Hysteroscopy

Hysteroscopy is a procedure that allows a doctor to look directly inside the uterus (the female reproductive organ that houses the embryo and fetus during pregnancy) to evaluate and treat specific uterine problems.


Indications
Hysteroscopy may be done to:
inspect the lining or evaluate the shape of the uterus
evaluate or remove uterine growths such as fibroids (abnormal tissue growths attached to the uterine wall that may cause heavy or prolonged menstrual periods and lower abdominal pain) or polyps (another type of abnormal tissue growth)
do a biopsy (take a tissue sample for microscopic examination)
locate or remove a foreign body in the uterus, such as an IUD (a device used for birth control)
verify the presence of a tumor
check for blockage in the fallopian tubes (the tubes located on each side of the uterus)
check for adhesions (tissues that stick together, causing pain, discomfort or organ restriction)
help determine the cause of abnormal uterine bleeding
perform endometrial ablation (surgical destruction of the uterine lining)
evaluate reasons for repeated miscarriages or infertility
provide a clear view of the uterus during dilation and curettage (D and C, a procedure used to scrape the lining of the uterus)
perform other surgical procedures

Patient preparation
A pregnancy test is typically done, when appropriate. The procedure will be postponed if you're pregnant.
Arrange for your care and recovery ahead of time. Find someone to drive you home after the procedure and help with any other activities for the rest of the day. Ask your doctor how long you may need help at home.

You may be instructed to eat a light supper the night before the procedure and not eat or drink anything after midnight or on the morning of the procedure. Even coffee, tea and water may not be permitted.


Procedure
Although every surgery has its own standard procedure, your individual health history could play a role in any variation to the procedure. Discuss these issues with your doctor.
A hysteroscopy can be done anytime except during menstruation, but the best time is within the first week after your period. Depending on how involved it will be, the procedure may be done in your doctor's office or the hospital.

Your doctor may recommend taking a mild pain reliever, such as ibuprofen, before the procedure. You may also be given antibiotics to prevent infection.

Local anesthesia is typically used along with intravenous or oral sedation. In some cases, general or regional anesthesia may be used instead. Local anesthesia numbs a small part of the body, regional anesthesia numbs a certain area of the body, and general anesthesia induces temporary unconsciousness.

To begin the procedure, a speculum (an instrument used to provide a better view of the vaginal canal) will be inserted into your vagina. Then, an instrument called a hysteroscope (a slender, telescope-like tube with a light on the end) will be passed through your vagina and cervix and into the uterus.

If treatment procedures are planned -- rather than simple observation -- your cervix will need to be dilated (opened) with a special instrument so that the doctor can use a larger hysteroscope that allows for other instruments to be passed through it. Dilation of the cervix may be started with medication taken the night before the procedure.

Because the uterus is typically deflated, the doctor will expand it with gas or fluid to provide a better view. Then, the doctor will complete the exam or treatment.

A laparoscope (a thin tube equipped with a camera lens and light that's inserted through a small incision in the abdomen) may be used at the same time to examine the outside of the uterus, fallopian tubes and ovaries.

Depending on what's done, hysteroscopy may take from 20 minutes to an hour or more.


Postprocedure care
You'll be monitored for a while after the procedure, depending on what type of anesthesia was used and what was done during the procedure. Mild uterine cramping is normal. You'll probably receive mild pain medication to ease the discomfort. Light watery to bloody discharge is also common for a day or two after the procedure. The discharge shouldn't be heavy.
Ask your doctor about any restrictions for exercise, tampon usage, sex or other activities, and be sure you know when to return for your follow-up visit. While you're recovering, notify your doctor immediately if you have heavy vaginal discharge or bleeding, run a fever or have severe lower abdominal pain.


Benefits
Diagnosis through hysteroscopy is especially accurate because the doctor can directly view the uterus. Because the procedure is usually done in a doctor's office or outpatient setting, you can typically avoid a hospital stay.

Risks
Risks associated with hysteroscopy may include:
reactions or complications related to the anesthesia
injury to the cervix or uterus (such as perforation)
infection
bleeding
allergic reaction to the fluid used to expand the uterus

Considerations
The procedure may not be recommended if you have cervical stenosis (constriction or narrowing of the cervix), a pelvic infection or vaginal bleeding.

Pregnancy-specific information
Hysteroscopy isn't done during pregnancy. Women who've had a hysteroscopy for a surgical procedure, such as removal of tumors or adhesions, have an increased risk of uterine rupture during pregnancy.

Senior-specific information
Hysteroscopy is most often done during the childbearing years, but it may be needed for older women in some cases. Discuss any concerns you may have with your doctor ahead of time.