Hysteroscopy

Hysteroscopy is the process of using a viewing scope to examine the interior of the uterus along with the cervical canal. The scope is inserted through the vagina and into the cervical opening. The procedure can be performed as an aid in the diagnosis of problems with the uterus, or it may be combined with simple surgical techniques for treatment purposes.

Since hysteroscopy examines the interior (lining) of the uterus, it is not appropriate for examination or diagnosis of problems or conditions that occur within the muscular wall or on the outside of the uterus. While hysteroscopy allows visualization of the openings to the Fallopian tubes to the uterine cavity, it does not allow for direct examination of the Fallopian tubes.

Hysteroscopy is one procedure that your doctor may consider for the evaluation and/or treatment of a number of different conditions, including abnormal vaginal bleeding, polyps or tumors inside the uterus, anatomic abnormalities, scarring following previous surgical procedures such as dilation and curettage (D&C), and retained placenta. It can also be used for surgical sterilization and to guide the physician to localize an area for endometrial (uterine lining) biopsy.

Hysteroscopy should not be attempted if a woman is pregnant or has an active pelvic infection. It should also not be performed in women who have uterine or cervical cancer. In addition, obstruction (stenosis) of the cervical opening may make it difficult or impossible to perform hysteroscopy.

Prior to the procedure, the doctor will usually perform a thorough physical examination, including a pelvic examination.

Depending upon the purpose of the hysteroscopy and the individual patient's health status, hysteroscopy may be performed in the office or an outpatient surgery department. In most procedures performed in a clinic, no special preparation is necessary. Less commonly, hysteroscopy may be performed in the operating room, especially when it is combined with surgical procedures. The doctor will advise the patient regarding preparation for surgery and the need for anesthesia before such procedures are performed.

A number of different sizes and types of hysteroscope are available. The choice of instrument varies according to the purpose of the procedure and whether surgical procedures are to be performed at the same time.

Sometimes, hysteroscopy using narrow-diameter hysteroscopes can be performed without anesthesia. Local anesthetic can also be applied topically or given by injection. In some cases, dilation of the cervical opening with medications known as prostaglandins and/or surgical instruments may be necessary. A vaginal speculum is often inserted prior to the procedure to facilitate insertion of the hysteroscope through the cervical os (opening). After insertion of the hysteroscope, fluid or gas is injected into the uterine cavity to distend the uterus and thus improve visualization.

Some mild cramping may be experienced during the procedure, depending upon the type of anesthesia used. If necessary, short-acting analgesics or sedatives medications may be given intravenously if necessary.

It is normal to experience light vaginal bleeding and some cramping following the procedure. In most cases, a woman may return to normal activities almost immediately. However, if she experiences any of the following, the patient should notify their doctor immediately:

• Heavy vaginal bleeding or discharge
• Severe abdominal pain
• Fever

Complications of hysteroscopy are rare. The most common complication that has been reported is accidental perforation of the uterus. Other possible (but rare) complications include bleeding, infection, damage to the urinary or digestive tract, and medical complications resulting from reactions to drugs or anesthetic agents. Other rare complications are fluid overload or gas embolism (when gas bubbles enter the bloodstream) from the liquid or gas that is injected to distend the uterine cavity during the procedure.

It is important for the woman to adhere to the doctor's recommendations regarding follow-up examinations and visits. Inform your physician if you are experiencing any adverse effects or recurrence of symptoms.

Many minor surgical procedures can be successfully performed using hysteroscopy, and it can be a valuable diagnostic tool. The outlook or prognosis depends upon the individual woman and the underlying condition or reason for hysteroscopy. Most women recover rapidly with only minor cramping and bleeding immediately following the procedure.