Hysteroscopy is used to diagnose and treat womb or uterine problems. The procedure involves a thin, telescope-like camera that is inserted into the uterus through the vagina. This camera has a light at the end and is called a hysteroscope. Diagnostic hysteroscopy is performed to check for abnormal uterine bleeding.
Abnormal bleeding means that menstrual periods are heavier, more frequent, or longer than usual. The second type of hysteroscopy, called operative hysteroscopy, uses a hysteroscope as a surgical instrument. It is a non-invasive procedure that does not require an incision in the patient’s body and is performed by inserting a hysteroscope through the vagina into the uterus.
Diagnostic hysteroscopy
In addition to abnormal bleeding, this method may be used for the following reasons:
- To determine the cause of recurrent miscarriage, this happens if a woman has two miscarriages in a row
- To diagnose certain diseases, such as fibroids or polyps that are non-cancerous growths of the uterus
- Check for fertility issues if there is a problem with infertility
- To check for pelvic pain
- Abnormal bleeding during periods
- Heavy periods
- Bleeding after menopause
- Uterine adhesions
- Endometrial cancer
- Endometrial hyperplasia
Operative hysteroscopy
This method is used in the following conditions:
- To eliminate adhesion: These are sores that connect the tissues inside the uterus and may result from an infection or surgery. Adhesion can stop periods and reduce fertility.
- To find and remove an intrauterine device that is inserted into the uterus to prevent pregnancy.
- To remove fibroids or growths.
- To perform a sterilization procedure.
- To take a biopsy of tissue for further investigations.
Preparing
Before having a hysteroscopy, should make sure that there is no possibility of pregnancy. For this reason, it is important to use contraception or not have sex between the last period and the test. Do not worry if there is bleeding during the operation. Hysteroscopy can usually continue unless it is severe.
Usually, the day of the procedure and the day of returning home is one day. The doctor may recommend an over-the-counter pain reliever such as ibuprofen one or two hours before surgery.
Depending on the severity of the operation, the patient may need local anesthesia or general anesthesia. General anesthesia, such as fibroid treatment, may be needed if the operation is longer and more complicated. In general, under anesthesia, do not eat or drink anything for six hours before hysteroscopic surgery.
Types of anesthesia
Anesthesia may be local, regional, or general.
Local
Local anesthesia blocks the nerves connecting a specific part of the body to the brain and prevents the transmission of pain signals to the brain.
Regional
This method anesthetizes only certain parts of the body on which the surgery is performed. The patient is still conscious during the surgery, but anesthesia works on the nerves and causes numbness at the injection site.
General
In general anesthesia, the patient is anesthetized and has no consciousness or sensation. Many different medications may be used during general anesthesia. Some are anesthetic gases or vapors administered through a breathing tube or mask. Some drugs are injected through IV to stimulate sleep, relax muscles, and relieve pain. In this case, the patient is temporarily anesthetized.
Procedure
The doctor first expands the cervix with a device called a speculum. The doctor then inserts the hysteroscope through the vaginal opening, then moves it through the cervix and then into the uterus. A liquefied petroleum gas or carbon dioxide is then gently passed through the device into the uterus to clear its surface and help it expand slightly.
The light and camera at the end of the hysteroscope allow the doctor to see the uterus and fallopian tubes. This allows them to diagnose any problems or perform the necessary surgical procedures. If this method is used for surgery, surgical instruments are also put through the hysteroscope tube for surgery.
This method is not painful. However, the patient may feel a little cramped during the operation. The doctor may prescribe a sedative to help the patient feel more relaxed. The amount of anesthesia required depends on the purpose of the hysteroscopy and the location where the hysteroscopy is performed. This method can take from 5 minutes to 30 minutes, depending on the purpose.
For diagnosis, hysteroscopy can be performed in a physician’s office with only local anesthesia. This is also usually the case with the simple removal of small polyps. When it is performed in conjunction with deeper surgery, it may be performed in a hospital.
Recovery
The purpose of hysteroscopy determines the recovery time. However, there are general cases that are common after any hysteroscopic procedure that, including:
- Cramping
- Slight bleeding or spotting for a day or so
- Shoulder pain
- Mild nausea
- Lightheadedness or dizziness
The patient can eat or drink immediately after the hysteroscopy. If this procedure is performed only under local anesthesia in the doctor’s office, the patient can usually leave the office in less than an hour. If the procedure is performed under regional anesthesia, the doctor may wait for the effects to subside before sending the patient home. In some cases, the doctor may prescribe painkillers to help recover. If surgery is involved, the doctor may recommend a day or two of rest before starting a regular program. For a hysteroscopy that is not completely diagnostic, sexual activity should be avoided for about a week, which helps reduce the risk of infection.
Benefits
Compared to other invasive procedures, hysteroscopy offers the following advantages:
- Shorter hospital stays
- Shorter recovery time
- Less pain medication is needed after surgery
- Avoidance of hysterectomy
- Possible avoidance of “open” abdominal surgery
Complications
This method is relatively safe. However, like any type of surgery, complications can occur. Complications that occur can include:
- Infection
- Risks associated with anesthesia
- Heavy bleeding
- Injury to the cervix, uterus, bowel, or bladder
- Reaction to the substance used to expand the uterus
- Pelvic inflammatory disease
- Scar tissue formation in the uterus
- Anaphylactic reactions to medications used during the procedure
- Over distension of the uterine cavity
- Pulmonary edema (swelling in the lungs)
- Blood clotting in the vessels
- Rupture or tearing of the uterus (rare)
- Excess fluid/gas buildup during the expansion of the womb
Alternatives to hysteroscopy
Depending on what is causing the symptoms, further research may be done. Ultrasound can be used to diagnose some gynecological diseases, such as Uterine fibroids. Ultrasound can be performed from the abdomen or inside using a device inserted into the vagina. Other tests, such as MRI scans, can be used to diagnose conditions such as endometriosis and fibroids.
If the doctor needs to take a sample of the uterus lining, an endometrial biopsy is an alternative to a hysteroscopy. They insert a narrow tube through the cervix and use gentle suction to remove the specimens of the lining; then, the specimens are examined under a microscope.
The bottom line
The uterus is a pear-shaped muscle in the pelvis. As one of the parts of the female reproductive system, the uterus plays the most important role in infertility. It is the main place for keeping and feeding the fetus during pregnancy. Like any other organ in the body, this organ can suffer from diseases and complications. One new medical method that examines and treats uterine problems is hysteroscopy.
In hysteroscopy, a telescope-like device is inserted into the uterine cavity through the cervix. The doctor then examines the uterus and uterine walls for direct internal adhesions, polyps, or fibroids. In addition to performing this type of surgery, any abnormality and pathology inside the uterine cavity and cervical canal can be treated simultaneously with a hysteroscopy and in the same session. Therefore, this method is considered diagnostic and Operative.
Dr. Arjang Naim, MD, uses hysteroscopy if the patient’s symptoms and previous diagnostic procedures indicate that further investigation is needed. The doctor and his team use both hysteroscopic methods based on the patient’s condition.
Additional questions
- How long is there bleeding after a hysteroscopy?
You may bleed from your vagina for 7 to 10 days after a hysteroscopy. This bleeding may be heavier than normal and can stop and start. These changes are normal.
- What is the treatment for uterus adhesion?
Intrauterine adhesions (IUAs) are bands of fibrous tissue that form in the endometrial cavity, often in response to a uterine procedure. IUA is often associated with menstrual abnormalities and infertility. IUAs are usually treated with hysteroscopic resection followed by mechanical or hormonal therapy.
- What is Endometrial hyperplasia?
Endometrial hyperplasia is a condition of the female reproductive system. The inner lining of the uterus (endometrium) becomes abnormally thick due to having many cells (hyperplasia). It is not cancer, but it increases the risk of endometrial cancer in some women.
- Is hysteroscopy a major surgery?
Hysteroscopy is considered minor surgery and usually does not require an overnight hospital stay.
- Do they remove polyps during a hysteroscopy?
During hysteroscopy, instruments inserted through the hysteroscope make it possible to remove the polyps. The removed polyp will likely be sent to a laboratory for microscopic examination.
References
https://www.medicalnewstoday.com/articles/320451
https://www.medicinenet.com/hysteroscopy/article.htm
https://www.bupa.co.uk/health-information/womens-health/hysteroscopy
https://my.clevelandclinic.org/health/treatments/10142-hysteroscopy
https://www.nhs.uk/conditions/hysteroscopy/recovery/
https://www.healthline.com/health/hysteroscopy