Definition & Overview
Hysteroscopy is a diagnostic procedure that involves visualizing the lining of the uterus using a hysteroscope, which is inserted into the vagina. The procedure is usually performed to inspect the uterus, fallopian tubes, cervix, cervical canal, and vagina for any signs of abnormalities. However, the procedure can also be used to perform minimally invasive surgeries.
When a hysteroscopy is performed as a diagnostic procedure, it is usually to determine the causes of pelvic pain, miscarriages, infertility, abnormal bleeding, or irregular periods. On the other hand, when performed as a minimally invasive surgical procedure, it is usually to remove fibroids, polyps, intrauterine adhesions, or as part of treatment of endometrial hyperplasia.
While hysteroscopy is an effective method of diagnosing certain medical conditions and in performing minor surgeries, it has its own limitations. For instance, it cannot be performed if the woman is pregnant, has an active pelvic infection, if there's an obstruction in the cervical opening, or if the patient has cervical or uterine cancer.
A hysteroscopy is usually performed as an outpatient procedure and does not require any special preparation. However, if the procedure is combined with another surgical procedure, then it will be performed in a hospital operating room.
Who should undergo and expected results
A hysteroscopy is performed to evaluate, diagnose, or treat a wide variety of gynaecological conditions. Typically, it is performed to:
- Remove products of conception after a miscarriage or birth
- Analyze congenital defects of the female genital tract
- Analyze abnormalities or injuries in the female genital tract
- Remove polyps or fibroids in the cervical canal or uterine cavity
- Perform a biopsy
Most hysteroscopy procedures don't require much time to complete. The patient will normally be able to go home following the procedure, unless it uncovers a condition that requires further diagnosis. However, patients can expect light vaginal bleeding and cramping after the procedure, which can be resolved by taking medications that the doctor will prescribe following the procedure.
How the procedure works
A hysteroscopy may be performed with or without anesthesia, depending on the type of hysteroscope used and the preference of the patient. Narrow diameter hysteroscopes do not require the cervical opening to be dilated; therefore there is no need for an anaesthetic. However, in some cases, the doctor may need to administer a local, regional, or general anaesthesia depending on the patient's unique circumstances.
A vaginal speculum is typically used to make the process of inserting the hysteroscope into the uterine cavity easier. Once the hysteroscope has been inserted, the uterine cavity will be filled with gas or fluid so the doctor could better visualize the inside of the cavity.
After the procedure, the patient may be provided with non-steroidal anti-inflammatory drugs (NSAIDs) to control pain or cramping. If the patient was administered a general anaesthetic, she would need to spend time in the recovery room until the effects of the anaesthesia wears off. The results of the procedure will be analyzed by the doctor who will discuss the diagnosis to the patients during a follow-up consultation.
Possible risks and complications
A hysteroscopy is a safe procedure and complications are very rare, but the procedure does have associated risks. The most common are the following:
- Accidental damage to the uterus
- Excessive bleeding
- Infections that could result in heavy bleeding or abnormal vaginal discharge
- Damage to the digestive tract
- Adverse reactions to the anaesthetic
- Fluid overload
- Gas embolism (gas entering the bloodstream)
- Medical complications
- Stomach cramps
Accidental damage and excessive bleeding rarely occur. In fact, only 1 in every 135 cases results in an accidental damage, and 1 in 400 cases results in excessive bleeding. Minor damage is normally not a concern, as the wound will heal without further medical intervention. If serious damage occurs, which only happens in 1 in 700 cases, surgery will be required.
Meanwhile, excessive bleeding will only happen if the surgeon accidentally damages a blood vessel. In such case, the surgeon will attempt to stop the bleeding by increasing the amount of gas or fluid. If the bleeding persists after the procedure, a fluid-filled balloon will be inserted into the womb to remedy the situation. Once the bleeding has stopped, usually within 24 hours, the balloon will be removed.
In cases where the bleeding does not stop after a certain period, a hysterectomy, which is a procedure to remove the womb, will be performed.
- Lentz G. Endoscopy: Hysteroscopy and Laparoscopy: Indications, Contraindications and Complications. In: Lentz GM, Lobo RA,Gershenson DM, Katz VL, eds. Comprehensive Gynecology. 6th ed. Philadelphia, PA: Mosby Elsevier; 2012:chap 10.