Hysteroscopy

Overview

Hysteroscopy serves as a key procedure for both diagnosing and treating the underlying factors contributing to abnormal uterine bleeding. It involves the utilization of a hysteroscope, a slender, illuminated tube, which is inserted through the vagina to meticulously examine the cervix and interior of the uterus. It can serve as a therapeutic intervention by allowing the removal of adhesions, fibroids, and polyps during a surgical hysteroscopy.

Diagnostic hysteroscopy aimed at identifying any structural irregularities within the uterus that could be the underlying cause of abnormal uterine bleeding. Moreover, hysteroscopy serves as a valuable tool to confirm and validate findings obtained through other diagnostic techniques, such as ultrasound or hysterosalpingography (HSG). HSG is an X-ray dye test utilized to evaluate the potential blockage of fallopian tubes, which can present challenges in achieving pregnancy.

Operative hysteroscopy addresses any abnormalities identified during a diagnostic hysteroscopy. A healthcare provider might opt to conduct both diagnostic and operative hysteroscopy simultaneously, thereby eliminating the necessity for a subsequent surgical procedure. In operative hysteroscopy, the surgeon employs specialized instruments to eliminate any detected irregularities that could be contributing to abnormal uterine bleeding.

Reasons for undergoing the procedure

The decision to undergo hysteroscopy is based on a thorough review of one’s medical history and current health. While there are numerous benefits, it may not be suitable for everyone, especially if pregnant or dealing with a pelvic infection.

Generally, the primary purpose of hysteroscopy is to diagnose and address conditions leading to abnormal uterine bleeding, excessive menstrual bleeding, irregular spotting between periods, and postmenopausal bleeding.

Uterine conditions that may require hysteroscopy include:

• Polyps and fibroids: A hysteroscopy myomectomy is the surgical excision of a fibroid. Hysteroscopy polypectomy is the surgical term for polyp removal. These uterine structural abnormalities are located and removed by hysteroscopy.
• Septums: A congenital abnormality of the uterus, known as uterine septum, may be identified through hysteroscopy.
• Adhesions: Hysteroscopy may be recommended to find and remove adhesions. Sometimes referred to as Asherman’s syndrome, adhesions are bands of scar tissue that can develop in the uterus that may alter menstrual flow and result in infertility.

Hysteroscopy also serves various purposes, including diagnosing the causes of repeated miscarriages or fertility issues, locating intrauterine devices (IUDs), and diagnosing/removing placental tissue post-birth.

Risk

Hysteroscopy is generally safe, with complications occurring in less than 1% of cases.

Potential complications include infection, heavy bleeding, intrauterine scarring, adverse reactions to anesthesia, injury to the cervix, uterus, bowel, or bladder, as well as reactions to substances used to expand the uterus.

Procedure

If a woman’s menstrual cycles are regular, the healthcare provider is likely to recommend scheduling the hysteroscopy during the first week after the cessation of menstruation to ensure the best visualization of the inside of the uterus. For women with irregular menstrual cycles, collaborating with the healthcare provider will be necessary to determine the most suitable timing for the hysteroscopy. Hysteroscopy is feasible at any time for individuals who have undergone menopause.

Before the procedure

Before undergoing a hysteroscopy, conducting a thorough medical history review, inquiring about medications including vitamins and supplements, and advising discontinuation of blood-thinning medications, such as aspirin, may be necessary.

A physical exam, pelvic exam, and pregnancy test may be performed, and further diagnostic tests or blood work may be required based on the specifics of the hysteroscopy.

Clear instructions will be provided to ensure one’s readiness for the procedure. This may include guidance on the necessary preparations such as appropriate attire, and the potential need for post-procedure transportation. If an individual is undergoing general anesthesia, they might be required to refrain from eating or drinking for a specified duration before the hysteroscopy.

During the procedure

The duration of a hysteroscopy can vary, ranging from five minutes to over an hour. The length of the procedure is influenced by factors such as whether it is diagnostic or operative and whether any additional procedures, such as laparoscopy, are performed concurrently.

On the day of the procedure, patients will be requested to empty their bladder and wear a hospital gown. One might be administered anesthesia or a sedative to aid in relaxation. Being awake or asleep during a hysteroscopy depends on the type of anesthesia administered. The anesthesia administered is contingent upon whether the hysteroscopy is conducted in a hospital setting or the surgeon’s office, as well as whether additional procedures are scheduled concurrently.

During the procedure, the individual will be positioned on the exam table with their legs in stirrups. Once in position, the healthcare provider will conduct a pelvic exam, dilate the cervix to facilitate the insertion of a hysteroscope through the vagina and cervix into the uterus. Then:

• A liquid solution will be introduced through the hysteroscope to gently expand and clear the uterus, allowing for a comprehensive examination of the uterus, uterine lining and fallopian tubes.
• The healthcare provider will inspect the uterine cavity and fallopian tube openings, utilizing the hysteroscope’s light for enhanced visibility.
• In cases requiring surgery, the healthcare provider may employ surgical instruments through the hysteroscope to address identified irregularities.

After the procedure

Generally considered a minor surgery, hysteroscopy typically does not necessitate an overnight hospital stay. However, in cases where there is concern about the individual’s response to anesthesia, an overnight stay may be recommended.

Monitoring for several hours in the recovery room may be required for patients who were administered anesthesia. It is not uncommon to feel somewhat faint or nauseous immediately after the procedure. Some individuals may experience cramping or light bleeding for a few days.

Outcome

Recovery duration varies based on the complexity of the procedure, particularly if it involved both diagnostic and operative hysteroscopy. After a hysteroscopy, individuals are typically instructed to refrain from douching, sexual intercourse, or inserting vaginal products such as tampons for approximately two weeks. It may also be recommended to avoid activities such as bathing, swimming, and using hot tubs during the recovery period. Following the specific advice of your surgeon tailored to your individual circumstances is crucial.

Seek medical attention if you encounter any of the subsequent symptoms:

• Fever
• Heavy vaginal bleeding
• Intense abdominal pain