What is Hysteroscopy?
What is hysteroscopy?
Hysteroscopy is a procedure that allows your doctor to look
inside your uterus in order to diagnose and treat causes of abnormal bleeding.
Hysteroscopy is done using a hysteroscope, a thin, lighted tube that is inserted
into the vagina to examine the cervix and inside of the uterus. Hysteroscopy can
be either diagnostic or operative.
What is diagnostic hysteroscopy?
Diagnostic hysteroscopy is used to diagnose problems of the uterus.
Diagnostic hysteroscopy is also used to confirm results of other tests, such as
hysterosalpingography (HSG). HSG is an X-ray dye test used to check the uterus
and fallopian tubes.
Additionally, hysteroscopy can be used with other procedures, such as
laparoscopy, or before procedures such as dilation and curettage (D&C). In
laparoscopy, your doctor will insert an endoscope (a slender tube fitted with a
fiberoptic camera) into your abdomen to view the outside of your uterus, ovaries
and fallopian tubes. The endoscope is inserted through an incision made through
or below your navel.
What is operative hysteroscopy?
Operative hysteroscopy is used to correct an abnormal condition that has been
detected during a diagnostic hysteroscopy. If an abnormal condition was detected
during the diagnostic hysteroscopy, an operative hysteroscopy can often be
performed at the same time, avoiding the need for a second surgery. During
operative hysteroscopy, small instruments used to correct the condition are
inserted through the hysteroscope.
When is operative hysteroscopy used?
Your doctor may perform hysteroscopy to correct the following uterine
conditions:
- 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.
- Septums—Hysteroscopy can help determine whether you
have a uterine septum, a malformation 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, is used to destroy the
uterine lining in order to treat some causes of heavy bleeding.
What are the benefits of hysteroscopy?
Compared with other, more invasive procedures, hysteroscopy may provide the
following advantages:
- Shorter hospital stay
- Shorter recovery time
- Less pain medication needed after surgery
- Avoidance of hysterectomy
- Possible avoidance of "open" abdominal surgery
How safe is hysteroscopy?
Hysteroscopy is a relatively safe procedure. However, as with any type of
surgery, complications are possible. With hysteroscopy, complications occur in
less than 1 percent of cases and can include:
- Risks associated with anesthesia
- Infection
- Heavy bleeding
- Injury to the cervix, uterus, bowel or bladder
- Intrauterine scarring
- Reaction to the substance used to expand the uterus
When should the procedure be performed?
Your doctor may recommend scheduling the hysteroscopy for the first week
after your menstrual period. This timing will provide the doctor with the best
view of the inside of your uterus. Hysteroscopy is also performed to determine
the cause of unexplained bleeding or spotting in postmenopausal women.
What type of anesthesia is used for hysteroscopy?
Anesthesia for hysteroscopy may be local, regional, or general:
- Local anesthesia--the numbing of only a part of the body
for a short time
- Regional anesthesia--the numbing of a larger portion of
the body for a few hours
- General anesthesia--the numbing of the entire body for
the entire time of the surgery
The type of anesthesia used is determined by where the hysteroscopy is to be
performed (hospital or doctor’s office) and whether other procedures will be
done at the same time. If you are having general anesthesia, you will be told
not to eat or drink for a certain amount of time before the hysteroscopy.
How is hysteroscopy performed?
Prior to the procedure, your doctor may prescribe a sedative to help you
relax. You will then be prepared for anesthesia. The procedure itself takes
place in the following order:
- The doctor will dilate (widen) your cervix to allow the
hysteroscope to be inserted.
- The hysteroscope is inserted through your vagina and cervix
into the uterus.
- Carbon dioxide gas or a liquid solution is then inserted into
the uterus, through the hysteroscope, to expand it and to clear away any
blood or mucus.
- Next, a light shone through the hysteroscope allows your doctor
to see your uterus and the openings of the fallopian tubes into the uterine
cavity.
- Finally, if surgery needs to be performed, small instruments
are inserted into the uterus through the hysteroscope.
The time it takes to perform hysteroscopy can range from less than 5 minutes
to more than an hour. The length of the procedure depends on whether it is
diagnostic or operative and whether an additional procedure, such as laparoscopy,
is done at the same time. In general, however, diagnostic hysteroscopy takes
less time than operative.
What can I expect after the procedure?
If regional or general anesthesia is used during your procedure, you may have
to be observed for several hours before going home. After the procedure, you may
have some cramping or slight vaginal bleeding for one to two days. In addition,
you may feel shoulder pain if gas was used during your hysteroscopy. It is also
not unusual to feel somewhat faint or sick. However, if you experience any of
the following symptoms, be sure to contact your doctor:
- Fever
- Severe abdominal pain
- Heavy vaginal bleeding or discharge
Will I have to stay in the hospital overnight?
Hysteroscopy is considered minor surgery and usually does not require an
overnight stay in the hospital. However, in certain circumstances, such as if
your doctor is concerned about your reaction to anesthesia, an overnight stay
may be required.
Who is a candidate for this procedure?
Although there are many benefits associated with hysteroscopy, it may not be
appropriate for some patients. A doctor who specializes in this procedure will
consult with your primary care physician to determine whether it is appropriate
for you.
©
Copyright 1995-2005 The Cleveland Clinic Foundation. All rights reserved
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