Hysteroscopy

Hysteroscopy is a medical procedure that involves the insertion of a thin telescope called a hysteroscope into the uterus (womb) through the cervix (neck of the womb).

It allows healthcare providers to visually examine the inside of the uterus for diagnostic purposes or to perform certain therapeutic procedures.

What is the purpose of a hysteroscopy?

• Evaluation and treatment of abnormal uterine bleeding and uterine anomalies

• Removal of polyps, fibroids, or adhesions
• Identification of uterine cancer
• Investigation of fertility issues
• Removal of foreign objections such as intrauterine device

A hysteroscopy is more accurate in diagnosing endometrial disease than a pelvic ultrasound scan. In addition, a see-and-treat approach can be used to treat any pathology found.

Hysteroscopy procedure

1. Patient preparation:

   • The patient is typically asked to empty their bladder before the procedure.

   • In some cases, a sedative or pain killers and local anaesthesia may be administered to minimise discomfort.

   • The patient is positioned on the examination table, similar to a pelvic exam.

2. Insertion of the hysteroscope:

   • A speculum is usually placed into the vagina to clean and visualise the cervix.

   • The cervix may sometimes require dilatation to allow the passage of the hysteroscope.

   • The hysteroscope is carefully inserted through the cervix into the uterine cavity. No cuts are needed.

3. Distension of the uterus:

   • To create a clearer view of the uterine walls, a sterile fluid (usually saline) is injected into the uterus through the hysteroscope.

   • The fluid helps expand the uterus, allowing the healthcare provider to examine the lining and identify any abnormalities.

4. Visual examination:

   • The hysteroscope transmits images to a monitor, enabling the doctor to visually inspect the entire uterine cavity.

   • The examination includes a detailed inspection of the endometrium, the openings of the fallopian tubes, and the overall structure of the uterus.

5. Diagnostic procedures:

   • If the hysteroscopy is primarily diagnostic, the healthcare provider may take samples of the endometrial tissue (endometrial biopsy) for further analysis.

   • Additionally, any visible abnormalities such as polyps, fibroids, or adhesions may be identified for further management.

6. Operative procedures (if necessary):

   • In cases where therapeutic intervention is needed, additional instruments can be introduced through channels in the hysteroscope.

   • Common operative procedures include:

     • Polyp or displace intrauterine device removal using grasping forceps.

     • Resection of polyps, fibroids or uterine septum using specialised instruments.

     • Adhesion lysis to remove scar tissue.

     • Ablation of endometrium (lining of the womb).

7. Completion of the procedure:

   • Once the examination and any necessary procedures are completed, the hysteroscope is carefully removed.

   • The fluid used for distension is allowed to drain out of the uterus.

   • Adhesion barrier may be used to reduce the risk of Asherman’s syndrome.

   • The patient may be observed for a short period to monitor vital signs and ensure there are no immediate complications.

8. Post-procedure care:

   • Patients are typically observed in a recovery area for a short time.

   • Information on post-procedure care, including potential side effects such as light bleeding or cramping, is provided.

   • Discharge instructions and any prescribed medications are given.

9. Follow-up and results:

   • If diagnostic sampling was performed, results may take a few days to be available.

   • The doctor will discuss the findings with the patient and recommend any necessary follow-up, additional treatments, or monitoring.

FAQ

Is hysteroscopy painful?

The level of discomfort varies among individuals. In general, diagnostic hysteroscopy is well-tolerated and may not require anesthesia. However, for operative hysteroscopy, local anesthesia or conscious sedation may be used to minimise pain. After the procedure, some women may experience mild cramping and discomfort, which can be managed with over-the-counter pain relievers.

How long does hysteroscopy take?

The duration of hysteroscopy can vary. Diagnostic hysteroscopies are usually shorter, typically lasting 15 to 30 minutes. Operative hysteroscopies, which involve additional procedures like polyp removal or adhesion treatment, may take longer, up to an hour or more.

Are you put to sleep for a hysteroscopy?

Whether you're put to sleep for a hysteroscopy depends on the procedure type. 

Diagnostic hysteroscopies often use local anaesthesia or sedation and are usually done awake, while operative hysteroscopies might require general anaesthesia, making you completely asleep. 

The choice of anaesthesia is based on the procedure's complexity, your pain tolerance, health, and potential reactions to anaesthesia. Your doctor will recommend the best option for you.

What conditions can hysteroscopy diagnose and treat?

Hysteroscopy can diagnose and treat various uterine conditions, including but not limited to:

• Polyps
• Fibroids
• Adhesions (scar tissue)
• Uterine septum
• Displaced intrauterine device
• Endometrial hyperplasia and cancer

Are there risks associated with hysteroscopy?

While hysteroscopy is generally safe, there are potential risks and complications. Medication can minimize common risks such as:

• Crampy pain
• Infection
• Bleeding

Serious risks are uncommon, affecting fewer than 1 in 500 women. These include:

• Damage to the uterus (1 in 2,000)
• Injury to other organs such as the bowel, bladder, and major blood vessels, which may necessitate further surgery (laparoscopy or laparotomy)
• Extremely rare deaths from complications (1 in 20,000)
• Reaction to anesthesia if used

Can hysteroscopy affect fertility?

Diagnostic hysteroscopy is unlikely to impact fertility. In fact, treating certain conditions discovered during hysteroscopy, such as removing polyps or adhesions, may improve fertility. However, it is essential to discuss individual circumstances and fertility concerns with the healthcare provider.

Can hysteroscopy be used to treat heavy menses?

Hysteroscopic resection of fibroids and/or polyps can reduce menstrual bleeding. In addition, hysteroscopic resection of endometrium or balloon endometrial ablation can significantly control heavy menses without any skin incision, such that a hysterectomy (removal of the womb) can be avoided.

Is hysteroscopy safe during pregnancy?

Hysteroscopy is contraindicated during pregnancy.

What to expect after a hysteroscopy?

After hysteroscopy, patients may experience:

• Light bleeding or discharge for a few days.
• Mild cramping.
• Rest is recommended, and activities like heavy lifting or strenuous exercise should be avoided for a brief period.

How often is hysteroscopy recommended? 

The frequency of hysteroscopy depends on the individual's health condition. It may be a one-time diagnostic procedure or repeated if ongoing monitoring or treatment is necessary such as in endometrial hyperplasia. The healthcare provider will determine the appropriate schedule based on the specific case.