Hysteroscopy

Hysteroscopy is a surgical procedure in which a long thin camera, or scope, is inserted into the uterus to evaluate the uterine cavity for causes of abnormal bleeding. Hysteroscopy can be performed in the office or in the operating room. It can be diagnostic (just to look and identify the problem) or operative (to look, identify, and remove the problem)¹.

Office Hysteroscopy

An office hysteroscopy is conveniently performed in a physician’s office under local anesthesia. Numbing medication is injected into the cervix and a very thin camera is guided into the uterine cavity.

An office hysteroscopy can identify abnormalities involving the uterine cavity:

• Intrauterine fibroids
• Intrauterine adhesions
• Endometrial polyps
• Masses suspicious for malignancy

A small biopsy can be performed during the evaluation to rule out malignancy. If fibroids or intrauterine adhesions are found, operative hysteroscopy under IV sedation in the operating room will be required.

Operative Hysteroscopy

Operative hysteroscopy removes intrauterine growth (fibroid or polyp), uterine septum, or adhesions. This procedure is performed in the operating room under IV sedation administered by an anesthesiologist.

During the procedure, the cervical canal is dilated and a larger-caliber camera (scope) is guided into the uterine cavity. The uterine cavity is distended with fluid and a heated loop device is then used to cut away the fibroid (hysteroscopic myomectomy), polyp, septum, or adhesions. In cases of large fibroids, uterine septum, or extensive adhesions, several procedures are required for complete removal and should be performed by an experienced surgeon to avoid complications.

One of the risks of operative hysteroscopy is the formation of intrauterine adhesions. In some cases, an intrauterine balloon is placed at the completion of the procedure to decrease bleeding and prevent scarring. The balloon is removed in the office after seven days, and the patient is prescribed high-dose estrogen for several weeks to rebuild a healthy uterine lining and further prevent the formation of intrauterine adhesions.

While recovering from a hysteroscopy:

• You may resume regular activities in one to two days
• Intercourse may be resumed when the spotting has stopped
• Shower as usual but avoid tub baths until the spotting has stopped
• If you have some abdominal cramping, you may take Advil or Tylenol to reduce the pain and discomfort
• Expect vaginal bleeding for a few days and use maxi pads, not tampons, to absorb blood and discharge
  • Avoid douching and call the office if you notice a foul-smelling discharge
• You may have regular food as tolerated, no special diet is required.

Some of the risks and complications associated with a hysteroscopy include:

• Risks associated with anesthesia
• Infection
• Heavy bleeding
• Injury to the cervix, uterus, bowel, or bladder
• Intrauterine scarring
• Reaction to the substance used to expand the uterus

Our specialists are ready to provide an evaluation of your symptoms and conditions and recommend an appropriate solution.

¹ Centini G, Troia L, Lazzeri L, et al. Modern operative hysteroscopy. Minerva Ginecol. 2016 Apr;68(2):126-32