Hysteroscopy

Procedure Overview

What is a hysteroscopy?

Hysteroscopy is the visual examination of the canal of the cervix and interior of the uterus using a thin, lighted, flexible tube called a hysteroscope. The device is inserted through the vagina.

Hysteroscopy may be used for both diagnostic and therapeutic purposes. The hysteroscope allows for easy visual access to the interior of the cervix and uterus to assess the lining of these structures. Therapeutic maneuvers, such as taking a tissue sample (biopsy), removal of polyps or fibroid tumors, or preventing bleeding with cautery (destruction of tissue by electric current, freezing, heat, or chemicals) may be performed during a hysteroscopy procedure.

Diagnostic hysteroscopy may be performed in a physician’s office or in an outpatient facility with local or no anesthesia required. More invasive therapeutic hysteroscopy procedures may be performed in the operating room under local, regional, or general anesthesia.

Because the physician is able to see the interior of the cervix and uterus during the procedure, diagnostic hysteroscopy has become a more common procedure than dilation and curettage (D & C), which is performed without endoscopic visualization.

Other related procedures that may be used to evaluate problems of the female pelvic organs include D & C, cervical biopsy, colposcopy, endometrial biopsy, laparoscopy, Pap test, and pelvic ultrasound. Please see these procedures for additional information.

What are female pelvic organs?

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The organs and structures of the female pelvis are:

• endometrium - the lining of the uterus
• uterus - also called the womb, the uterus is a hollow, pear-shaped organ located in a woman's lower abdomen, between the bladder and the rectum. The uterus sheds its lining each month during menstruation, unless a fertilized egg (ovum) becomes implanted and pregnancy follows.
• ovaries - two female reproductive organs located in the pelvis in which egg cells (ova) develop and are stored, and where the female sex hormones estrogen and progesterone are produced
• cervix - the lower, narrow part of the uterus located between the bladder and the rectum, forming a canal that opens into the vagina, which leads to the outside of the body
• vagina - the passageway through which fluid passes out of the body during menstrual periods. Also called the "birth canal," the vagina connects the cervix and the vulva (the external genitalia).
• vulva - the external portion of the female genital organs

Reasons for the Procedure

Hysteroscopy may be performed in women who have an abnormal Pap test, dysfunctional uterine bleeding, or postmenopausal bleeding. It may be used to help diagnose causes of infertility or repeated miscarriages. Hysteroscopy may also be used to evaluate uterine adhesions (Asherman’s syndrome), polyps, and fibroids, and to locate and remove displaced intrauterine devices (IUDs).

Therapeutically, hysteroscopy may be used to help correct uterine problems. For example, small adhesions and fibroids may be removed through the hysteroscope, often eliminating the need for open abdominal surgery. Endometrial biopsy or ablation (removal of the endometrial lining) may be performed via hysteroscopy.

There may be other reasons for your physician to recommend a hysteroscopy.

Risks of the Procedure

As with any surgical procedure, complications may occur. Some possible complications of hysteroscopy may include, but are not limited to, the following:

• infection
• bleeding
• pelvic inflammatory disease
• perforation of the uterus (rare)

You may experience slight vaginal bleeding and cramps for a day or two after the procedure.

There may be other risks depending upon your specific medical condition. Be sure to discuss any concerns with your physician prior to the procedure.

Certain factors or conditions may interfere with a hysteroscopy. These factors include, but are not limited to, the following:

• pelvic inflammatory disease
• vaginal discharge
• inflamed cervix
• distended bladder

Before the Procedure

• Your physician will explain the hysteroscopy procedure to you and offer you the opportunity to ask any questions that you might have.
• You may be asked to sign a consent form that gives permission to do the procedure. Read the form carefully and ask questions if something is not clear.
• For certain more invasive hysteroscopy procedures: In addition to a complete medical history, your physician may perform a complete physical examination to ensure you are in good health before undergoing the procedure. You may undergo blood tests or other diagnostic tests.
• Depending on the type of procedure to be performed, you may be asked to fast before the procedure if you are to receive local or general anesthesia. The procedure may be performed with local or regional anesthesia or without anesthesia depending on what other procedures are to be performed at the same time.
• If you are pregnant or suspect that you may be pregnant, you should notify your physician.
• Notify your physician if you are sensitive to or are allergic to any medications, iodine, latex, tape, and anesthetic agents (local and general).
• Notify your physician of all medications (prescription and over-the-counter) and herbal supplements that you are taking.
• Notify your physician if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure.
• Depending on the procedure to be performed, you may receive a sedative prior to the procedure to help you relax. Because the sedative may make you drowsy, you will need to arrange for someone to drive you home.
• You will be scheduled to undergo the procedure after menstrual bleeding has ended and before ovulation. This allows better visualization of the uterus and avoids damaging a newly formed pregnancy.
• Dress in clothes that permit access to the area or that are easily removed.
• Based upon your medical condition, your physician may request other specific preparation.

During the Procedure

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A hysteroscopy may be performed on an outpatient basis or as part of your stay in a hospital. Procedures may vary depending on your condition and your physician's practices.

Generally, a hysteroscopy follows this process:

1. You will be asked to remove clothing and will be given a gown to wear.
2. You will be asked to empty your bladder prior to the procedure.
3. An intravenous (IV) line may be inserted in your arm or hand.
4. You will be positioned on an operating table, lying on your back with your feet in stirrups.
5. The vaginal area will be cleansed with an antiseptic solution.
6. The cervix may be dilated prior to the insertion of the hysteroscope.
7. The hysteroscope will be inserted into the vagina, through the cervix, and into the uterus.
8. A liquid or gas will be injected through the hysteroscope to expand the uterus, allowing for better visualization.
9. The wall of the uterus will be examined for abnormalities. Photographs or video documentation may be made. Biopsy specimens may be taken.
10. If a procedure such as fibroid removal is to be performed, instruments will be inserted through the hysteroscope.
11. For more detailed or complicated procedures, a laparoscope (a type of endoscope inserted through the abdomen) may be used to view the outside of the uterus simultaneously.
12. When the procedure is completed, the hysteroscope will be removed.

After the Procedure

Your recovery process will vary depending upon the type of anesthesia that is given. If general anesthesia or a sedative was used, your blood pressure, pulse, and breathing will be monitored until they are stable and you are alert. When stable, you will be discharged to your home. Hysteroscopy is usually performed on an outpatient basis.

Otherwise, there is generally no special type of care following a hysteroscopy.

You may experience cramping and vaginal bleeding for a day or two after the procedure.

You may experience flatulence (gas in the digestive tract) and pains resulting from the gas administered during the procedure for about 24 hours. You may feel pain in your upper abdomen and shoulder.

Take a pain reliever for soreness as recommended by your physician. Aspirin or certain other pain medications may increase the chance of bleeding. Be sure to take only recommended medications.

You may be instructed to avoid vaginal douching and sexual intercourse for two weeks after the procedure, or for an alternate period of time recommended by your physician.

Other activities and normal diet may be resumed unless your physician advises you differently.

Your physician may give you additional or alternate instructions after the procedure depending on your particular situation.