Diagnostics
Hysteroscopy
Hysteroscopy is a diagnostic procedure to look inside the womb (uterus). A special tool called a hysteroscope, which is like a thin, lighted, flexible tube, is used for this. The hysteroscope is inserted through the vagina and cervix (the opening of the womb), so there is no need for any cuts on the skin. The images taken by the hysteroscope are shown on a monitor, allowing the doctors to see inside the womb. The procedure is used to diagnose and treat the problems of the uterus.
Who performs hysteroscopy?
Hysteroscopy procedures are typically performed by gynecologists or gynecologic surgeons specializing in reproductive health and treating conditions related to the female reproductive system. This procedure is performed in hospitals (gynecology or surgical units), gynecology clinics, and fertility clinics. For a hysteroscopy, the patient may receive local anesthesia or no anesthesia. In certain situations, more complex procedures may be performed in an operating room with local, regional, or general anesthesia.
When is the hysteroscopy procedure carried out?
- Investigation of symptoms or problems: Assessing and investigating symptoms such as heavy periods, abnormal vaginal bleeding, postmenopausal bleeding, pelvic pain, recurrent miscarriages, or difficulties in conception.
- Diagnosis of conditions: Identifying and diagnosing various conditions such as fibroids (non-cancerous growths in the womb) and polyps.
- Treatment of conditions and problems: Providing therapeutic interventions to address specific issues, such as the removal of fibroids, polyps, displaced intrauterine devices (IUDs), and intrauterine adhesions (scar tissue that can cause absent periods and reduced fertility).
Hysteroscopy has replaced the previously common procedure known as dilatation and curettage (D&C) for examining the womb and removing abnormal growths. It has become the preferred method due to its effectiveness and minimally invasive nature.
How is a hysteroscopy performed?
Before hysteroscopy
- The doctors will gather medical history and inquire about medications, including supplements. The patient may be advised to discontinue anticoagulant medications, including aspirin, prior to the procedure to prevent excessive bleeding.
- Doctors will do a physical and pelvic examination, as well as a pregnancy test. Depending on the specific situation, additional diagnostic tests or blood work may be necessary.
- The patient may be advised about appropriate attire, fasting requirements, and whether need someone to accompany them after the hysteroscopy.
During hysteroscopy procedure
- The patient will be asked to empty the bladder and change into a hospital gown.
- Anesthesia or sedation may be administered depending on the setting and additional procedures.
- The patient will lie on the examination table and place their legs in special holders called stirrups.
- The surgeon will perform a pelvic exam to assess reproductive organs.
- The cervix will be dilated to allow the hysteroscope to be inserted.
- The hysteroscope, a thin tube with a light and camera, will be inserted into the uterus through the vagina and cervix.
- A liquid or gas will be injected through the hysteroscope to expand the uterus and allow clear visualization of the uterus, uterine lining, and fallopian tubes.
- The surgeon will carefully examine the uterine cavity and the openings of the fallopian tubes using the light and camera of the hysteroscope.
The duration of a hysteroscopy can vary, typically ranging from 5 minutes to over an hour.
If a patient had anesthesia during hysteroscopy, a few hours may be spent in the recovery room for observation. Mild cramping or light bleeding that can last for a few days may be experienced. Feeling slightly lightheaded or nauseous immediately after the procedure is also common.
The patient can return to usual activities and diet unless the doctor gives different instructions.
Hysteroscopy is generally a safe procedure, but as with any surgery, there is a small risk of complications. These complications occur in less than 1% of cases and may include:
- Infection.
- Heavy bleeding.
- Intrauterine scarring.
- Reaction to anesthesia.
- Injury to the cervix,
- uterus, bowel, or bladder.
- Reaction to the substance used to expand the uterus.
References
- Cleveland Clinic. Hysteroscopy. Available from: https://my.clevelandclinic.org/health/treatments/10142-hysteroscopy
- Hysteroscopy Overview. Available from: https://www.nhs.uk/conditions/hysteroscopy/#:~:text=A%20hysteroscopy%20is%20a%20procedure,and%20camera%20at%20the%20end
- Hysteroscopy. Available from: https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/hysteroscopy
