Hysteroscopy Treatment

What is Hysteroscopy?

Hysteroscopy is a procedure that allows the doctor to look inside the uterus for diagnosing and treating the cause of abnormal bleeding. Hysteroscopy is performed using a hysteroscope, a thin, lighted tube which is inserted into the vagina to examine the cervix and inside of the uterus. Hysteroscopy can be either diagnostic or operative.

• Diagnostic Hysteroscopy: Diagnostic hysteroscopy is used for diagnosing problems of the uterus. Diagnostic hysteroscopy can also use to confirm the results of other tests, such as hysterosalpingography. Diagnostic hysteroscopy can be usually performed in an office setting; it can be used with other procedures, such as before the procedures of dilation and curettage or with laparoscopy, In laparoscopy, the doctor will insert an endoscope into the abdomen to view the outside of the uterus, ovaries and fallopian tubes. The endoscope is inserted through an incision made through or below the patient’s navel.
• Operative hysteroscopy: Operative hysteroscopy is used for correcting an abnormal condition that has been detected during a diagnostic hysteroscopy. If an abnormal condition was recognized during the diagnostic hysteroscopy, an operative hysteroscopy can be performed along with the diagnostic hysteroscopy, thus avoiding the need for a second surgery. During operative hysteroscopy, small instruments used for correcting the condition are inserted through the hysteroscope.

What are the risks?

Some possible difficulty of hysteroscopy may include:

• Infection
• Bleeding
• Pelvic inflammatory disease
• Tearing of the uterus or damage to the cervix 
• Complications from fluid or gas, that is used for expanding the uterus

The patient may have slight vaginal bleeding and cramps for a day or two after the procedure. There may be other risks based on the conditions.

Certain things may constrain a hysteroscopy. These may include:

• Pelvic inflammatory disease
• Vaginal discharge
• Inflamed cervix
• Bloated bladder

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The Alternative to hysteroscopy:

The womb can also be examined by using

• Pelvic Ultrasound: In this, a small probe is inserted in the vagina and sound waves are used to produce an image of the inside of the womb
• Endometrial Biopsy: In this procedure, a narrow tube is passed through the cervix into the womb, with the suction used for removing a sample of the womb’s lining.

These methods may be performed alongside a hysteroscopy, but these methods do not provide as much information and can’t be used to treat problems in the same way as a hysteroscopy.

When one should have hysteroscopy?

The doctor may perform a hysteroscopy to correct the following uterine conditions:

• Polyps and fibroids: Hysteroscopy is used for the removal of these non-cancerous growths found in the uterus.
• Adhesions (Asherman’s Syndrome): Uterine adhesions are bands of scar tissue that can form in the uterus and which may result in the changes in menstrual flow as well as infertility. Hysteroscopy can help the doctor locate and remove the adhesions.
• Septums: Hysteroscopy can help determine whether the patient has a uterine septum, a malformation of the uterus that is present from the birth.
• Abnormal bleeding: Hysteroscopy can also help in identifying the cause of heavy or lengthy menstrual flow, as well as bleeding between periods or after menopause. Endometrial ablation is a procedure in which the hysteroscope, along with the help of other instruments, is used to destroy the uterine lining in order to treat heavy bleeding.

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What does the procedure involve?

This procedure will take place with the patient in the same position as they’re normally in for a gynecological exam, with their feet in the stirrups at the end of the exam table.

During a hysteroscopy:

• The doctor will first spread the cervix with the help of a tool called a speculum
• The doctor will then insert the hysteroscopy device in via the vaginal opening. They will continue moving it through the cervix and then finally into the uterus.
• A liquid or carbon dioxide gas will then be gently sent into the uterus through the device to clear the surface and to help widen it slightly.
• With the help of light and camera on the end of the hysteroscope allow the doctor to see the uterus and fallopian tubes. This allows them to diagnose any issues or to perform any surgical procedures, if necessary.

If the procedure is used for surgery, the surgical devices will be put through the hysteroscope tube for performing the surgery. The procedure isn’t painful. However, the patient may experience some cramping during the procedure. The doctor may order some type of sedative for the patient to take beforehand so that the patient remains relaxed. The extent of anesthesia depends on the purpose of the hysteroscopy. The procedure takes from 5-30 minutes depending on what’s being done.

How soon will I recover?

The purpose of the hysteroscopy will determine the length of recovery; however, there are some things that are common after any hysteroscopy procedure. The patient may experience the following:

• cramping
• spotting for a day or slight bleeding
• shoulder pain
• mild nausea
• lightheadedness or dizziness

The patient will be able to eat or drink immediately following the hysteroscopy. If the patient has their procedure in the doctor’s office with just local anesthesia, then they will be able to leave in less than an hour. If the procedure requires regional anesthesia, the doctor may want the patient to wait until the effects of anesthesia have worn off before the patient is being sent to the home. This usually takes less than an hour, but it could take longer depending on the amount of anesthesia used. If the procedure requires general anesthesia, then it’s still an outpatient procedure. The patient will be able to return home after a few hours. The doctor will only require an overnight stay in the hospital for observation if the patient has a past reaction to anesthesia. In some cases, the doctor may prescribe pain medication to make recovery easier. The doctor’s instructions for recovery must be followed by the patient. For a hysteroscopy that isn’t purely diagnostic, the patient should refrain themselves from sexual activity for about a week. This helps in reducing the chance of infection.

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