What is a hysteroscopy?
A hysteroscopy is a minimally invasive surgery that requires the insertion of a tiny telescope through the cervix into the uterus. This allows the surgeon to see the inside of the uterine cavity on a monitor and inspect it for any abnormalities. The surgeon will examine the shape of the uterus, the lining of the uterus, and look for any evidence of any abnormalities. The surgeon may also try to see the opening of the fallopian tubes.
A hysteroscope is inserted into the uterus using a sugar or salt solution to distend the uterus and obtain a view of the uterine cavity. A local anaesthetic block of the cervix is often done first to provide pain relief. After the inspection of the uterine cavity has been completed, several different instruments may be used to help treat polyps, uterine fibroids or heavy menstrual bleeding.
Why we perform hysteroscopies
One of the most common reasons a hysteroscopy is performed is to find the cause of any abnormal uterine bleeding. Abnormal bleeding can be heavier or longer, or more or less frequent menstrual periods.
Hysteroscopies can also be used for:
- The removal of adhesions caused by infections or past surgery
- Locating an intrauterine device
- Diagnosing the cause of repeated miscarriages
- Performing sterilisation
Candidates for endometrial hysteroscopy
Women who have gone through menopause or have heavy or irregular bleeding that is not caused by fibroids can be treated by endometrial ablation. Your gynaecologist must rule out any intrauterine pathology that may be causing the bleeding. An endometrial biopsy will often be performed in the office to ensure no cancer is present.
A saline enhanced ultrasound (SIS) or contrast ultrasound can also be performed to assess the size and cavity of the uterus. An SIS is similar to a vaginal ultrasound, but fluid is injected into the uterus to help in seeing inside the uterus. Ablation is not recommended if:
- A polyp or fibroid is identified
- The uterine cavity is very large
- Endometrial cancer or hyperplasia is present
- You have severe menstrual cramping
About endometrial ablation via hysteroscopy
Endometrial ablation is a surgery that requires no hospital stay, being used to reduce or stop heavy uterine bleeding. During ablation, the lining of the uterus (endometrium) is destroyed with a mild electrical current or heat. This stops the uterine lining from growing back, and can be an alternative to a hysterectomy in patients with heavy or irregular uterine bleeding.
What procedures can be performed with hysteroscopy?
Many gynaecologists use a hysteroscope to inspect the lining of the uterus, to look for fibroids or polyps that may cause irregular or heavy menstrual bleeding. Women who are having difficulty becoming pregnant may also have their uterine cavity assessed this way. Other conditions that can be treated or assessed by a hysteroscopy include:
- The removal of fibroids
- A biopsy of the endometrial lining
- The removal of endometrial or cervical polyps
- Opening of the fallopian tubes
- The removal of intrauterine scarring
- Endometrial ablation
- The removal of a lost intrauterine contraceptive device
How long does it take to recover from a hysteroscopy?
There are no incisions involved in a hysteroscopy, so the recovery time tends to be very quick. Most patient require some pain medication after the operation, but anti-inflammatory medication will often suffice. Sexual intercourse and sporting activities should be avoided for two weeks. It is advised that nothing should be inserted into the vagina for two weeks, which includes tampons. Most women will be able to return to work immediately.
What does a hysteroscopy feel like?
You may be able to feel some pressure during a hysteroscopy, but you should not be able to feel any pain due to the use of anaesthesia. After the procedure, you may experience the following:
- Vaginal bleeding
- Nausea or lightheadedness
- Abdominal pain or cramping
- If a breathing tube was used during the anaesthesia, you may have a scratchy throat
What are the benefits of a hysteroscopy
Some of the benefits of a hysteroscopy include:
- A quick recovery time
- Very little to no hospital stay
- No abdominal wounds
- Little postoperative pain
- Minimal chance of infection
What side effects could I experience?
Following any surgery, some bleeding or infection may occur. Occasionally a surgeon may not be able to complete the procedure safely because of excessive bleeding, size of the fibroid, or fluid absorption. Some of the complications that are specific to hysteroscopy include the perforation of the uterus and disproportionate fluid retention. Fluid is used to distend the uterine cavity during a hysteroscopy, and this fluid may be absorbed by general circulation, but if there is excess absorption of fluid the procedure will be stopped.
What should I do if I experience side effects?
If you experience any side-effects you should call your doctor. Side-effects can include:
- Heavy vaginal bleeding
- Inability to urinate
- Shortness of breath
- Severe or increasing abdominal pain
Your doctor will explain all of the risks and benefits of this procedure and you will be able to ask questions.