Hysteroscopy

Types of Hysteroscopy

1. Diagnostic Hysteroscopy:
   • Performed to investigate uterine conditions when a woman experiences abnormal symptoms such as heavy menstrual bleeding, pelvic pain, or difficulty getting pregnant.
   • The procedure allows the doctor to directly view the inside of the uterus and take biopsies if needed.
2. Operative Hysteroscopy:
   • Used to treat uterine problems identified during diagnostic hysteroscopy.
   • Involves the use of specialized surgical instruments passed through the hysteroscope to remove or correct uterine conditions like polyps, fibroids, adhesions, or septa.

How Hysteroscopy is Performed

Hysteroscopy is typically done in an outpatient setting, although it may also be performed in a hospital, depending on the complexity of the procedure.

1. Preparation:
   • Fasting: You may be asked to fast for a few hours before the procedure if general anesthesia or sedation will be used.
   • Pain management: Most hysteroscopies are performed under local anesthesia (where you are awake but numbed) or general anesthesia (where you are asleep). In some cases, regional anesthesia (e.g., spinal or epidural) may be used.
   • Positioning: The procedure is done while you are lying on your back with your legs in stirrups, similar to a pelvic exam.
2. Procedure:
   • Insertion of the Hysteroscope: The doctor gently inserts the hysteroscope through the cervix into the uterus. The hysteroscope is connected to a monitor, allowing the doctor to view the uterus in real-time.
   • Distension of the Uterus: To provide a clear view, the uterus is filled with a sterile fluid or gas to expand it and improve visibility.
   • Examination: The doctor examines the walls of the uterus, checking for abnormalities such as fibroids, polyps, adhesions, or signs of cancer. If something is found that needs treatment, additional instruments are used to remove or correct the problem.
3. Post-Procedure:
   • After the procedure, you may experience mild cramping, spotting, or a watery discharge due to the fluid used during the procedure.
   • In cases where surgery was performed (operative hysteroscopy), you may have some discomfort or light bleeding for a few days.
   • Depending on the type of anesthesia used, you may need to rest until the effects wear off if you were sedated or under general anesthesia.

Conditions Treated with Hysteroscopy

Hysteroscopy is useful for diagnosing and treating a wide range of uterine conditions. Some of the common problems that can be addressed through this procedure include:

1. Uterine Polyps:
   • Noncancerous growths in the lining of the uterus that can cause abnormal bleeding or infertility. Polyps can be removed using the hysteroscope.
2. Fibroids (Myomas):
   • Noncancerous tumors that develop in the uterine muscle. Hysteroscopy can be used to remove submucosal fibroids, those that grow just beneath the uterine lining.
3. Endometrial Hyperplasia:
   • Thickening of the uterine lining, which can lead to abnormal bleeding. A biopsy or removal of excess tissue may be done during the procedure.
4. Uterine Septum:
   • A congenital abnormality where the uterus has a wall (septum) that divides it into two parts. This can lead to recurrent miscarriages or infertility. Hysteroscopy can be used to remove the septum.
5. Asherman’s Syndrome (Uterine Adhesions):
   • Scarring inside the uterus, often caused by previous surgeries like D&C (dilation and curettage) or infection. Adhesions can be removed with hysteroscopic surgery.
6. Abnormal Bleeding:
   • When a patient experiences heavy, prolonged, or irregular bleeding, hysteroscopy can help diagnose the cause, whether it’s polyps, fibroids, or other issues.
7. Removal of Foreign Bodies:
   • If a foreign object (such as a forgotten IUD or surgical sponge) is present in the uterus, it can be removed using hysteroscopy.
8. Endometrial Cancer:
   • Although rare, hysteroscopy can help identify abnormal growths or lesions in the uterus that could be cancerous, allowing for biopsy and early detection.

Advantages of Hysteroscopy

• Minimally Invasive: Hysteroscopy is performed through the cervix without requiring incisions, which reduces the risk of infection, scarring, and a lengthy recovery time.
• Short Recovery Time: Most women can resume normal activities within a day or two, especially after diagnostic hysteroscopy.
• Precision: The procedure allows for direct visualization of the uterine cavity, which leads to more accurate diagnoses and treatment of uterine abnormalities.
• Outpatient Procedure: Hysteroscopy is typically done on an outpatient basis, meaning there’s no need for an overnight hospital stay.
• No Scarring: Because no large incisions are made, there is minimal risk of scarring or complications compared to traditional surgery.

Risks and Complications

Although hysteroscopy is generally safe, there are some risks and potential complications to consider, particularly if operative procedures are involved:

1. Infection: As with any surgical procedure, there is a small risk of infection.
2. Uterine Perforation: The hysteroscope may unintentionally puncture the uterus, which could lead to bleeding or injury to other organs. This is rare but more common if the uterus is very large or abnormal.
3. Bleeding: Light bleeding or spotting is common, but excessive bleeding may require further intervention.
4. Fluid Imbalance: During the procedure, the uterus is filled with a sterile fluid. In rare cases, too much fluid may be absorbed into the bloodstream, leading to electrolyte imbalances or fluid overload.
5. Scarring: If adhesions are treated during operative hysteroscopy, there’s a small chance of new scar tissue forming, which could cause future fertility problems.
6. Anesthesia Risks: If general anesthesia is used, there are always risks associated with anesthesia, although these are typically low.

Recovery and Aftercare

• Pain Management: You may experience mild cramping, similar to menstrual cramps, for a day or two after the procedure. Over-the-counter pain relievers like ibuprofen can help manage discomfort.
• Discharge and Spotting: It’s common to have a watery or bloody discharge for a few days following the procedure, particularly after operative hysteroscopy.
• Activity: Most women can return to work and light activities the day after the procedure, but heavy exercise or sexual activity may need to be avoided for 1–2 weeks to allow the uterus to heal.
• Follow-Up: Your doctor may schedule a follow-up visit to ensure the procedure was successful and to address any concerns.

Conclusion

Hysteroscopy is a versatile and effective tool in modern gynecology for diagnosing and treating a variety of uterine conditions. Whether used for investigating abnormal bleeding, addressing fibroids or polyps, or treating adhesions, hysteroscopy offers a minimally invasive, relatively quick recovery option compared to traditional surgery.

If you are considering or have been advised to undergo a hysteroscopy, it’s important to discuss your individual situation with your gynecologist to understand the potential benefits, risks, and expected outcomes of the procedure.