A hysteroscopy is a frequently used minimally invasive diagnostic procedure
A hysteroscopy is a frequently used minimally invasive diagnostic procedure

A hysteroscopy is a frequently used minimally invasive diagnostic procedure that gives your doctor/gynecologist (women's specialist) a clear view of the inside of your womb (uterus).

In this procedure, a thin, light flexible telescope-like tube (hysteroscope) is inserted through your vagina into your womb (uterus) through the cervix that projects images of your womb onto a screen.

In this procedure, the insides of the womb can be visualized with the camera. If there is any growth seen, it is removed either directly or with smaller instruments (curettes). These tissues will then be sent to the laboratory to check the presence of any cancerous growth.

When does your doctor suggest a diagnostic hysteroscopy?

Your gynecologist will suggest a diagnostic hysteroscopy to check the inside of your womb and take a tissue sample (biopsy) if you have

It is useful to diagnose

  • Uterine fibroids (non-cancerous growths of the fibrous tissue in the womb).
  • Uterine polyps (abnormal tissue growth inside the womb lining).
  • Uterine adhesions (scar tissue formation in the womb).
  • Endometrial cancer (cancer of the womb lining).
  • Endometrial hyperplasia (enlargement of the womb tissues).

What happens during the procedure?

Diagnostic hysteroscopy may be done in a clinic under local or no anesthesia. However, if you have more complex issues, it may be done in the hospital in an operating room under local, regional, or general anesthesia.

Before the procedure

  • You will be informed to empty your bladder.
  • You will be prepped and draped in a sterile manner.
  • The vaginal area will be cleaned and shaved.
  • An intravenous line may be put on your arm and sedatives will be given if required.
  • You will be asked to lie down on your back and keep your feet in stirrups.
  • Your gynecologist may dilate your cervix for an easier view.

During the procedure

  • A hysteroscope (thin flexible scope) will be inserted into your vagina toward the cervix into your uterus (womb).
  • Saline fluid or gas may be pumped through the hysteroscope to expand your womb for a better view.
  • Your gynecologist will view and check the womb linings through the hysteroscope and take photographs or videos.
  • If your gynecologist feels that it is required to take a tissue sample, they may pass a small instrument through the hysteroscope and take a tissue sample.
  • If further your gynecologist feels the need for a procedure such as a fibroid removal, a tool is inserted through the hysteroscope.
  • For some complex issues, your gynecologist may insert a laparoscope through your belly to view outside of your womb at the same time.
  • When the procedure is done, the hysteroscope is removed.

After the procedure

  • Your recovery will vary based on the type of anesthesia used during the procedure.
  • If your doctor uses general anesthesia or sedative, then your blood pressure, pulse, and breathing will be monitored until they are stable and you are alert.
  • Once you are stable, you will be discharged.

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What to expect?

What you should expect:
  • You may feel sleepy if you are given general anesthesia during the procedure.
  • You will recover rapidly after this procedure and can return to your normal activities within a few hours to one to two hours.
  • You can start taking a normal diet unless your doctor tells you otherwise.
  • You may have uterine cramps for a day or two, which will be normally managed with over-the-counter painkillers.
  • You may experience minimal-to-moderate bleeding from the vagina or spotting.
  • You may feel gaseous distension and pain in the upper belly or shoulder due to gases used during the procedure, which may last for 24 hours. Pain can be managed with some painkillers.
  • You will be informed to 
    • Take pain relievers for your soreness as advised by your doctor.
    • Not take aspirin or certain other medicines because this may increase your chances of bleeding.
    • Not douche (showering of the vagina with water) or have sex for the next two weeks after the procedure.
    • Avoid using tampons for some weeks.

What are the possible complications?

It is a generally safe procedure, and significant complications are very rare. However, if inappropriate instruments or techniques are used, it may cause

  • Risk of anesthesia (if general anesthesia was given).
  • Infection.
  • Bleeding.
  • Pelvic inflammatory disease (inflammation of the women’s reproductive organs).
  • Damage to the cervix.
  • Scar tissue formation in the uterus.
  • Anaphylactic reactions to medications used during the procedure.
  • Over distension of the uterine cavity
  • Pulmonary oedema (swelling in the lungs).
  • Blood clotting in the vessels.
  • Rupture or tearing of the uterus (rare). 
  • Excess fluid/gas buildup during the expansion of the womb.

You should seek for doctor’s advice if you have

  • Breathlessness or difficulty in breathing.
  • Fever.
  • Nausea and vomiting.
  • Heavy bleeding from the vagina.
  • Severe tummy pain.

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Medically Reviewed on 11/11/2020
References
Medscape: https://emedicine.medscape.com/article/1848258-overview

American Association of Gynecologic Laparoscopists AAGL (Elevating Gynecologic Surgery) https://www.aagl.org/patient/Diagnostic-Hysteroscopy-Dilation-and-Curettage-AAGL.pdf

John Hopkins Medicine https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/hysteroscopy

Geneva Foundation for Medical Education and Research: https://www.gfmer.ch/Books/Endoscopy_book/Ch19_hysteroscopy_diagnostic%20.html