Hysteroscopy

Hysteroscopy at a glance

  • Hysteroscopy is a procedure that allows a doctor to look inside a woman’s uterus in order to diagnose and treat causes of abnormal bleeding or possible causes of infertility.
  • A hysteroscope is a thin, lighted tube that is inserted into the vagina to examine the cervix and the inside of the uterus.
  • Operative hysteroscopy involves the use of small surgical instruments inserted through the hysteroscope to remove growths in the uterus, such as fibroids or polyps.

What is hysteroscopy?

A diagnostic hysteroscopy identifies a problem. An operative hysteroscopy corrects the problem with surgery conducted through the hysteroscope. Hysteroscopy can also be used along with laparoscopic surgery that corrects an identified problem. It can also be used before certain procedures, including curettage and dilation.

A hysteroscopy is a tool used by a physician to look at the lining of a woman’s uterus. The tip of the hysteroscope is put into the vagina and gently moved through the cervix into the uterus. The hysteroscope has a light and camera hooked to it so the doctor can see the lining of the uterus, called the endometrium, on a video screen.

Hysteroscopy can find the cause of abnormal bleeding or bleeding after a patient has passed menopause. It also may be done to see if a problem in the uterus is preventing a woman from becoming pregnant (infertility).

The following steps are generally part of a hysteroscopy:

  • The patient receives anesthesia, either local, regional or general
  • The physician inserts the hysteroscope through the vagina and the cervix, which has been dilated, and into the uterus
  • The uterus is cleared with gas or liquid and the physician examines it and the opening of the Fallopian tubes
  • If correction can be done at this juncture, instruments are passed through the hysteroscope and the doctor performs the surgery, making it an operative hysteroscopy.

When is operative hysteroscopy used?

Operative hysteroscopy can correct the following uterine conditions:

  • Polyps and fibroids—operative hysteroscopy removes these growths, which are non-cancerous, from the uterus
  • Abnormal bleeding—hysteroscopy can help identify the cause of heavy or lengthy menstrual flow, as well as bleeding between periods or after menopause.
  • Adhesions—bands of scar tissue that form in the uterus, sometimes causing infertility or changes in menstrual flow (also known as Asherman syndrome)
  • Septums—operative hysteroscopy can help identify and correct a uterine septum, which is an abnormally formed uterus present at birth.

What are the risks and side effects of hysteroscopy?

If a fluid is used during the test to help the doctor see the uterine lining clearly, the patient may absorb some of it and feel bloated. It may also change the level of sodium in her blood.

A hysteroscopy can cause bleeding, an infection, or injury to the uterus, cervix, bladder or bowel. In rare cases, the uterus, bladder, or bowel can be punctured during the test, requiring surgical repair. If general anesthesia is used, normal risks associated with its use are possible.

Right after the test, the patient will usually stay in the recovery area for 1-4 hours, and then will be moved to a hospital room or go home. It is normal to have a small amount of vaginal bleeding for a day or so after a hysteroscopy.

What are the benefits of hysteroscopy?

Hysteroscopy has advantages over other forms of surgery. These include:

  • Less time for recovery
  • None or little time in the hospital
  • Less need for pain medication after surgery
  • Reduces the need for a hysterectomy and traditional large incision (“open”) abdominal surgery.