Hysteroscopy

What is a Hysteroscopy?

Hysteroscopy is a medical procedure in which a thin, lighted tube (called a hysteroscope) is inserted into the uterus through the cervix. The procedure allows a doctor to see the inside of the uterus and diagnose or treat specific conditions. It is commonly used to diagnose and treat issues such as abnormal bleeding, polyps, fibroids, or adhesions, as well as to confirm the placement of an intrauterine device (IUD) or to perform certain types of surgery, such as a biopsy or removal of a growth. It may also be used to assist in the diagnosis of infertility or recurrent miscarriage.

Who is Suitable for Hysteroscopy?

Hysteroscopy is a relatively safe and well-tolerated procedure that can be performed on women of all ages. However, it is most commonly used to diagnose or treat conditions in women of reproductive age.

Hysteroscopy may be recommended for women who are experiencing:

Abnormal bleeding
Infertility
Recurrent miscarriage
Polyps or fibroids in the uterus
Adhesions or scar tissue in the uterus
Uterine anomalies
Suspected retained products of conception
Confirmation of the placement of an intrauterine device (IUD)

Dr Crawford will determine the suitability for hysteroscopy after assessing the patient's medical history, symptoms, and examination results.

What are the Benefits of Hysteroscopy?

Hysteroscopy is a minimally invasive procedure that can provide several benefits, including:

Accurate diagnosis: Hysteroscopy allows doctors to visualise the inside of the uterus, making it an effective tool for diagnosing conditions such as polyps, fibroids, and adhesions.
Treatment options: Many conditions diagnosed using hysteroscopy can also be treated during the same procedure, which can help avoid additional surgeries.
Minimally invasive: Hysteroscopy is typically performed using a thin, lighted tube inserted through the cervix, meaning there is no need for large incisions.
Faster recovery time: Because a hysteroscopy is minimally invasive, recovery time is usually shorter than traditional surgery.
Fewer complications: Hysteroscopy has a lower risk of complications than traditional surgery, such as bleeding, infection, and damage to surrounding organs.
Can help in infertility: Hysteroscopy can help diagnose and treat specific causes of infertility.
Can aid in the diagnosis of recurrent miscarriage: Hysteroscopy can help identify and treat uterine abnormalities that may be causing recurrent miscarriages.

What are the Types of Hysteroscopy?

There are two main types of hysteroscopy: diagnostic hysteroscopy and operative hysteroscopy.

Diagnostic hysteroscopy: This type of hysteroscopy is used to diagnose conditions such as polyps, fibroids, and adhesions. The procedure is performed using a thin, lighted tube called a hysteroscope inserted into the uterus through the cervix. During the procedure, the doctor can see the inside of the uterus and diagnose any issues.
Operative hysteroscopy: This type of hysteroscopy is used to treat conditions diagnosed during a diagnostic hysteroscopy. The procedure is performed using the same equipment as diagnostic hysteroscopy, but the doctor will also use specialised instruments to perform surgery, such as removing polyps, fibroids, or adhesions. Operative hysteroscopy can also be used to perform a biopsy, remove a growth, or place an intrauterine device (IUD).

What are the Alternative Options to Hysteroscopy?

There are several alternative options to hysteroscopy that may be used to diagnose or treat conditions in the uterus. These include:

Ultrasound: Ultrasound can create images of the uterus and ovaries and is often used to diagnose fibroids, polyps, and cysts.
Pelvic exam: A pelvic exam, where a doctor manually examines the uterus and ovaries, may be used to identify conditions such as fibroids or cysts.
Endometrial biopsy: This procedure involves taking a small sample of the lining of the uterus (endometrium) and is used to diagnose conditions such as abnormal bleeding or endometrial cancer.
Laparoscopy: This minimally invasive surgical procedure allows a doctor to see the inside of the abdomen and pelvis using a small camera. It can diagnose and treat conditions such as endometriosis, pelvic adhesions, and ovarian cysts.
Magnetic Resonance Imaging (MRI): MRI scans can create detailed images of the uterus and surrounding structures. It helps diagnose certain conditions such as adhesions, fibroids, and endometrial cancer and in planning surgery, although it is rarely required.

What Happens Before a Hysteroscopy?

Before a hysteroscopy, a patient will typically undergo several steps to prepare for the procedure.

Your doctor will review your medical history and perform a pelvic exam to determine if hysteroscopy is the right option for you.
If you are experiencing heavy bleeding, your doctor may advise you to stop taking blood thinners, such as aspirin or warfarin, a few days before the procedure.
You may be asked to avoid eating or drinking anything for a certain period before the procedure.
You will be given instructions on how to prepare for the procedure, such as taking any medications you have been prescribed.
The anaesthetic to be used will be considered together with the Anaesthetist. This most commonly involves a general anaesthetic or sedation, but at times might involve spinal or local anaesthesia.

How is a Hysteroscopy Performed?

Hysteroscopy is a relatively safe and well-tolerated procedure, but it's essential to understand the steps involved to know what to expect. During the procedure:

You will be placed in a lithotomy position, lying on your back with your feet in stirrups.
A speculum will be inserted into your vagina to hold it open and allow your doctor to see the cervix.
The hysteroscope, a thin tube with a light and a camera on end, will be inserted through the cervix and into the uterus.
Your doctor can see the inside of the uterus on a screen and diagnose or treat any issues they find.
If the hysteroscopy is operative, special instruments will be inserted through the hysteroscope to perform the surgery.

What to Expect After a Hysteroscopy?

The recovery time varies from person to person and depends on the type of hysteroscopy and the underlying condition that was treated. In general, patients can expect to experience the following after a hysteroscopy:

You will be moved to a recovery room, where you will be monitored until the anaesthesia wears off.
You may experience cramping and bleeding for a few days after the procedure.
You will be given instructions on how to care for yourself at home, such as managing pain and bleeding and when to return for a follow-up appointment.
You may be able to resume normal activities within a day or two after the procedure, but you should avoid strenuous activity or sexual intercourse for a few days.
It is important to follow your doctor's instructions and report any signs of infection, excessive bleeding or fever.

Hysteroscopy Prognosis

For diagnostic hysteroscopy, the prognosis is generally reasonable. In most cases, the procedure can accurately diagnose the underlying condition, and further treatment can be planned accordingly.

For operative hysteroscopy, the prognosis will depend on the condition being treated. For example, if fibroids or polyps are removed, the patient may experience an improvement in symptoms such as heavy bleeding or pelvic pain. If adhesions or scar tissue are removed, the patient may experience an improvement in infertility.

If hysteroscopy is done to assist in the diagnosis of infertility or recurrent miscarriage, it may reveal underlying issues that can't be treated with hysteroscopy. The patient may need additional treatments or investigations.

The prognosis for hysteroscopy is generally good, and many women can return to normal activities soon after the procedure. However, discussing the potential risks and benefits with Dr Crawford before undergoing the procedure is essential.

What are the Risks of Hysteroscopy?

Hysteroscopy is a relatively safe and well-tolerated procedure, but like any medical procedure, it does carry some risks.

Bleeding: Hysteroscopy may cause bleeding, ranging from light spotting to heavy bleeding. This bleeding may be caused by the procedure or by removing any growths or abnormal tissue.
Infection: There is a small risk of disease following hysteroscopy. Symptoms of infection include fever, foul-smelling discharge, and pain or tenderness in the pelvic area.
Perforation: There is a risk of perforation, or puncture, of the uterus or other organs during the procedure. This can cause bleeding, pain, and the need for additional surgery.
Fluid overload: as fluid is used to hold the walls of the uterus open, some may leak into your bloodstream causing problems such as salt imbalance and wet lungs
Adverse reaction to anaesthesia: Some people may have an allergic reaction or other adverse reactions to the anaesthesia used during the procedure.
Uterine contractions: In some cases, hysteroscopy can cause the uterus to contract, which can cause cramping or pain.

What if Hysteroscopy is Delayed?

Delaying a hysteroscopy may prolong the diagnosis and treatment of a condition, and it may become more complicated or harder to treat over time. If a hysteroscopy is delayed, it's important to discuss the reasons for the delay and the potential risks and benefits with Dr Crawford and to schedule a follow-up appointment as soon as possible.