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Hysteroscopy

 

Hysteroscopy

 

A hysteroscopy is a minimally invasive procedure that uses a thin telescope, called a hysteroscope, to examine the inside of the uterus.  Using a hysteroscope, a Gynaecologist is able to inspect the lining of the uterus and the openings of the fallopian tubes whilst also looking for other abnormalities.  A hysteroscopy may be diagnostic, operative or both.

 

Dr Li may recommend hysteroscopy for you if you present with abnormal uterine signs and/or symptoms including:

  • Abnormal uterine bleeding (heavy/absent/irregular periods)
  • Post menopause uterine bleeding
  • Irregular or painful periods
  • Pain or discomfort in the pelvic area
  • Infertility
  • Recurrent miscarriages

 

Certain uterine problems can be treated by an operative hysteroscopy.  Tiny instruments are inserted through the hysteroscope, sometimes replacing the need for major surgery.  Most commonly, operative hysteroscopy is used to:

  • Remove fibroids (non-cancerous growths of the uterine muscle wall)
  • Remove polyps (non-cancerous growths of the endometrial lining)
  • Treat abnormally heavy periods by ablating the endometrium
  • Remove adhesions (scar tissue)
  • Correct deformities of the uterus (such as uterine septum)
  • Remove or insert an IUD

 

Before surgery:

Before having a hysteroscopy, some patients may need to have  an ultrasound to assist in the planning of the surgery. 

It is preferable to have a hysteroscopy within the first week after your period has finished.  During other times of a womans cycle, menstrual fluids or a thickened endometrium could obstruct the view inside the uterine cavity.

 

Anesthesia

A hysteroscopy may be performed under general, epidural or local anesthesia depending on your medical history and general health.

Dr Li and your anaesthetist can discuss and explain the best options for you.

 

Diagnostic hysteroscopy

A speculum is inserted into the vagina to keep the walls of the vagina apart.  The cervix is then dilated, allowing a small passage for the hysteroscope to pass through into the uterus.

Fluid (generally saline)  is passed through the hysteroscope to separate the walls of the uterus.  This allows the Doctor to easily examine the walls and shape of the uterus, as well as the internal openings of the fallopian tubes.

 

Infertility investigation

Hysteroscopy may be used to investigate infertility as it gives the doctor a very clear view of what is going in inside the uterine cavity.  Endometrial polyps, submucosal fibroid, uterine septate, adhesion and uterine abnormalities can be diagnosed and sometimes treated during the procedure.

 

Recovery

Most patients are able to go home a few hours after the surgery, this may be a little longer for patients who have a general anaesthetic.  It is advisable to have a friend or relative drive you home. 

Some women may feel well enough to return to work the following day, whilst others prefer to allow themselves a few days off to recover.

Post operatively you can shower as normal, but avoid baths, spas, swimming pools and sexual intercourse as there is a small risk of infection until you have healed completely.  Do not use tampons or insert anything into the vagina until advised by your doctor as these can increase the risk of infection.

Some patients experience mild cramping after the procedure, which can be managed with over the counter pain relief medication.  This should resolve within a few days.

Following the surgery, some blood stained fluid may leak from the vagina.  Do not be alarmed if the fluid contains small clots or pieces of tissue, it is completely normal.  A small amount of bleeding for a few days is considered normal, but this should be no heavier than a normal period and should stop within 14 days.

You may resume normal physical and sexual activity once all bleeding and discomfort have completely disappeared.

 

 

Risks/Complications

As will ALL surgeries, there are risks.  Whilst medical professionals make every attempt to minimize risks, complications can occur that may have permanent effects.  It is important that you are well informed about the possible complications so that you can weigh up the benefits and risks of the procedure.

A doctor cannot guarantee a patient that their symptoms will improve after having a hysteroscopy.  However a majority of patients can expect very good outcomes.   

Please note:  Smoking, obesity and other significant medical problems greatly increase the risk of complications with any surgery.

The following are some risks specific to hysteroscopy:

 

  • Infection of the bladder or uterine lining; treatment with antibiotics is generally required.
  • Trauma to the cervix (usually during dilation).
  • Perforation of the uterus.  Although this is very uncommon, the risk of this happening is slightly greater in postmenopausal women and women who have recently been pregnant.
  • Damage to nearby organs if the uterus is perforated (such as cuts or puncture damage to bladder or bowel).  Again this is very uncommon, but laparoscopy or open surgery may be required to repair the damage.
  • Heat damage to nearby organs.  This can be caused by electrical or laser instruments used in surgery.
  • Heavy post-operative bleeding.  In severe and extremely rare cases, hysterectomy may be needed if the bleeding cannot be stopped.
  • Fluid imbalance.  The uterus is sometimes filled with fluid during hysteroscopic surgery.  Pressure in the uterus can sometimes force fluid into the bloodstream which causes a fluid imbalance within the body.  Severe complications can include a fluid build up in the brain or lungs.  In rare cases, it can be life threatening.
  • Gas embolism.  If carbon dioxide gas is used to fill the uterus during surgery, rarely, a gas bubble may enter the blood stream.  Although life threatening, this can usually be quickly treated by the surgeon or anaesthetist.