Hysteroscopy
What is Hysteroscopy?
Hysteroscopy is a very commonly used procedure in Gynecology. It helps to evaluate the cavity of the uterus for any problem (pathology). The cavity of the uterus is like a room and the lining of the uterus thickens and sheds every month during the menstrual cycle. If there is a problem in the lining of the uterus in the form of a polyp, fibroid or thickened lining, it can manifest as heavy periods, irregular bleeding or bleeding after menopause.
The hysteroscopic procedure involves placement of a long thin device which is attached to a light source and camera inside the uterus. This device is very thin, about 4mm, and since this does not involve making any incisions, the procedure is well tolerated and can be done in the office or ambulatory surgery setting.
Why is Hysteroscopy done?
The hysteroscopic procedure helps remove the polyps, fibroids, areas of endometrial thickening or endometrial lining to help treat abnormal bleeding patterns. It also provides a tissue sample which can be assessed under the microscope by a pathologist to rule out any changes which may become cancer later on.
Women who experience difficulty getting pregnant may also have conditions like uterine polyp, fibroid, septum or adhesions within the uterine cavity. These conditions prevent the embryo from attaching to the uterine cavity and hence decrease pregnancy rates. These conditions can be treated using hysteroscopic techniques.
Types of Hysteroscopy
Hysteroscopy can be roughly classified into two types:
– Diagnostic Hysteroscopy
– Operative Hysteroscopy
What is a diagnostic hysteroscopy?
In a diagnostic hysteroscopy, we use a hysteroscope ( thin tube with camera and light) to examine the inside of your uterus. Depending on patient tolerance and pathology , it can be done under local anesthesia or IV sedation.
What is operative hysteroscopy?
While performing an operative hysteroscopy we insert small tools through the hysteroscope to take a biopsy, remove a growth such as a polyp or a fibroid or treat other problems.
Reasons for doing Hysteroscopy:
- To evaluate the causes of abnormal uterine bleeding
- Investigate possible causes of infertility
- Investigate the causes of repeated miscarriages
- Detect benign or non-cancerous growths in the uterus such as fibroids, polyps, scars or malformations.
- To remove polyp or fibroid from the uterus. Some types of fibroids which grow inside the cavity are called submucous fibroid and can be removed hysteroscopically.
- To remove a uterine septum
- Obtain a tissue sample or biopsy from the lining of the uterus
- Locate an Intrauterine device (IUD).
In what situations Hysteroscopy is done?
Hysteroscopy is used in patients with irregular bleeding, uterine polyps, uterine fibroids, bleeding after menopause, uterine septum, adhesions/bands in the endometrial cavity and many other conditions to help diagnose and treat them.
Patients with irregular bleeding or bleeding after menopause usually undergo a pelvic ultrasound to evaluate the cavity for polyps, fibroids or thickened lining of the uterus. If these conditions are suspected on ultrasound, we then recommend a hysteroscopic evaluation to confirm the diagnosis and help treat them.
Procedure:
We may elect to do the procedure under local or general anesthesia depending on patient tolerance and pathology. The procedure will begin by inserting a speculum to spread open the walls of the vagina. The cervix is then held towards the entry of the vagina. The hysteroscope (a thin tube equipped with a camera and a light) is then guided through the vagina and into the uterus. The camera transmits images of the uterus to a screen. Fluid will be injected to expand the uterus to visualize the uterine cavity and remove the pathology such as fibroid, polyp, septum, adhesions or take a sample.
After the procedure:
We usually recommend Tylenol/ Motrin for pain relief. You should be able to return to your normal activities within 1 to 2 days after your procedure. You may have mild cramping and some bloody discharge for several days, but they will soon start diminishing with time.