A hysteroscopy is a procedure that allows a surgeon to diagnose or treat uterine problems. The procedure involves inserting a narrow, lighted lens through your vagina and cervix in order to view the inside of the uterus projected on a screen.
Your gynecologist may recommend a hysteroscopy for one of several reasons:
- Determine the cause of abnormal or heavy bleeding
- Remove adhesions (scar tissue) that formed during a previous surgery or disease
- As part of a sterilization procedure
- Diagnose problems with fertility or recurring miscarriages
- Locate an IUD (intrauterine device for birth control)
How are Hysteroscopies Performed?
Some hysteroscopies are performed at the hospital, but they can also be performed right in your doctor’s office. Your doctor will give you a local anesthetic to numb your cervix. Additionally Dr. Aliabadi often uses Nitrious Oxide (aka “laughing gas”) while performing this procedures to greatly minimize pain as well as anxiety. On some occasions general anesthetic to put you to sleep during the procedure may be recommended.
A hysteroscopy is conducted with you lying on your back, with your feet in stirrups, much like during a pelvic exam. A speculum will be inserted into your vagina and your doctor will dilate your cervix. This can be done with medication or with dilation rods.
Next, the doctor inserts the hysteroscope through your cervix. Your uterus may be filled with fluid in order to push the uterine walls out and make it easier for the hysteroscope to view the lining. Your doctor can pass other instruments through the hysteroscope at this time if other procedures need to be performed (i.e. a biopsy).
Hysteroscopic Polypectomy and Myomectomy
Hysteroscopy can be performed as a surgical treatment for some uterine abnormalities. Surgeries to remove polyps (polypectomy) and uterine fibroids (myomectomy) are often conducted with the guiding help of a hysteroscope.
Uterine polyps and myomas can be surgically removed with a narrow instrument tipped with a wire loop electrode. When electricity is run through the instrument, the loop can cut polyps and fibroids and cauterize the tissue at the base. This stops any bleeding and helps prevent any regrowth. The entire procedure takes about 45-60 minutes.
An endometrial ablation is a procedure that removes the uterine lining. The uterine lining, also known as the endometrium, is the tissue that thickens throughout your menstrual cycle and sheds as your period when a pregnancy does not occur. Women who suffer from irregular or heavy bleeding, and do not desire future pregnancies, may have an endometrial ablation to manage their symptoms.
Following the procedure, most women will see their period disappear altogether or see a significant decrease in menstrual flow.
Ablation is typically performed as an outpatient procedure, along with a hysteroscopy. Your doctor can use one of several methods to remove the uterine lining. The method your doctor chooses will depend upon the severity of your condition and your personal health history.
Fertility after Endometrial Ablation. Endometrial ablation significantly reduces your chances of conceiving naturally, but it is not impossible. Speak with your doctor about your family planning needs before treatment.
After your surgery, you may need to wait in the recovery room for a couple of hours until your anesthesia wears off. Upon discharge, you will need someone to drive you home and take care of you for the next 24 hours. You may be able to return to work the next day, and you should expect a full recovery within about 2-3 days.
Avoid any rigorous activity or heavy lifting for the first few days following surgery. You will also want to abstain from sex and avoid putting anything into your vagina until you are completely healed, including tampons. This is to prevent any infection. You might experience some mild-moderate pain from the procedure, but this can usually be managed with over-the-counter ibuprofen or a prescription-strength pain medication from your doctor.
It’s normal to experience some light bleeding or spotting for about 3-4 days following surgery. Call your doctor right away if you experience any severe symptoms, such as:
- Fever over 100 degrees
- Severe or increasing pain
Risks of Hysteroscopy
Every gynecological surgery carries some inherent risk, but complications due to hysteroscopy are very uncommon. Risks may include:
- Adhesions (scarring)
- Blood loss
- Perforation and/or burns of the uterus
- Damage to other pelvic tissue, including fallopian tubes, bladder, or bowel