Hysteroscopy allows the direct visualization of the cervical canal and internal uterine architecture. This helps in revealing defects that can lead to infertility problems such as polyps, fibroids, tumors, bands of scar tissue or congenital abnormalities. Hysteroscopic findings complement the results of the Hysterosalpingogram (HSG).
All About Hysteroscopy
Hysteroscopy is used to diagnose or treat problems in the uterus. A hysteroscope is a thin, lighted telescope-like device. It is inserted through your vagina into your uterus. The hysteroscope transmits the image of your uterus onto a screen. Certain things may interfere with a hysteroscopy.
These may include:
- Pelvic inflammatory disease
- Vaginal discharge
- Inflamed cervix
- Bloated bladder
Why is this procedure needed?
One of the most common uses for hysteroscopy is to find the cause of abnormal uterine bleeding. Abnormal bleeding can mean that a woman’s menstrual periods are heavier or longer than usual or occur less or more frequently than normal. Bleeding between periods is abnormal. In some cases, abnormal bleeding may be caused by benign (not cancer) growths in the uterus, such as fibroids or polyps.
Hysteroscopy may be used in the following situations:
- Adhesion removal from infection or a past surgery
- Diagnose the cause of repeated miscarriage when a woman has more than two miscarriages in a row
- Locate an intrauterine device (IUD)
- Perform sterilization using the hysteroscope to place small implants into a woman’s fallopian tubes as a permanent form of birth control
How is the hysteroscopy performed?
Before the procedure begins, you may be given a medication to help you relax, or a general or local anaesthetic may be used to block the pain. If you have general anaesthesia, you will not be awake during the procedure. Hysteroscopy can be done in a health care professional’s office or at the hospital. It will be scheduled when you are not having your menstrual period. To make the procedure easier, your health care professional may dilate (open) your cervix before your hysteroscopy. You may be given medication that is inserted into the cervix, or special dilators may be used. A speculum is first inserted into the vagina.
The hysteroscope is then inserted and gently moved through the cervix into your uterus. Carbon dioxide gas or a fluid, such as saline (saltwater), will be put through the hysteroscope into your uterus to expand it. The gas or fluid helps your health care professional see the lining more clearly. The amount of fluid used is carefully checked throughout the procedure. Your health care professional can view the lining of your uterus and the openings of the fallopian tubes by looking through the hysteroscope. If a biopsy or other procedure is done, small tools will be passed through the hysteroscope.
This procedure is used to diagnose problems in the uterus. Diagnostic hysteroscopy is also used to confirm the results of other tests, such as hysterosalpingography (HSG). An HSG test uses an X-ray dye to check the uterus and Fallopian tubes. Often, diagnostic tests can be done in an office setting without the need for full sedation.
The operative procedure 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.
During a hysteroscopy, your doctor inserts a hysteroscope -- a thin tube with a light on the end -- into your vagina. They'll be able to see into your cervix and inside your uterus. If they find anything abnormal, they can take a sample for later testing.
Among the most common reasons for a hysteroscopy are periods that are longer or heavier than normal, or bleeding between periods.
You might also need the procedure in these situations:
- Your Pap test results are abnormal.
- You’ve been bleeding after menopause.
- There are fibroids, polyps, or scarring on your uterus.
- You’ve had more than one miscarriage or problems getting pregnant.
- Your doctor needs a small tissue sample (biopsy) of the lining of your uterus.
- You’re having a sterilization procedure as a permanent form of birth control.
- Your IUD has come out of place.
A hysteroscopy can either be in a hospital or at your doctor’s office. You can be either awake or under general anaesthesia during the procedure. If you’re awake, your doctor will give you medicine to help you relax. They'll also use medication or tools called dilators to help open your cervix.
Your doctor will likely use a tool called a speculum to keep your vagina open. If you’ve ever had a Pap smear, your doctor has probably used one during that procedure, too.
Next, they'll gently insert the hysteroscope through the cervix into your uterus and push gas or liquid-like saline through the hysteroscope into your uterus to expand it. This will give them a clear view of its lining and the opening of your fallopian tubes through the hysteroscope.
Having a Hysteroscopy procedure done is very safe. However, there is a small risk of problems as with any procedure. The uterus or cervix can be punctured by the hysteroscope which can cause bleeding, or excess fluid may build up in your system. In very rare cases, hysteroscopy can cause life-threatening problems.
Other possible risks:
- Pelvic inflammatory disease
- Tearing of the uterus (rare) or damage to the cervix
- Complications from fluid or gas used to expand the uterus
- You may have slight vaginal bleeding and cramps for a day or two after the procedure.
If the procedure is done on an outpatient basis, you should be able to go home shortly after the procedure. It’s normal to have some mild cramping or a little bloody discharge for a few days after the procedure. Medication will be given to help ease the pain if this is the case. Having a fever, chills, or heavy bleeding or discharge is cause for concern and your doctor should be informed immediately.
With general anaesthesia, you may need to wait until its effects have worn off and have your blood pressure, pulse, and breathing monitored until they are stable and you are alert. When stable, you will be discharged home. Gas may be in your digestive tract from the anaesthesia that may cause upper belly and shoulder pain.
Be sure to take only the specified pain relievers as advised by your physician. Aspirin or certain other pain medicines may increase the chance of bleeding. Don’t douche or have sex for 2 weeks after the procedure or be advised otherwise. You will be given instructions on when you may resume normal activities. You shouldn’t need any special care after a hysteroscopy.