My doctor has recommended hysteroscopy to check out my bleeding problem. Can you tell me what to expect?
Hysteroscopy is a procedure used to evaluate the inside of a woman’s uterus. It is performed using a hysteroscope, which is a very thin telescope-like instrument. The hysteroscope is introduced through the cervix and allows the doctor to look directly at the uterine cavity to detect and treat problems.
Hysteroscopy is used to evaluate a number of problems including abnormal uterine bleeding, displaced IUDs (an IUD that has migrated out of proper position), infertility, abnormal growths (such as polyps or fibroids), or repeated miscarriages. Hysteroscopy may also be used to evaluate an abnormal finding on a hysterosalpingogram (HSG).
In addition to getting a closer look at the uterine wall and cavity, hysteroscopy allows the doctor to take a biopsy or sample of tissue to further evaluate bothersome findings. Hysteroscopy is also used to separate intra-uterine scar tissue or to remove a displaced IUD.
Hysteroscopy is a brief, minor surgical procedure that may be performed in a physician’s office, a surgicenter or a hospital operating room. It is usually performed with either local or general anesthesia, though some women require no anesthesia at all. The procedure is performed while you are lying on your back with your legs resting on stirrups. It begins with a gentle pelvic exam to confirm the position of your uterus. A speculum is then placed in the vagina and opened to allow proper visualization of the cervix. The area is sterilized and a local anesthetic is administered. The cervix is dilated to allow insertion of the hysteroscope into the uterine cavity. The cavity is then distended with a liquid or gas which is released through the hysteroscope. A light is shown through the hysteroscope and close inspection of the uterine cavity is performed. The openings of the Fallopian tubes are visualized and biopsies are obtained if needed. The instruments are then removed and you are usually able to go home after a brief recovery period.
Hysteroscopy is a safe procedure and complications are rare, occurring in less than 3 percent of cases. The most common problems that occur include injury to the cervix or uterus, infection, reaction to the anesthesia, or, if no anesthesia was used, nausea or fainting. Minimal discomfort and light bleeding are common after the procedure and resolve quickly. If a liquid is used to distend the uterine cavity, a thin discharge may be present after the procedure. Be sure to call your physician if you have a fever, severe abdominal pain or heavy vaginal bleeding or discharge after the procedure.
In certain cases, hysteroscopy is combined with laparoscopy or dilation and curettage (D&C). When a surgical procedure is performed within the uterine cavity a larger diameter “operative” hysteroscope is used. The operative hysteroscope contains channels through which slender instruments can be introduced into the uterine cavity. General anesthesia is usually needed in these cases.
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