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Hysteroscopy

Hysteroscopy is a procedure to examine the inner of the uterus and cervix with a thin, flexible, lighted tube known as a hysteroscope. During the examination, this device is inserted through the vagina.

Hysteroscopy can be recommended for various reasons, such as:

  • Biopsy (removing a tissue sample)
  • Removing fibroid tumors or polyps
  • Preventing bleeding through tissue destruction using methods like an electric current, heat, freezing, or chemicals

The procedure can be performed in the physician’s office or an outpatient facility. You may receive local anesthesia or none at all. More complex procedures may be conducted in an operation room while under local, regional, or general anesthesia.

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Why You May Require a Hysteroscopy

A hysteroscopy may be done for several purposes, including:

  • Abnormal Pap test results
  • Unusual uterine bleeding
  • Postmenopausal bleeding
  • Retained pregnancy tissue
  • Infertility or recurrent miscarriage diagnosis
  • Examining and removing uterine scarring, fibroids, or polyps
  • Treating a uterine abnormality known as a uterine septum
  • Removing displaced intrauterine devices (IUDs)
  • Obtaining a small tissue sample (biopsy)
  • Removing the endometrial lining

Hysterectomy is usually not recommended for pregnant women.

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Preparing for Hysterectomy

A general practitioner or a doctor can suggest a hysteroscopy procedure if necessary. You will receive printed material with details about the procedure, along with pain relief options, or a link to an online resource with such helpful information.

Prior to your appointment, it’s essential to tell the hospital or health center staff if your friend or family member will accompany you. Additionally, a nurse or trained staff member will be with you during the procedure as a chaperone.

Pain relief choices

A hysteroscopy may cause some discomfort that can resemble period pain. Taking paracetamol or ibuprofen an hour beforehand can help ease this.

For some, the procedure can cause severe pain. So, if you have concerns about the pain, it may be helpful to discuss pain relief options with the hospital or clinic staff in advance. Inform them if:

  • You faint due to painful periods
  • Your previous vaginal exams or cervical smears were painful
  • Past experiences of sexual violence may make the procedure more difficult

Sometimes, general anesthesia or intravenous sedation may be an option to keep you relaxed as you undergo a hysterectomy. However, not all facilities offer these. If necessary, you may be referred to a clinic that does.

Before undergoing a procedure that involves general anesthesia or sedation, you’ll be scheduled for a different appointment for health checks.

How is Hysteroscopy Done?

Before you undergo hysteroscopy, you will first meet with the healthcare expert performing the exam (the hysteroscopist), who will talk you over the process, explain pain relief choices, and address any worries or questions. You’ll also be required to sign a consent form.

During the procedure, a thin, camera-equipped tube is inserted through your vagina and cervix into the womb. A saline solution is then administered through the tube, making it easy to view inside the uterus. The camera transmits images to a monitor to allow the hysteroscopist to keep an eye on the process. If you’d like, you can also watch through the screen.

You might faint or feel sick throughout the examination. However, if you experience significant pain or discomfort, a local anesthetic or gas and air may be the solution. You can also request to stop the process whenever you want.

If necessary, the hysteroscopy can be rescheduled to allow for local or general anesthesia or intravenous sedation.

The whole procedure usually takes about 10-15 minutes but may be longer if a tissue sample, small growth, or fibroid is removed. After that, you’ll be transferred to a recovery room until you are ready to leave.

Hysteroscopy with general anesthesia or sedation

If your hysteroscopy requires general anesthesia, an overnight hospital stay may be essential. It’s recommended to have a friend or family member pick you up afterward if you have had general anesthesia or intravenous sedation, as driving yourself is not advisable.

Recovery after a Hysteroscopy

Your recovery may vary depending on the anesthesia used. If you had general anesthesia or sedation, your healthcare provider will monitor your pulse, blood pressure, and breathing until they are stable and you are fully alert. Once stable, you will be allowed to go home.

Hysteroscopies are normally done on an outpatient basis. If you did not receive anesthesia, no special post-procedure care is needed.

You may experience mild cramping and vaginal bleeding for one or two days following hysterectomy. Contact your healthcare provider if you experience a fever, intense abdominal pain, discharge, or heavy bleeding.

Some people may experience gas within their digestive system and shoulder or upper abdominal pain due to gas used during the procedure. However, this often resolves within 24 hours.

Use pain relievers as directed by your doctor to ease the soreness. Avoid aspirin or other pain medications, as they may increase bleeding risk. It’s advisable to take only the prescribed drugs.

Avoid douching or having intercourse for two weeks following the hysterectomy or as suggested by your provider.

You can resume your usual diet and activities unless otherwise directed by your healthcare provider. Additional instructions may be provided depending on your situation.

Risks of a Hysteroscopy

Although generally safe, a hysteroscopy does come with a small possibility of complications, especially if additional treatments are done during the procedure.

The major risks that may result from a hysteroscopy include:

  • Unintentional damage to the uterus: Though uncommon, this may require antibiotic treatment in a medical facility or, in rare cases, a follow-up surgery to correct it.
  • Unintentional damage to the cervix: Rare and usually easily repairable.
  • Too much bleeding: More likely with general anesthesia, this can be effectively managed with medication or an additional procedure; in very rare cases, a hysterectomy (removal of the womb) may be required.
  • Infection of the womb: This may lead to fever, foul-smelling discharge, and heavy bleeding. It is usually treatable with antibiotics prescribed by the GP.
  • Fainting: Occurs in about 1 out of 200 women undergoing the procedure without anesthesia or with only local anesthesia.

A hysteroscopy is recommended only when the potential benefits outweigh these risks.