Hysteroscopy

Hysteroscopy is a form of minimally invasive surgery. A tiny telescope (hysteroscope) inserted through the cervix lets the surgeon see inside the uterus on a video monitor. The hysteroscope is used to examine the uterus for any evidence of fibroids or polyps, and it can sometimes show the openings to the fallopian tubes. Instruments can be inserted through the hysteroscope to perform surgical procedures.

The Procedure
Hysteroscopy usually requires general anesthesia. For diagnosis only, the procedure may be done in the office with local anesthesia. A solution of salt (NaCL) or sugar (Sorbitol) is used to distend the uterus and make seeing easier. The hysteroscope is inserted through the cervix and into the uterus. Surgical instruments may be inserted through the hysteroscope to treat uterine fibroids, heavy menstrual bleeding, and polyps.

Often a laparoscopy is performed at the same time as hysteroscopy, especially when women are undergoing diagnostic procedures for infertility. Women may have an elective surgery, such as bladder suspension (TVT) or liposuction, with their gynecologic procedure.

Patients with systemic health problems that may be aggravated by general anesthesia should use caution in planning a hysteroscopy. Consult an anesthesiologist if you have such a health problem, especially diseases of the heart and lungs. Often a regional (epidural/spinal) or local anesthetic can be used. The anesthesiologist will help you choose the safest method.

Reasons for Hysteroscopy
Many gynecologists will use the hysteroscope to inspect the lining of the uterus for fibroids, polyps, or other conditions that may cause irregular or heavy menstrual bleeding. When women have difficulty becoming pregnant, hysteroscopic inspection can help find the cause. Other conditions suitable for hysteroscopy include:

Removal of endometrial or cervical polyps
Removal of fibroids
Biopsy of the endometrial lining
Cannulation (opening) of the fallopian tubes
Removal of intrauterine adhesions (scarring)
Removal of a lost IUCD (intrauterine contraceptive device)
Endometrial ablation - destruction of the uterine lining, a treatment for irregular or heavy menstrual bleeding

Endometrial Ablation
Endometrial ablation is an outpatient procedure that can reduce or stop heavy bleeding from the uterus. Ablation destroys the endometrium (lining of uterus) with a mild electrical current or heat. The lining will not grow back. Endometrial ablation can be an alternative to hysterectomy for patients who have heavy and irregular bleeding.

If you have heavy bleeding that is not caused by fibroids and you don’t want to have more children, you may be treated with an endometrial ablation. The gynecologist must first rule out any disease that may cause this bleeding. You may have an endometrial biopsy in the office to make sure there is no cancer. You may also have a saline enhanced (SIS) or contrast ultrasound of the uterus. Injection of saline fluid in SIS makes it possible to see the inside of the uterus. This type of ultrasound is similar to hysteroscopy but not as precise.

An ablation is not recommended if:

The uterine cavity is very large
Endometrial cancer or hyperplasia (precancer) is found
A submucosal polyp or fibroid is identified
There is severe dysmenorrhea (menstrual cramps)

Your bleeding should be much lighter or stop altogether. In rare cases, bleeding does not improve after an ablation. Pap tests and pelvic exams are still required yearly, even if you are no longer menstruating.

Risks
Bleeding or infection may occur after any surgery. Occasionally the procedure cannot be completed because of excessive bleeding, excessive fluid absorption, or size of the fibroid. Fluid is used to distend the uterus during hysteroscopy. Occasionally this fluid is absorbed into the general circulation (lungs and brain). The procedure must be stopped if there is excessive absorption of fluid. Perforation of the uterus can sometimes occur. Emboli, such as blood clots, and death are RARE but potential complications of any surgery.

Recovery
Recovery from hysteroscopy is usually very quick because no incisions are made. Almost all the patients go home the same day that they have hysteroscopic surgery. No abdominal incision is required so there is little postoperative pain and no risk of wound infection. Most patients need some pain medication right after the procedure, and a prescription for a narcotic will be provided before discharge from the hospital. However, many patients need no more than an anti-inflammatory, such as Motrin (ibuprofen). Sexual intercourse, tampon use, and active sports should be postponed for two weeks. Most women can return to work within two weeks.

Right after the hysteroscopy, you may experience:

Abdominal pain or cramping
Vaginal bleeding
Nausea or lightheadedness
Scratchy throat if a breathing tube was used during the general anesthesia

Call the doctor if you develop any of the following symptoms:

Heavy vaginal bleeding (requiring more then one sanitary napkin an hour)
Fever
Inability to urinate
Severe or increasing abdominal pain
Vomiting
Shortness of breath