What is hysteroscopy?
Hysteroscopy is a minimally invasive surgical procedure for viewing the inside of the uterus. Hysteroscopy is performed by inserting a visualizing scope through the vagina and into the cervical opening. Hysteroscopy allows visualization of the inside of the uterus, including the openings to the Fallopian tubes, as well as direct examination of the cervix, cervical canal, and vagina.
Why is a hysteroscopy done?
Hysteroscopy can be performed for both diagnosis or also for treatment (therapeutic). Hysteroscopy is one of several procedures that your doctor may recommend to evaluate or treat abnormalities of the uterus or cervix. Since hysteroscopy examines the lining and interior of the uterus, it is not suitable for evaluating problems within the muscular wall or on the outer surface of the uterus.
Hysteroscopy may be recommended as one step in the evaluation of a number of gynecological problems, including:
- Abnormal vaginal bleeding
- Retained placenta or products of conception after birth or miscarriage
- Congenital (inborn) anatomical abnormalities of the female genital tract
- Scarring, or adhesions, from previous uterine surgery or instrumentation such as dilation and curettage (D&C)
- Polyps or fibroid tumors inside the cervical canal or inside the uterine cavity
Hysteroscopy can be used to help pinpoint the location of abnormalities in the uterine lining for sampling and biopsy, and it can be used to perform surgical sterilization.
SLIDESHOW
See SlideshowHow is the hysteroscopy performed? What are the types?
There are a number of different sizes and types of hysteroscopes available, depending upon the type of procedure that is required. Some hysteroscopes are combined with instruments that allow surgical manipulation and removal of tissues if necessary.
Hysteroscopy may be performed in an outpatient surgery center or a hospital operating room, or a physician's office. A number of different methods for anesthesia and pain control may be used, depending upon the individual situation. Sometimes, hysteroscopy using narrow-diameter hysteroscopes that do not require dilation of the cervical opening can be performed without anesthesia. In other cases, a local anesthetic can be applied topically or given by injection. In certain cases, a regional or general anesthetic may be recommended.
A vaginal speculum is often inserted prior to the procedure to facilitate insertion of the hysteroscope through the uterine cavity. Depending upon the exact type of hysteroscope that is used, dilation of the cervical opening with surgical instruments may be necessary. After insertion of the hysteroscope, fluid or gas is injected to distend the uterine cavity and allow for better visualization.
Acetaminophen (Tylenol and others) and nonsteroidal antiinflammatory medications are generally recommended after the procedure to control any pain or cramping that may occur.
Hysteroscopy should not be performed if a woman is pregnant or has an active pelvic infection. It is also not recommended if a woman has known uterine or cervical cancer. Certain conditions (abnormal position of the uterus, obstruction of the cervical canal or uterine cavity, scarring or narrowing of the cervical opening) may make hysteroscopy more difficult or impossible to perform in certain cases.
What are the side effects, risks, and complications of hysteroscopy?
Women should expect to experience light vaginal bleeding and some cramping after the hysteroscopy procedure. Some cramping may be felt during the procedure, depending upon the type of anesthesia.
Complications of hysteroscopy are rare and include perforation of the uterus, bleeding, infection, damage to the urinary or digestive tract, and medical complications resulting from reactions to drugs or anesthetic agents. Accidental perforation of the uterus is the most common complication and occurs in 0.1% of diagnostic hysteroscopy procedures and 1% of therapeutic (surgical) hysteroscopies. Other rare complications are fluid overload or gas embolism (when gas bubbles enter the bloodstream) from the distending medium used in the procedure.
What is the prognosis after hysteroscopy?
The outlook depends upon the individual case and the reason for hysteroscopy. Many minor surgical procedures can be successfully performed using hysteroscopy. Complications are rare, and most women recover with only minor post-procedure cramping and bleeding.
Jansen FW; Vredevoogd CB; van Ulzen K; Hermans J; Trimbos JB; Trimbos-Kemper TC. Complications of hysteroscopy: a prospective, multicenter study. Obstet Gynecol 2000 Aug;96(2):266-70.
Petrozza, JC, MD, et al. Hysteroscopy. Medscape. Updated: Aug 15, 2018.
<https://emedicine.medscape.com/article/267021-overview>
Top Hysteroscopy Related Articles
acetaminophen
Acetaminophen is a drug that reduces fever and relieves pain. It is available alone, or in combination with hundreds of other drugs available both over-the-counter (without a prescription) or that that may require a prescription from your doctor, for example, acetaminophen and hydrocodone (Vicodin, Norco) or acetaminophen and oxycodone (Percocet). Acetaminophen treats a variety of diseases or other medical problems that cause pain or fever. Examples of conditions acetaminophen treats include headache, minor arthritis pain, back pain, tooth pain, menstrual cramps, PMS, osteoarthritis, common cold, tension headache, chronic pain, hip pain, shoulder and neck pain, sore throat, sinus infection, teething, TMJ, bites and stings, and sprains and strains. Acetaminophen generally has no side effects when taken as prescribed. When side effects are experienced, the most common are headache, rash, and nausea.Cervical Dysplasia
Cervical dysplasia is a condition in which the cells of the inner lining of the cervix have precancerous changes. There are two types of cervical dysplasia: squamous intraepithelial lesion and cervical intraepithelial neoplasia. Cervical dysplasia is caused by infection of the cervix with HPV (human papillomavirus). There are various diagnostic measures for cervical dysplasia. Treatment generally depends upon the progression of the dysplasia: mild, moderate, or severe.Endometrial Ablation
Endometrial ablation is a surgical procedure performed to treat abnormal uterine bleeding. Endometrial ablation destroys the lining of the tissues of the uterus. There are several procedures used with endometrial ablation including laser beam, electricity ,freezing, heating, or microwave energy Complications may arise during or after the procedure.Endometrial Biopsy (Procedure)
During endometrial biopsy, a piece of tissue is removed from the inner lining of the uterus that is painful. Endometrial biopsies are performed to determine the cause of abnormal uterine bleeding. Endometrial biopsy can cause moderate to severe pain. Medications can be given to reduce the pain. Risks include infection, bleeding, and perforation of the uterus.
IUD (Intrauterine Device for Birth Control)
An IUD (intrauterine device) is a birth control method designed for a woman. The IUD is a small "T" made of molded polyethylene plastic coated with barium so that, if need be, it can be seen on X-ray.
There are two types of IUDs 1) Intrauterine contraceptive device (IUCD) including the ParaGard, Copper 7, and Mini-7; and 2) Intrauterine system (IUS) including Progestasert and Mirena.
Side effects of the IUD include spotting, infection, infertility, pelvic inflammatory disease, and heavy menstrual bleeding. Risks and complications of the IUD are miscarriage, ectopic pregnancy, pelvic inflammatory disease, and increased menstrual bleeding.
Miscarriage
Miscarriage is the medical term for the spontaneous loss of pregnancy from conception to 20 weeks gestation. Risk factors for a woman having a miscarriage include cigarette smoking, older maternal age, radiation exposure, previous miscarriage, maternal weight, illicit drug use, use of NSAIDs, and trauma or anatomical abnormalities to the uterus. There are five classified types of miscarriage: 1) threatened abortion; 2) incomplete abortion; 3) complete abortion; 4) missed abortion; and (5 septic abortion. While there are no specific treatments to stop a miscarriage, a woman's doctor may advise avoiding certain activities, bed rest, etc. If a woman believes she has had a miscarriage, she needs to seek prompt medical attention.
Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
Nonsteroidal anti-inflammatory drugs (NSAIDs) are a class of drugs are used to treat inflammation, mild to moderate pain, and fever. Examples of the most common NSAIDs include: aspirin salsalate (Amigesic), diflunisal (Dolobid), ibuprofen (Motrin), ketoprofen (Orudis), nabumetone (Relafen), piroxicam (Feldene), naproxen (Aleve, Naprosyn,) diclofenac (Voltaren), indomethacin (Indocin), sulindac (Clinoril), tolmetin (Tolectin), etodolac (Lodine), ketorolac (Toradol), oxaprozin (Daypro), celecoxib (Celebrex).propofol
Propofol is an intravenous anesthetic drug used for general anesthesia and sedation during surgical procedures. Common side effects of propofol include injection site burning, stinging or pain; low blood pressure (hypotension), reduced cardiac output, elevated blood pressure (hypertension), pause in breathing (apnea), lung impairment (respiratory acidosis), impaired movement, high level of emulsified fats in the blood (hyperlipidemia), and high triglyceride level in blood (hypertriglyceridemia). Abuse of propofol can cause death and other injuries.succinylcholine
Succinylcholine is a skeletal muscle relaxant used for medical procedures done under general anesthesia, including tracheal intubation, mechanical ventilation, and surgeries. Common side effects of succinylcholine include postoperative muscle pain, jaw rigidity, muscle twitch (fasciculation), respiratory depression, cessation of breathing (apnea), low or high blood pressure (hypotension or hypertension), irregular heart rhythms (cardiac arrhythmias), slow or rapid heartbeat (bradycardia or tachycardia), cardiac arrest, increase in intraocular pressure (IOP), high blood potassium levels (hyperkalemia), severe life-threatening drug reaction with excessively high temperature (malignant hyperthermia), salivary gland enlargement, excessive salivation, rash, hypersensitivity reactions, and others.Birth Control: Surgical Sterilization
Surgical sterilization is considered a permanent method of contraception. In certain cases, sterilization can be reversed, but this is not guaranteed. For this reason, sterilization is meant for men and women who do not intend to have children in the future. Types of surgical sterilization include: vasectomy, tubal ligation, STOP (selective tubal occlusion procedure), and hysterectomy.Uterine Fibroids (Benign Tumors of the Uterus)
Uterine fibroids are benign (non-cancerous) tumors in the womb (uterus). Most uterine fibroids do not cause symptoms; however, if the fibroid is large enough and in the right location, it may cause symptoms of pelvic pain, abnormal vaginal bleeding, and pressure on the bladder or rectum. Uterine fibroids that remain small and do not grow usually do not need treatment; however, surgery to remove the fibroid may be necessary. Uterine fibroids do not cause cancer; however, there is a rare, fast-growing cancerous called leiomyosarcoma.Uterine Growths
Benign uterine growths are tissue enlargements of the female womb (uterus). Three types of benign uterine growths are uterine fibroids, adenomyosis, and uterine polyps. Symptoms include abdominal pressure and pain, pelvic pain, pain during intercourse, and pain during bowel movements. Diagnosis and treatment of benign uterine growths depend upon the type of growth.Vagina Picture
The vagina is an elastic, muscular canal with a soft, flexible lining that provides lubrication and sensation. See a picture of the Vagina and learn more about the health topic.Vaginal Bleeding
Normal vaginal bleeding (menorrhea) occurs through the process of menstruation. Abnormal vaginal bleeding in women who are ovulating regularly most commonly involves excessive, frequent, irregular, or decreased bleeding. Causes of abnormal may arise from a variety of conditions that may include, uterine fibroids, IUDs, hypothyroidism, hyperthyroidism, lupus, STDs, pelvic inflammatory disease, emotional stress, anorexia nervosa, polycystic ovary syndrome (PCOS), cancers, early pregnancy.What Are the Methods of Permanent Contraception?
Permanent contraception methods are ways to permanently prevent pregnancy. Permanent contraception involves a minor surgical procedure by which the man or the woman is sterilized.