Hysteroscopy is a procedure that allows a gynecologist to look inside your uterus. The hysteroscope is a long tube, about the size of a straw, which has a built-in viewing device. It is inserted through the vagina and cervix into the cavity of the uterus (endometrial cavity). The uterine cavity is then distended with fluid and visualized.
Hysteroscopy is useful for diagnosing and treating some problems that cause infertility, miscarriages, and abnormal menstrual bleeding. Sometimes other procedures, such as laparoscopy, are done at the same time as hysteroscopy.
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What is the purpose of Diagnostic Hysteroscopy?
Problems that occur with a woman’s reproductive organs sometimes cannot be found by a physical examination alone. Laboratory tests, ultrasounds and x-rays may still leave some uncertainty. Frequently, problems, which cannot be discovered by routine investigations, can be discovered by laparoscopy, or hysteroscopy, two procedures that provide a direct look at the pelvic organs.
Hysteroscopy may be either diagnostic or operative.
Diagnostic hysteroscopy is used to examine the inside of the uterus, also known as the uterine cavity and may also be used to confirm the results of other tests such as hysterosalpingography (HSG). This procedure is helpful in diagnosing abnormal uterine conditions such as polyps, internal fibroids, scarring, and developmental abnormalities.
Operative hysteroscopy may be used, instead of open abdominal surgery, to both diagnose and treat certain conditions such as uterine adhesions, septums, or fibroids which can often be removed through the hysteroscope
What are the benefits of Diagnostic Hysteroscopy?
- Hysteroscopy is a commonly performed and generally safe procedure.
- Gives a clear diagnosis.
- Helps in the diagnosis of conditions such as septum, fibroids, polyps and adhesions.
- Treatment, if required, is quick and effective.
How do I prepare for Diagnostic Hysteroscopy?
- The procedure can be done at any time of the cycle, but is usually avoided during the menses.
- Do not eat or drink anything after midnight or the morning before the procedure. Do not even drink coffee, tea, or water.
- You will need to shave your private parts prior to the procedure.
You need to be accompanied by your spouse or another relative to help you in your post- op recovery period.
- Tell the doctor ahead of time if you have ever had an allergic reaction to lidocaine or the numbing medicine used at the dentist’s office.
What kind of anesthesia is used for Diagnostic Hysteroscopy?
Diagnostic hysteroscopy is usually conducted on an out patient basis with either general or local anesthesia.
How is Diagnostic Hysteroscopy performed?
Hysteroscopy is performed as a day case, with no overnight stay. The procedure usually takes around 15-20 minutes.
You lie on your back on an examination table, with your knees bent and your feet in footrests, as you would for a pelvic examination. Your vaginal area is cleaned with an antibacterial soap.
The first step of diagnostic hysteroscopy involves slightly stretching the canal of the cervix with a series of dilatators. Once the cervix is dilated, the hysteroscope, a narrow lighted viewing instrument similar to but smaller than the laparoscope, is inserted through the cervix and into the lower end of the uterus. The scope is then attached to a camera, allowing the doctor to see a clear image on a video screen. Special clear solutions (normal saline) are then injected into the uterus through the hysteroscope sheath. This distends the uterine cavity, clears blood and mucus away, and enables the doctor to directly view the internal structure of the uterus – the walls and the openings of the fallopian tubes.
If surgery is to be done, small instruments will be inserted through the hysteroscope.
After the examination, the hysteroscope is removed quickly and easily.
What happens after Diagnostic Hysteroscopy?
After hysteroscopy, the patient is allowed to rest for 2–4 hours to recover from the anesthesia. As the anesthetic wears off, there may be some abdominal pain, and painkillers may be required. You are allowed liquids after 4 hours and soft diet in the evening.
Since the operation has been planned as a day case, you will be able to go home once you have recovered from the anesthetic. A general anesthetic can temporarily affect co-ordination and reasoning skills, so people are advised to avoid driving, drinking alcohol or signing legal documents for 24 hours afterwards.
Before leaving the hospital, the doctor will explain the findings of the hysteroscopy. If a biopsy has been done, it will take 5 to 7 days before the results are available.
Once home, further painkillers may be taken if needed. It’s important to take it easy for the rest of the day. Some women feel ready to resume normal activities and work the day after the procedure.
What are the risks associated with Diagnostic Hysteroscopy?
Most patients do not have any problems and can even go back to work the same day. Some patients may feel weak and have cramps that last several hours afterward. Spotting and light bleeding like a period can occur for several days afterward and are considered normal. Complications of hysteroscopy are rare, and seldom serious. These include
- Perforation (hole) of the uterus with the hysteroscope– the hole usually heals on its own
- Allergic reaction to the anesthetic
When should I call the doctor?
You should call the doctor is you develop
- A fever above 101
- Severe lower abdominal pain
- Abnormal discharge
- Heavy bleeding