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Hysteroscopy

Hysteroscopy is a procedure that allows your doctor to look inside your uterus in order to diagnose and treat causes of abnormal bleeding. Hysteroscopy is done using a hysteroscope, a thin, lighted tube that is inserted into the vagina to examine the cervix and inside of the uterus. Hysteroscopy can be either diagnostic or operative.

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.

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 fiberoptic 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 often 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.

Septom – Hysteroscopy can help determine whether you have a uterine septum, a malformation 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 hysteroscopy, along with other instruments, is used to destroy the uterine lining in order to treat some causes of heavy bleeding.

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

How safe is hysteroscopy?

Hysteroscopy is a relatively safe procedure. However, as with any type of surgery, complications are possible. With hysteroscopy, complications occur in less than 1 percent of cases and can include:

  • Risks associated with anesthesia
  • Infection
  • Heavy bleeding
  • Injury to the cervix, uterus, bowel or bladder
  • Intrauterine scarring
  • Reaction to the substance used to expand the uterus

When should the procedure 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.

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.

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 hysteroscopy to be inserted.

The hysteroscopy 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 hysteroscopy, to expand it and to clear away any blood or mucus.

Next, a light shone through the hysteroscopy 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 hysteroscopy.

The time it takes to perform hysteroscopy can range from less than 5 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.

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