Hysteroscopy

What is Hysteroscopy?

Hysteroscopy is a minimally invasive tool to help specialists view the uterus to diagnose and even treat several gynecological problems. During the procedure, a camera and light enabled scope is inserted through the vagina to examine the cervix, cervical canal, inside of the uterus and the fallopian tubes.

What are the different types of hysteroscopy procedures?

Diagnostic hysteroscopy
This procedure is performed to pinpoint the cause of the problems in the uterus. It can also be used to validate the results from other investigations. Diagnostic hysteroscopy is also used with other procedures such as Dilation and Curettage (D&C) and Laparoscopy. If required, a biopsy is also performed to investigate the presence of any malignant growth. This procedure can be performed in an outpatient clinic.

Operative hysteroscopy
Operative hysteroscopy is performed to remedy any abnormality detected during diagnostic hysteroscopy. It is simple to perform an operative hysteroscopy while doing a diagnostic hysteroscopy. This avoids surgery for a second time. Doctors insert the required instruments through the hysteroscope to treat certain conditions.

Why do I need to undergo hysteroscopy?

You may need to undergo hysteroscopy if you suffer from the following uterine conditions:

Polyps and fibroids: Hysteroscopy can effectively remove polyps and fibroids present in the uterus.

Adhesions: Scar tissue or adhesions sometimes form in the uterus. These tissues can alter the menstrual flow. Hysteroscopy helps medical specialists spot the adhesions and remove them.

Uterine defects: Uterine defects such as malformation of the uterus which can be present at birth is detected using this diagnostic tool.

Abnormal bleeding: If you suffer from excessive bleeding or heavy and lengthy periods, or even bleeding between cycles or after menopause, hysteroscopy is used to detect the cause of these problems. An important reason for abnormal bleeding could be attributed to the benign growth of fibroids and polyps.

What are the other uses of hysteroscopy?

Hysteroscopy is also used to:

– To validate and confirm visually another test result

– To ascertain causes of infertility

– Examine uterine openings to the fallopian tubes. In case of any blockage, the specialist can open the tubes using special instruments inserted through the hysteroscope.

– Ascertain reasons for repeated miscarriages.

– Locate and shift an intrauterine device (IUD) which has gone out of place.

– Employ heated instruments to remedy problem areas in the uterus lining, a procedure called endometrial ablation.

– Position a contraceptive implant inside the opening of the fallopian tubes as a way of permanent sterilization.

How is hysteroscopy performed?

A hysteroscopy can be performed in your doctor’s office or at a hospital. Your specialist may administer general anesthesia before the start of the procedure.  In some cases, doctors prefer to use local anesthesia or a sedative to numb the pain and discomfort. Doctors follow the following steps during hysteroscopy:

– The patient is made to lay on a couch with supports for the legs.

– An antiseptic solution is used to clean the cervix and vagina.

– Specialists use certain dilators to assist in dilating the opening of the cervix.

– The specialist inserts the hysteroscope through the vagina, then the cervix to reach the uterus.

– A liquid solution or carbon dioxide is introduced into the uterus with the hysteroscope. This helps expand as well as clean away possible presence of blood or mucus.

– A light attached at the hysteroscope enables the specialist to examine the uterus, its cavity and the opening of the fallopian tubes. The camera transmits visuals to a monitor to enable a study of potential abnormalities.

– Incase surgery is needed, small instruments are introduced into the uterus with the hysteroscope to help specialists remedy the problem. In certain cases, other procedures like laparoscopy are also performed at the same time. At such times the duration of the procedure could extend.

Diagnostic hysteroscopy takes very less time as compared to the operative. However, the duration of the procedure can vary. In some cases, it gets done within minutes while in others it takes more than 60 minutes. Doctors can also perform an endometrial biopsy in case they suspect an abnormality.

Hysteroscopy cannot be performed if the patient has a pelvic infection. This diagnostic procedure cannot be performed among known cases of cervical cancer or if there is any obstruction in the cervical canal or cavity.  The procedure is not possible if the position of the uterus is abnormal.

What is the price of Hysteroscopy in India?

In India, the price for hysteroscopy could be anywhere between Rs. 16000 to Rs.50000.

When will I get the results?

Your medical specialist will be able to inform you about any unusual findings during the hysteroscopy procedure. The results of the procedure will be available on the same day. In case of a biopsy, the results may take a few weeks to arrive. It is good to check with your specialist when you can expect the results.

What do the results mean?

If your medical specialist spots any abnormality in the ultrasound, a biopsy is the next step. Any cancerous growth detected early can be treated successfully. For those with unexplained infertility, remedying the problem of polyps or fibroids or other uterine issues, may up the chances of pregnancy.

Do I need to fast for Hysteroscopy?

Hysterectomy with general anesthesia means you need to be on an empty stomach a few hours prior to the procedure. It is better not to consume food or water before the procedure. Fasting is not needed for hysteroscopy with local anesthesia.

What else do I need to know before hysteroscopy?

Hysteroscopy does not fall under the category of major surgery. It is a minimally invasive procedure compared to other procedures. The benefits are reduced hospital stay, faster recovery, and lesser requirement of pain medications post-procedure. Hysteroscopy is a very safe procedure with very little risk.

It is possible to go back home on the day of the procedure. Only in very rare cases, if there are any severe side effects, or if your specialist is concerned about your reaction to anesthesia, an overnight stay at the hospital is a possibility.

You can resume your regular activities and return to your work on the same day or the next depending on the type of anesthesia used. If it was general, you may need to rest for a day. Take a few days off in case your hysteroscopy has involved the removal of fibroids and polyps.

Keep away from driving and alcohol until the effect of general anesthesia wears off. During recovery, you may experience cramps much like the menstrual cramps. In a few days, this should become alright. You can take painkillers like a Paracetamol to relieve pain.

Bleeding or spotting can go on for a week. These are the expected side effects post hysteroscopy. Seek medical advice only if symptoms become severe. Eating small and lighter meals post hysteroscopy is highly recommended.

You may feel a bit dizzy after general anesthesia, so make sure you are not alone. You can shower the same day following this diagnostic test.

It is advisable to avoid sex for a week after hysteroscopy and till any spotting or bleeding stops. This reduces the chances of infection.

After the procedure, some women complain of pain in the shoulder. This happens if gas was used during hysteroscopy.

Are there any severe complications of the procedure?

Some of the severe complications post hysteroscopies that need immediate medical intervention include:

– Excessive bleeding
– Severe abdominal pain
– Perforation of uterus
– Injury to bladder, uterus, cervix or bowel
– Infection
– Severe reaction to the substance used to cause expansion of the uterus
– Adverse reaction to drugs or anesthesia

In some rare cases, patients can experience complications like an overload of fluids or even gas bubbles making way into the bloodstream, causing a gas embolism.

Can pregnant women undergo Hysteroscopy?

Hysteroscopy cannot be performed during pregnancy.

What are the dos and don’ts of this procedure?