A hysteroscopy is a minimally invasive medical procedure used to examine the inside of the uterus (uterine cavity) and the opening of the cervix. This technique utilizes a thin, lighted tube called a hysteroscope, which is gently inserted through the vagina and cervix without external incisions. The hysteroscope is equipped with a small camera and a light source that transmits magnified images to a video monitor, allowing a clear, direct view of the inner uterine wall.
Why is a Hysteroscopy Performed?
The procedure is performed for two primary purposes: diagnosis and treatment of conditions affecting the uterus. A diagnostic hysteroscopy focuses on observing and identifying abnormalities within the uterine cavity. It is recommended to investigate symptoms like abnormal uterine bleeding, including heavy or prolonged periods, bleeding between cycles, or postmenopausal bleeding.
The procedure is also commonly used to investigate fertility issues, such as recurrent miscarriages or difficulty conceiving, by checking for structural problems. It allows the doctor to look for conditions like a uterine septum, intrauterine adhesions, or polyps that may be affecting the ability to carry a pregnancy. If an abnormality is identified during the diagnostic phase, the procedure can transition immediately into an operative hysteroscopy.
Operative hysteroscopy is a surgical treatment that uses the same scope but involves passing specialized instruments through a channel. This allows the surgeon to treat the identified pathology without a separate procedure. Common operative uses include the removal of uterine fibroids or polyps, scar tissue (Asherman’s syndrome), or a misplaced intrauterine device (IUD).
Preparing for the Procedure
Preparation steps are necessary to ensure the procedure is safe and effective. The timing is often scheduled for the first week after menstruation ends (days 5 to 12 of the cycle). This timing is preferred because the uterine lining is thinnest, allowing for optimal visualization of the cavity.
Depending on the type of anesthesia planned, specific fasting instructions apply. For general anesthesia or deep sedation, patients are instructed not to eat or drink anything after midnight. Patients may also be advised to take an over-the-counter pain reliever, such as ibuprofen, about an hour before the appointment to minimize cramping or discomfort.
Patients must discuss all medications, vitamins, and supplements with the doctor, as some, particularly blood thinners, may need to be temporarily stopped. Medication may be given beforehand to help soften the cervix, making the insertion of the hysteroscope easier. It is important to arrange for a responsible adult to drive the patient home, especially if sedation or general anesthesia is used.
The Step-by-Step Process
The procedure begins with the patient lying on an examination table, positioned similarly to a routine pelvic exam. A speculum may be inserted into the vagina to hold the walls open and allow the doctor to access the cervix. The cervix and vagina are then typically cleansed with an antiseptic solution.
The hysteroscope is carefully guided through the cervical opening and into the uterine cavity. Because the uterine cavity is usually a collapsed space, a distention medium is necessary to gently expand the walls for a clear view. For most procedures, a liquid medium, such as sterile saline solution, is continuously infused through the hysteroscope to inflate the uterus.
The fluid pressure separates the front and back walls of the uterus, allowing the surgeon to see the entire lining and the openings to the fallopian tubes. If complex operative work requires a larger hysteroscope, the cervix may be slightly dilated before insertion. For operative procedures, miniature surgical tools are passed through the working channel to remove tissue, correct structural issues, or take a biopsy.
Recovery and Post-Procedure Care
The recovery time following a hysteroscopy is generally short, as it is a minimally invasive, outpatient procedure. Many people are able to resume their normal daily activities the day after the procedure, though it is often recommended to rest for the remainder of the day. If general anesthesia was used, it is common to feel slightly groggy or unwell for up to 24 hours.
Mild, period-like cramping is a common side effect and typically lasts for a day or two, managed with over-the-counter pain relievers. Patients should expect light vaginal bleeding or spotting, which can persist for a few days up to two weeks. To prevent infection, patients are advised to avoid using tampons and refrain from sexual intercourse until the bleeding stops.
While complications are rare, monitor for signs requiring immediate medical attention. Warning signs include heavy bleeding (soaking through one pad every hour or two), severe abdominal pain unrelieved by medication, fever, or foul-smelling vaginal discharge.