Hysteroscopy
Hysteroscopy is now an integral part of evaluation for abnormal uterine bleeding and infertility. It is a technique to diagnose as well as treat intrauterine problems. It involves introducing a telescope inside the uterus.
After this distension of uterine cavity is done with fluid distention medium for adequate visualization. Several distending fluids are used like normal saline or Glycine. This helps in inspecting the uterine cavity for abnormalities and if present can immediately be treated in the same sitting (SEE & TREAT). It is usually scheduled in the first week after the menstrual period. A combined procedure along with laparoscopy is recommended for infertility or when operative hysteroscopic surgeries is being done.
When does a doctor suggest for hysteroscopy?
- Abnormal bleeding in women- Heavy bleeding, irregular bleeding or reduced bleeding or secondary amenorrhea
- Recurrent pregnancy failure or difficulty in getting pregnant.
- Unexplained infertility
- Before IVF
- Postmenopausal bleeding
- Abnormality detected on Ultrasound
When advised hysteroscopy-What to expect?
The procedure is usually performed in Operation Theater with or without anaesthesia. The procedure can take anywhere from just 15-30 minutes depending on what’s being done and there is hardly any pain afterwards. Vaginal spotting or bleeding can happen after hysteroscopy and last up to a week. This bleeding can be variable, heavier than a normal period and can stop and start. This is expected and is normal.
Almost always done as a day care procedure, meaning that there is no need to stay overnight in the hospital and most women can do their regular activities the next day. Usually, no preparation is required. Some general blood tests is recommended to see if the woman has no health issues and is fit to undergo anesthesia.
Procedures using Hysteroscopy (Treatments)
- Directed biopsy of the abnormal area.
- Polyps- Usually non-cancerous growth and Hysteroscopy is used to remove them from the uterus.
- Submucous fibroids- These are resected using an operating hysteroscope with the use of electrosurgical current.
- Adhesions inside uterus- This can present as reduced bleeding during menstrual cycle or infertility. Hysteroscopy is used to remove the adhesions and create a cavity that can carry a pregnancy.
- Septum of uterus- Sometimes the uterus is divided due to presence of a septum that can again present as reduced bleeding during menstrual cycle or infertitilty. This sepum can be removed easily with hysteroscopy without the need for a major surgery.
- Lost IUCD- At times the tail of the intra utereine contraceptive device is lost and it becomes difficult to remove it. Hysteroscope can be used to remove this under vision.
When not to do hysteroscopy?
When pregnant
Active pelvic infection
Heavy bleeding-compromised vision leading to suboptimal procedure
Risks or complications
- Damage to cervix
- Perforation- Tearing of the uterus (rare)
- Bleeding during the procedure
- Infection
- Pelvic inflammatory disease
- Complications from absorption of fluid or gas used to expand the uterus
Benefits
- Shorter hospital stay
- Shorter recovery time
- Less pain medication needed after surgery
- Avoidance of hysterectomy
- Possible avoidance of “open” abdominal surgery
- Hysteroscopy is an effective procedure for the diagnosis and treatment of intrauterine pathology. It is a day care minimally invasive procedure, It is usually safe when done with adequate care and infrastructure.