Hysteroscopy

What is a hysteroscopy?

A hysteroscopy is a procedure for looking at the inside of your uterus with a thin, flexible, lighted tube. The tube is called a hysteroscope. The uterus is the muscular organ at the top of the vagina. Babies develop in the uterus, and menstrual blood comes from the uterus.

When is it used?

A hysteroscopy is used to diagnose or treat problems inside your uterus. Examples of such problems are abnormal bleeding or abnormal growths, such as fibroids or polyps. It may be done to help discover the cause of infertility or miscarriages. It can be used to do get a sample of tissue from the uterus (a biopsy) to check for cancerous growth.

Examples of alternative procedures that may be used to diagnose or treat problems in the uterus are:

• an ultrasound scan, which is an exam with high-frequency sound waves
• D&C (dilation and curettage), which is a procedure for opening the cervix and then scraping or suctioning tissue from the uterus.
• a special type of x-ray, such as a hysterosalpingogram (putting dye into the uterus so it can be seen on an x-ray film)
• endometrial biopsy (the insertion of a tiny tube through the vagina and into the uterus to remove a sample of the inner layer of the uterine wall)
• removal of the uterus (hysterectomy)
• choosing not to have treatment.

You should ask your provider about these choices.

How do I prepare for a hysteroscopy?

Make plans for your care and recovery after the procedure. Allow for time to rest and try to find other people to help you with your day-to-day duties.

Follow your health care provider's instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery. For this reason, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6 to 8 weeks before surgery. Also, your body will heal much better if you do not smoke after the surgery.

Follow any other instructions your provider gives you. If you are to have general anesthesia, eat a light meal, such as soup or salad, the night before the procedure. Do not eat or drink anything after midnight or the morning before the procedure. Do not even drink coffee, tea, or water.

What happens during the procedure?

Hysteroscopy may be done in your health care provider's office, at a surgical center, or at the hospital.

You will be given a local, regional, or general anesthetic before the procedure to keep you from feeling pain. A local or regional anesthetic numbs part of your body while you remain awake. It should keep you from feeling pain during the procedure. You may also be given a sedative to relax you. A general anesthetic relaxes your muscles, puts you to sleep, and prevents you from feeling pain.

During the procedure, your health care provider may stretch open (dilate) your cervix. The cervix is the opening to your uterus. He or she will guide a hysteroscope into your vagina, through the cervix, and into your uterus. Gas or fluid may be released through the scope to inflate your uterus. This helps your provider see the uterus better. If necessary, your provider may use a small laser or other tool to remove or get a sample of abnormal tissue.

What happens after the procedure?

After the procedure, you may stay in your provider's office or hospital for a short time. In some cases you will need to stay overnight. After the procedure you may:

• feel sleepy or groggy from the anesthetic
• have some cramps
• have trouble urinating the first few hours after the procedure
• have a watery or bloody discharge for 3 or 4 weeks.

Ask your provider how to care for yourself after the procedure and when you should come back for a checkup.

What are the benefits of this procedure?

Your health care provider can make a more accurate diagnosis of your problem and possibly treat any problems that are found. The procedure is short with a quick and easy recovery.

What are the risks associated with this procedure?

A hysteroscopy is a very safe procedure and rarely has complications. Possible complications may include:

• A local or regional anesthetic may not numb the area quite enough and you may feel some minor discomfort. Also, in rare cases, you may have an allergic reaction to the drug used in this type of anesthesia. In most cases, local or regional anesthesia is considered safer than general anesthesia. There are some risks when you have general anesthesia. Discuss these risks with your provider.
• You may have infection or bleeding.
• Rarely, the uterus could be punctured and need surgery to repair it.
• Rarely, the bowel or bladder may be injured.
• You may have an allergic reaction to the fluid used during the procedure.

You should ask your health care provider how these risks apply to you.

When should I call my health care provider?

Call your provider right away if:

• You start to bleed a lot (like a menstrual period).
• You develop a fever over 100°F (37.8°C).
• You have a lot of pain in your lower abdomen.
• You have a vaginal discharge with a bad odor.

Call during office hours if:

• You have questions about the procedure or its results.
• You want to make another appointment.