Hysteroscopy

Hysteroscopy is a procedure that allows a gynecologist to look inside the uterus. The hysteroscope is a long tube, about the size of a straw, which has a built-in camera. The scope is inserted through the cervix and vagina, and is used to diagnose and treat certain medical conditions that can cause such problems as infertility, miscarriages, and abnormal menstrual bleeding.   Sometimes other procedures, such as laparoscopy, are done at the same time as hysteroscopy.The procedure is usually performed in the physician’s office under local anesthesia; although sometimes no anesthesia is needed.  Some women require general anesthesia and the procedure will be performed in the operating room. The hysteroscopy is used as a diagnosis tool for several problems, including:

• Infertility – Sometimes infertility is caused by an abnormality in the woman’s uterus.  Hysteroscopy allows the physician to search for and identify the abnormalities.
• Polyps, Fibroids or Adhesions – Hysteroscopy allows the physician to locate and take a biopsy, or samples, of any abnormal growths in the uterus to see if they are cancerous or might one day become cancerous.
• Abnormal Uterine Bleeding – Hysteroscopy is often used to take a biopsy of the uterus to help the physician identify the cause of unusual bleeding.  The bleeding might be in the form of unusually heavy or long periods, bleeding in between periods, or bleeding after menopause.
• Repeated Miscarriages – Miscarriage is defined as the loss of a pregnancy before 20 weeks.  They are very common among women, but if more than one occurs, the physician can use hysteroscopy to check for a physical reason.
• Locating IUDs – An IUD, or intrauterine device, is a small plastic device inserted in the uterus to prevent pregnancy.  They occasionally move out of place and become attached to the uterus itself. 

A physician can use hysteroscopy to locate the IUD.Hysteroscopy is also used to treat some conditions, such as:

• Fibroids or Adhesions - Once located, they can often be removed by the surgeon through the hysteroscope.
• Abnormal Uterine Bleeding – Is sometimes treated by using the hysteroscope to perform a procedure that destroys the lining of the uterus and stops the bleeding.  This procedure is called endometrial ablation.

The Procedure 

A hysteroscopy may be performed on an outpatient basis or in a hospital, depending on the woman’s medical conditions and the physician’s normal practices.  A typical procedure is as follows:

• The patient is asked to remove all clothing and is given a gown to wear.  She is also asked to empty her bladder prior to the procedure. 
• If a general or regional anesthesia is to be used, an intravenous (IV) line may be inserted in the arm or hand.
• The woman is positioned on the procedure table, lying on her back with feet supported in foot rests.
• The vaginal area is cleansed with an antiseptic solution.  If necessary, the cervix may be dilated to ease insertion of the hysteroscope.
• The hysteroscope is inserted into the vagina, through the cervix, and into the uterus, and a special liquid is injected through the hysteroscope.  The liquid expands the uterus to allow for a better view.
• The uterus is examined for abnormalities.  At this point, biopsy samples may be taken, as well as photos or video documentation.
• If treatment is to be performed, such as removal of fibroids, the instrument will be inserted through the hysteroscope.
• Depending on the goal of the procedure, a laparoscope (another viewing instrument that is inserted through a small slit in the abdomen) may be used to view the outside of the uterus at the same time.
• When the procedure is completed, the hysteroscope will be removed.  The procedure can take anywhere from several minutes to a few hours in the case of treatments.

After the Procedure

The recovery process will vary depending upon the type of anesthesia used.  If general anesthesia or a sedative was used, the woman’s blood pressure, pulse, and breathing will be monitored until they are stable and the woman is alert.  The following may result from the procedure and are not a cause for concern unless they become extreme:

• Cramping for a day or two after the procedure
• Vaginal bleeding or spotting for a few days following the procedure If either of these symptoms last for more than a few days, or if you experience heavy bleeding or increasing pain, the physician should be notified.

Remember

Hysteroscopy is a common and very safe procedure that can be extremely helpful to the healthcare provider in diagnosing and even treating problems with the uterus.