Diagnosing and Operating Using Hysteroscopy
A hysteroscopy is a method used by a physician to examine the lining of the uterus, called the endometrium. A thin viewing tool (called a hysteroscope) is inserted into the vagina and guided through the cervix into the uterus. This scope has a light and camera on the end, allowing the doctor to see the endometrium on a TV monitor. A hysteroscopy is done to find the cause of abnormal uterine bleeding or any bleeding that occurs after menopause, or to assess the uterus when the couple has infertility. A hysteroscopy is a useful treatment tool, allowing the doctor to remove growths from the uterus. During the hysteroscopy, the doctor may take a small sample of the endometrial tissue by biopsy. With the diagnostic hysteroscopy, the doctor can determine the cause of abnormal bleeding or infertility. With the operative hysteroscopy, the doctor can correct adhesions, remove growths, fix malformations, and stop abnormal bleeding.
A diagnostic hysteroscopy is used to diagnose problems with the uterus. This procedure is often done in combination with other procedures, such as laparoscopy or dilation and curettage (D&C). The diagnostic hysteroscopy is done when a woman has problems with fertility or abnormal uterine bleeding.
The operative hysteroscopy is used to correct any abnormal condition that is found during a diagnostic hysteroscopy. Most of the time, the doctor goes ahead and performs the operative procedure during the diagnostic one. Reasons for an operative hysteroscopy include:
- Adhesions. Uterine adhesions are bands of scar tissue that form inside the uterus and cause menstrual flow problems and infertility.
- Septums. A uterine septum is a malformation of the uterus that is congenital.
- Polyps and fibroids. Growths inside the uterus can cause abnormal bleeding and/or infertility.
- Abnormal bleeding. To stop excessive bleeding, an endometrial ablation is done during the procedure.
Reasons for a Hysteroscopy
- Find the cause of infertility.
- Find the cause of severe cramping or abnormal bleeding.
- Stop heavy menstrual bleeding.
- Look at the uterine openings and fallopian tubes for blockages.
- Open the fallopian tubes.
- Find the possible cause of repeated miscarriages.
- Check for endometrial cancer.
- Find and remove small polyps or fibroids.
- Find and reposition an intrauterine device (IUD).
- Remove problem areas of the endometrium (endometrial ablation).
- Position a contraceptive implant (Essure) for sterilization.
Preparing for a Hysteroscopy
You should have the hysteroscopy done when you are not on your menstrual period. If you may be pregnant, the hysteroscopy should be done following the next menstrual period and before ovulation. Do not douche, use vaginal medications, or tampons 24 hours before the procedure.
Things to Tell the Doctor
Before the procedure, there are some things you need to tell the doctor. These include if you:
- Are or could be pregnant.
- Are allergic to any medications.
- Are taking medicines.
- Have been using blood thinners, such as aspirin or Coumadin.
- Have been treated for a vaginal, cervical, or pelvic infection recently.
- Have any lung or heart conditions.
Things to Consider
- Don't eat or drink after midnight if you will have general anesthesia.
- Follow the doctor's instruction regarding any medications.
- Arrange for someone to drive you home in case you receive a sedative.
- Talk to the doctor about any concerns you have regarding the procedure.
A hysteroscopy is often done by a gynecologist in an operating room of a hospital or surgery center. Most women will go home the same day. In order to relax or go to sleep, anesthesia will be given. You must wear a gown for the test, empty your bladder before, and lie on your back during the procedure.
The doctor uses a speculum to spread the vaginal walls and clean the inside with a special soap. The hysteroscope is inserted through the vagina and advanced into the uterus via the cervix. The doctor examines, diagnoses, and treats the condition, and possibly obtains a biopsy. The total procedure takes around 30 minutes.
How it Feels
Most women are given a sedative and local or regional anesthesia. If this occurs, you will be awake during the test and experience mild cramping. With general anesthesia, you do not remain awake during the test, but experience side effects afterwards, such as dry throat, tickling, hoarseness, and soreness. Some women also feel nauseated or dizzy.
Risks of the Procedure
A hysteroscopy does have a few risks associated with it. These include:
- Bloating. You may absorb fluid that is used during the test and feel bloated from a change in the level of sodium in your blood.
- Air embolism. If gas is used, there is a slight risk of an air embolism in a blood vessel (rare).
- Cervical or uterine problems. These include injury, infection, or bleeding.
After the Procedure
After the doctor performs the hysteroscopy, you will be taken to a recovery area for observation. This takes around one to three hours before you are either sent home or moved to a hospital room. The nurses will give you home care sheets and instructions regarding follow-up care. Expect to have a small amount of vaginal bleeding for a couple of days after the procedure.
A hysteroscopy is a method of viewing the lining of the uterus vial a small scope. The doctor will review his or her findings with you following the procedure. Things that affect the test include a vaginal, cervical, or pelvic infection, pregnancy, or menstrual bleeding.
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