Hysteroscopy

Hysteroscopy is a form of minimally invasive surgery. The surgeon inserts a tiny hysteroscope through the cervix into the uterus. The hysteroscope allows the surgeon to visualize the inside of the uterine cavity on a video monitor. The uterine cavity is then checked for any abnormalities. The doctor examines the shape of the uterus, uterine tissue and looks for any evidence of intrauterine pathology (fibromas, or polyps). The doctor also tries to visualize the holes in the fallopian tubes. The advantage of this method is that the recovery time is very fast. Almost all patients return home the same day after hysteroscopic surgery. There is no abdominal wound, so postoperative pain is minimal and there are no wound infections.

How is a hysteroscopy performed?

After general anesthesia (this procedure can also be performed in a doctor’s office with local anesthesia, but is usually limited to diagnostics only), the hysteroscope is inserted into the uterus using a saline solution (NaCL) or a sugar solution (sorbitol) to stretch the uterus and obtain visualization of the uterine cavity.

A local anesthetic block of the cervix is ​​often performed first to provide local anesthesia. After completing the examination of the uterine cavity through the hysteroscope, several different instruments can be inserted to treat uterine fibroids, heavy menstrual bleeding (periods), and polyps.

Contraindications for hysteroscopy

Systemic health problems, especially cardiopulmonary problems, which may be exacerbated by general anesthesia, may be a contraindication to hysteroscopy. Anesthesia consultations are recommended if there is any uncertainty regarding the surgical condition of women. Often this procedure can be performed without general anesthesia, but rather with regional anesthesia (epidural/spinal) or local anesthesia. The anesthesiologist will help you choose the safest method of anesthesia.

What procedures can a gynecologist perform with a hysteroscope?

Many gynecologists will use a hysteroscope to look inside the uterus and look for intrauterine abnormalities, such as fibroids or polyps, that may be causing abnormal or heavy menstrual bleeding. Cavity assessment is also done for women who are having difficulty getting pregnant.

Other conditions suitable for hysteroscopy include:

• removal of polyps in the endometrium or cervix;
• removal of fibroids;
• biopsy of endometrial tissue;
• cannulation (opening) of the fallopian tubes;
• removal of intrauterine adhesions (scars);
• removal of a lost intrauterine contraceptive device;
• endometrial ablation – destruction of the uterine endometrium, treatment of irregular or heavy menstrual bleeding;
• removal of the cervical polyp.

When can a hysteroscopy be performed?

Hysteroscopy can be used to:

1. Investigation of symptoms or problems – such as heavy periods (periods), abnormal vaginal bleeding, postmenopausal bleeding, pelvic pain, recurrent miscarriages, or difficulty getting pregnant.
2. Diagnosis of conditions – such as fibroids and polyps (non-cancerous growths in the uterus).
3. Carrying out scraping.
4. Treating conditions and problems such as removal of fibroids, polyps, displaced intrauterine devices (IUDs), and intrauterine adhesions (scar tissue that causes missed periods and decreased fertility).

A procedure called dilation and curettage was commonly used to examine the uterus and remove abnormal tumors, but hysteroscopy is now done.

Preparing for the procedure

Before the procedure, you need to tell the doctors about all the medicines that the patient is taking. Some of them may increase the risk of bleeding or interact with anesthesia. If the patient is taking medications such as Warfarin (Coumadin), Clopidogrel (Plavix) or Aspirin, it is important to talk to the doctor as the doctor will advise you exactly whether to stop taking these medicines before the procedure. You may need to stop taking certain medications a week or more before your procedure. Prior to the procedure, anesthesia options can be discussed, including the risks, benefits, and alternatives to each.

On the day of the procedure:

1. 8 hours before the procedure, you can not eat or drink, if you need to drink medicines, then this is allowed to be done only with a small sip of water.
2. Before undergoing hysteroscopy, you need to take a bath or shower in the morning.
3. Do not use lotions, perfumes, deodorants.
4. Remove all jewelry, piercings and contact lenses.
5. At least one hour before the procedure, it is recommended to avoid emptying the bladder.

Before hysteroscopy, you should undergo the following tests:

• UAC;
• coagulogram;
• OAM;
• testing for HIV and sexually transmitted diseases;
• blood type and Rh factor;
• smear on the microflora of the vagina;
• fluorography;
• ECG.

What Happens During a Hysteroscopy

Hysteroscopy is usually performed in outpatient or day hospitals. This means that the patient does not need to stay overnight in the hospital. Hysteroscopy is routinely performed on the 7th-9th day of the cycle, and menstrual bleeding (menstruation) is a relative contraindication to the procedure

It may not be necessary to use an anesthetic for the procedure, although local anesthesia (where medication is used to numb the cervix) is sometimes used. General anesthesia (anesthesia) may be used if the patient is scheduled for a hysteroscopy for treatment during the procedure.

During hysteroscopy:

• the patient lies on a chair;
• an instrument called a speculum may be inserted into the vagina to hold it open (the same instrument used for the cervical screening test), although this is not always necessary
• the hysteroscope is placed in the uterus and fluid is gently pumped in to make it easier for the doctor to see the inside;
• the camera sends images to a monitor so that the doctor can detect and/or treat any abnormalities.

A hysteroscopy can take up to 30 minutes, although it can take as little as 5-10 minutes if done just to diagnose a condition or examine symptoms.

During the procedure, patients may experience some discomfort, similar to periods of cramps when it is performed, but this should not be painful.

Recovery after hysteroscopy

Most women feel able to return to their normal activities the next day, although some women return to work the same day.

During the recovery period:

• you can eat and drink, as usual, immediately;
• there may be cramping similar to period pain and some spotting or bleeding for a few days – this is normal and nothing to worry about;
• sex after a hysteroscopy should be avoided for a week, or until bleeding stops, to reduce the risk of infection.

Recovery tends to be very fast as there are no incisions. Most patients will require some pain medication in the immediate postoperative period, but an anti-inflammatory drug is often sufficient. Sexual intercourse should be postponed, as well as active sports for two weeks. It is advisable not to insert anything into the vagina for at least 2 weeks, including tampons. Most women can return to work within two weeks.

You should see a doctor if any of the following symptoms occur:

• heavy vaginal bleeding;
• inability to urinate;
• increase in abdominal pain.

Risks of Hysteroscopy

Hysteroscopy is generally very safe, but like any procedure, there is a small risk of complications. The risk is higher in women who are treated during hysteroscopy.

Some of the main risks associated with hysteroscopy are as follows:

1. Accidental damage to the uterus – this is very rare, but may require antibiotic treatment in a hospital or, in rare cases, other surgery to repair it.
2. Accidental damage to the cervix is ​​a rare complication and the injury can usually be easily repaired.
3. Excessive bleeding during or after surgery – this can happen if treated under general anesthesia, very rarely the uterus may need to be removed (hysterectomy)
4. Uterine infection – can cause smelly vaginal discharge, fever, and heavy bleeding it is usually treated with a short course of antibiotics.
5. Feeling weak – affects 1 out of every 200 women who have had a hysteroscopy performed without anesthesia or with only local anesthesia.

Bleeding or infection can occur after any surgery. Sometimes the surgeon cannot safely complete the procedure due to excessive bleeding, fluid absorption, or the size of the fibroma. Complications specific to hysteroscopy include uterine perforation and disproportionate fluid retention. The fluid is used to stretch the uterine cavity during hysteroscopy. Sometimes this fluid can be absorbed into the general circulation (lungs and brain). If excessive fluid absorption occurs, the procedure should be terminated.

Emboli, as well as death, are rare but potential complications of any operation.

Alternatives to Hysteroscopy

A hysteroscopy will only be performed if the benefits are thought to outweigh the risks.

The uterus can also be examined with:

• pelvic ultrasound – where a small probe is inserted into the vagina and uses sound waves to create an image of the inside of the uterus
• endometrial biopsy – where a narrow tube is passed through the cervix into the uterus, with suction used to remove a sample of uterine tissue.

These alternatives can be performed along with a hysteroscope but do not provide as much information and cannot be used to treat problems in the same way as a hysteroscopy.

Types of hysteroscopy

Office hysteroscopy

Office hysteroscopy is one of the options for hysteroscopy, it is performed in the gynecologist’s office, hence its name, differs from the classical one in that it is mainly a diagnostic procedure, and not a surgical intervention.

Hysteroscopy before IVF

Before IVF, hysteroscopy is the recommended procedure to make sure that the uterus is healthy and ready to bear a child. Failed IVF attempts are usually related to factors in the embryo, such as genetic problems, or problems with the woman’s uterus. In the past, many fertility clinics routinely performed hysteroscopy on women who had not had IVF cycles to look for abnormal uterine growths or scar tissue and remove them. There are other, non-invasive methods to evaluate the uterine cavity, including hysterosonography, where a small amount of salt water is injected into the uterus and an ultrasound is performed to evaluate the uterus. Usually hysteroscopy is performed in cases where the anomaly has already been identified during other studies.

Hysteroscopy and laparoscopy

Sometimes, according to indications, patients undergo laparoscopy and hysteroscopy at the same time, these two procedures are endoscopic and are performed with minimal intervention. Used to treat endometriosis, uterine polyps, tubal obstruction. Laparoscopy is often performed at the same time as hysteroscopy, especially in women undergoing fertility treatment. Endometrial ablation

Endometrial ablation, an outpatient surgery that can reduce or stop heavy uterine bleeding, is performed using hysteroscopy. During ablation, the endometrium is destroyed. The endometrium is destroyed using mild electrical current or heat. This process inhibits tissue growth. Removal of the endometrium may be an alternative to hysterectomy in patients with severe and irregular uterine bleeding. The gynecologist must first rule out any intrauterine pathology that may be contributing to this bleeding. An endometrial biopsy is often done to make sure there is no cancer. Ablation is not recommended if: the uterine cavity is very large (more than 12 centimeters), endometrial cancer or hyperplasia (precancerous condition) is present, a submucosal polyp or fibrosis is present, the patient has severe dysmenorrhea (menstrual cramps).

After ablation, bleeding should decrease. For some women, it may stop altogether. Even if the bleeding does not stop completely, it will probably be much easier. Rarely there is no improvement in bleeding after ablation.