Your Health - Hysteroscopy

Hysteroscopy

Pronounced: His-ter-OSS-co-pee

Definition

This is the use of a hysteroscope to view the inside of a woman’s uterus (womb). A hysteroscope is a thin long telescope with a camara on the end. Other tiny tools may also be insterted into the uterus through the hysteroscope also.

Female Reproductive Organs

Reasons for Procedure

Hysteroscopy is done for:

Diagnostic reasons—to examine the inner uterus to identify problems or abnormalities; may be done if you have:
- Repeated miscarriage
- Infertility
- An abnormal pap test
- Abnormal or postmenopausal uterine bleeding
Therapeutic reasons—to correct anatomic problems and defects in the uterus; may be done for:
- Endometrial ablation—removal of uterine lining from the uterus
- Myomectomy—removal of fibrous or muscular tissue (fibroids)
- Removal of polyps (usually noncancerous)
- Locate and remove intrauterine devices (IUDs)

The result of the hysteroscopy depends on the reason for the procedure. In some cases, the doctor may be able to treat a condition right away. In other cases, you may need further surgery or other treatment.

Possible Complications

Complications are rare but no procedure is completely free of risk. If you are planning to have hysteroscopy, your doctor will review a list of possible complications, which may include:

Swelling or bleeding
Infection
Organ injury
Reaction to anesthesia

Factors that may increase the risk of complications include:

History of pelvic inflammatory disease
Inflammation of the cervix
Distended bladder
Pregnancy or possible pregnancy
Allergies to surgical materials (eg, iodine, latex, medications, anesthetics)

Be sure to discuss these risks with your doctor before the procedure.

What to Expect

Prior to Procedure

Your doctor will likely do the following:

Ask about your medical history, medications, and allergies
Do a physical exam and blood work.

Leading up to the procedure:

Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure like:
- Anti-inflammatory drugs (eg, aspirin)
- Blood thinners like clopidogrel (Plavix) or warfarin (Coumadin)
Arrange to have someone drive you home. Also, arrange for help at home.
If instructed, eat a light meal the night before the surgery. Do not eat or drink anything after midnight.

Anesthesia

Depending on the reason for the hysterscopy, your doctor may use:

General anesthesia—blocks pain and keeps you asleep through the surgery; used for therapeutic procedure
Regional anesthesia—numbs one area of the body; used for diagnostic or therapeutic procedure
Local anesthesia—just the area that is being operated on is numbed; given as an injection and may also be given with a sedative; used for diagnostic procedure

Description of the Procedure

A speculum will be inserted into the vagina, similar to performing a Pap smear. It will hold your vagina open and allow instruments to pass easier. The doctor will clean the vagina and may dilate the cervix. The hysteroscope will then be put into the uterus through the vagina and cervix. The uterus will be filled with carbon dioxide gas or a liquid. This will cause the uterus to inflate, allowing the doctor to get a closer, clear look at the uterine walls.

If you are having the procedure done for diagnostic reasons, the doctor will examine the uterus for abnormal tissue. A biopsy may be taken or, the uterine walls may be swabbed to get cell samples.

If you are having the procedure done for therapeutic reasons, the doctor will insert small tools through the hysteroscope. The doctor will use the tools to remove diseased tissue and make repairs. In some cases, the doctor will use another viewing tube called a laparoscope passed into the abdomen. This allows the doctor to monitor the outside of the uterus and detect any possible perforation of the uterus.

How Long Will It Take?

About 15-45 minutes (or longer for therapeutic procedure)

How Much Will It Hurt?

You will have mild cramping and soreness. Ask your doctor about pain medicine.

Post-procedure Care

When you return home after the procedure, do the following to help ensure a smooth recovery:

Rest as needed. Ask for someone to help you at home.
Recovery time is minimal. Return to your normal activities the day after the procedure.
Do not take medicine without your doctor’s approval. Some medicines may make bleeding worse.
Keep in mind that you may have difficulty using the bathroom for a few hours after the procedure. You may also have watery or bloody vaginal discharge for 3-4 weeks.
You may have some bleeding or discharge from your vagina for several days postsurgery. A sanitary napkin or pad may be worn.
Talk to your doctor about when it is okay to have sex, use tampons, or put anything else in the vagina.
Be sure to follow your doctor's instructions.

Call Your Doctor

After arriving home, contact your doctor if any of the following occurs:

Signs of infection, including fever and chills
Abnormal bleeding (more than a menstrual period)
Foul smelling vaginal discharge
Abdominal pain
Nausea, vomiting
Cough, shortness of breath, difficulty swallowing, or chest pain
Trouble urinating
Any other concerns

In case of an emergency, call 911.

RESOURCES:

The American College of Obstetricians and Gynecologists
http://www.acog.org/publications/patient_education/

Women's Health.gov
http://www.womenshealth.gov/

CANADIAN RESOURCES:

The Society of Obstetricians and Gynaecologists of Canada
http://www.sogc.org/

Women's Health Matters
http://www.womenshealthmatters.ca/

References:

Diagnostic hysteroscopy for abnormal bleeding of the uterus. Health Source website. Available at: http://web28.epnet.com . Accessed August 22, 2005.

Gynecologic evaluation. The Merck Manual of Medical Information, Second Home Edition Online website. Available at: http://www.merck.com/mmhe/sec22/ch242/ch242c.html?qt=hysteroscopy&alt=sh#sec22-ch242-ch242c-124. Updated March 2007. Accessed September 23, 2009.

Hysteroscopy. St. John’s Mercy Health Care website. Available at: http://www.stjohnsmercy.org/healthinfo/test/gyn/TP117.asp. Accessed August 22, 2005.

Julian T. Hysteroscopic complications. Journal of Lower Genital Tract Disease. 2002;6:39-47.

Reproductive endocrinology and infertility. Duke University Medical Center website. Available at: http://www2.mc.duke.edu/depts/obgyn/ivf/hysteros.htm . Accessed August 22, 2005.

Last reviewed November 2009 by Ganson Purcell,Jr., MD, FACOG, FACPE

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.