at the same time. If you are having general anesthesia, you will be told not to eat or drink for a certain amount of time before the hysteroscopy.
After Hysteroscopy Procedure
Aftercare and Recovery
If you didn’t have an anaesthetic or had a local anaesthetic, you should be able to go home a short time after your procedure.
If you had a general anaesthetic, you’ll need to rest until the effects have passed and then, when you feel ready, you can go home. Make sure someone can take you home. And ask someone to stay with you for a day or so while the anaesthetic wears off. After a general anaesthetic, you may find you’re not so coordinated or that it’s difficult to think clearly. This should pass within 24 hours. In the meantime, don't drive, drink alcohol, operate machinery or sign anything important.
You might have some discomfort as the anaesthetic or painkiller wears off. You can take over-the-counter painkillers, such as paracetamol or ibuprofen if you need to.
You may have some bleeding from your vagina. You can use sanitary pads until the bleeding stops – it’s best not to use tampons.
Your nurse may give you a date for a follow-up appointment. If your doctor or specialist nurse took tissue samples, it can take a couple of weeks to get the results. These will usually be sent to the doctor or specialist nurse who did the hysteroscopy and they’ll go through them with you.
Most women don’t have any problems after having a hysteroscopy. But contact your doctor or specialist nurse or go to the accident and emergency department of your local hospital if you have:
. Heavy bleeding
. Signs of an infection, such as a fever, shivering and chills or foul-smelling discharge from your vagina.
. Severe abdominal (tummy) pain
Will I have to stay in the hospital overnight after hysteroscopy?
Hysteroscopy is considered minor surgery and usually does not require an overnight stay in the hospital. However, in certain circumstances, such as if your doctor is concerned about your reaction to anesthesia, an overnight stay may be required.
Your doctor may suggest a hysteroscopy for several different reasons. These are situations where a closer look or minor surgery may be required for your long-term health and well-being. If you have questions, be open and honest with your doctor. Ask any questions that you need to.
The risks with a hysteroscopy are extremely low, but should still be discussed with your doctor before any procedure is performed. Recovery from a hysteroscopy is quick, and there’s generally no lasting effect beyond the first couple of days following the procedure.