Hysteroscopy?
It is carried out using a narrow telescope, called the
hysteroscope, which is inserted through the cervix (opening of the womb) into the uterus. The hysteroscope is connected to a light and camera, which sends images to a monitor so that the gynaecologist is able to see inside the uterus.
As the hysteroscope is passed into your uterus through the
vagina and cervix, no cut needs to be made in your skin.
Hysteroscopy can be either diagnostic or operative.
When is operative hysteroscopy used?
Abnormal bleeding, fibroids, polyps or Infertility.
Polyps and fibroids:
Hysteroscopy is used to remove these non-cancerous growths found in the uterus.
Adhesions:
Also known as Asherman's Syndrome, uterine adhesions are bands of scar tissue that can form in the uterus and may lead to changes in menstrual flow as well as infertility. Hysteroscopy can help your doctor locate and remove the adhesions.
Septum:
Hysteroscopy can help determine whether you have a
uterine septum, a malformation (defect) of the uterus that is
present from birth.
Abnormal bleeding:
Hysteroscopy can help identify the cause of heavy or lengthy menstrual flow, as well as bleeding between periods or after menopause. Endometrial ablation is one procedure in which the hysteroscope, along with other instruments are
WHEN SHOULD HYSTEROSCOPY BE PERFORMED?
The first week after your menstrual period. This timing will be ideal to view the inside of your uterus. Hysteroscopy is also performed to determine the cause of unexplained bleeding or spotting in postmenopausal women.
ARE THERE ANY RISKS WHEN HAVING A HYSTEROSCOPY?
A hysteroscopy is generally safe but like any procedure, there is a small risk of complications, and the risk is higher if the procedure is used for carrying out a surgical treatment rather than simply to make an examination (diagnostic hysteroscopy).
Some of the main risks include:
· Accidental damage to the uterus where a perforation (hole) is made in the wall. This is not common but may require treatment with antibiotics in the hospital, or in rare cases, another operation such as laparoscopy (keyhole surgery) or laparotomy (open surgery) to repair the uterus or organs close by such as the bowel · Accidental damage to the cervix – this is rare and can be easily repaired · Infection – this can cause a vaginal discharge, fever and heavy bleeding. It is usually treated with a short course of antibiotics from your doctor · Excessive bleeding during or after surgery – this can be treated with medication or another procedure; very rarely it maybe necessary to remove the uterus (hysterectomy)
Alternatives to hysteroscopy:
This depends on the nature of the problem. An ultrasound scan may be performed to look at the uterus, but it does not provide as detailed an examination as hysteroscopy.
What happens during a hysteroscopy?
A hysteroscopy is generally a simple procedure that is usually carried out as a daycare procedure, meaning that you need not stay in hospital overnight.
Before a hysteroscopy, you may be advised to:
· Have blood tests to make sure that there are no health issues that might prevent you from proceeding with the procedure. This is usually done in the week before the hysteroscopy · Have a vaginal swab taken to make sure there is no likelihood of infection · Use contraception as a hysteroscopy cannot be performed if you are pregnant. You may have a pregnancy test on the day you arrive for the procedure. Although hysteroscopy is usually carried out under general anesthesia, modern hysteroscopes are very thin and allow for the procedure to be performed in an outpatient setting without anaesthesia. Your doctor will discuss with you which type of procedure will be suitable for you. It is usually a quick procedure, lasting 10 to 30 minutes and does not involve any cut. If general anaesthesia is used, you will be asleep throughout the procedure and will not feel anything. If it is performed as an outpatient procedure, most women do not feel much pain but may feel some discomfort, similar to period pain. Taking painkillers such as ibuprofen or paracetamol about an hour beforehand can help reduce this. Occasionally, a local anaesthetic may be used to numb your cervix during the procedure. Every patient is different and the anaesthetist will make changes as required to suit your needs.
What will my doctor see during a hysteroscopy?
During the procedure, the doctor will be looking at the inside of your uterus via the narrow hysteroscope. Any abnormality is noted and sometimes a small sample of the lining of the womb is taken for testing (this is called a biopsy). If there is a need to remove an abnormality such as a polyp or fibroid, an appropriate instrument can be inserted through the side of the hysteroscope for this purpose. Any tissue removed is sent to the laboratory for testing.
After a hysteroscopy:
Most women having a general anaesthetic are able to go home after four hours, although some may stay longer. Can return to normal activities later that day or the next day. Regular diet. Might feel some mild, period-like pain or cramps. vaginal spotting or bleeding – this can last up to a week. This bleeding might be heavier than a normal period and can stop and start – these variations are normal can have intermittent bleeding or spotting PV Avoid sexual intercourse for at least seven days after the procedure to help prevent an infection
Contact if you notice any of the following:
Persistent bleeding from the vagina that becomes heavier than a normal period and is bright red Severe pain in the lower part of your abdomen A high temperature (38oC or above) An offensive (bad) smelling vaginal discharge Increasing nausea and vomiting Pain or burning on passing urine or the need to pass urine frequently.