hysteroscopy

Hysteroscopy is a procedure that allows a physician to look through the vagina and neck of the uterus (cervix) to inspect the cavity of the uterus. A telescopelike instrument called a hysteroscope is used. Hysteroscopy is used as both a diagnostic and a treatment tool.

Diagnostic hysteroscopy may be used to evaluate the cause of infertility, to determine the cause of repeated miscarriages, or to help locate polyps and fibroids.

The procedure is also used to treat gynecological conditions, often instead of or in addition to dilatation and curettage (D&C). A D&C is a procedure for scraping the lining of the uterus. A D&C can be used to take a sample of the lining of the uterus for analysis. Hysteroscopy is an advance over D&C because the doctor can take tissue samples of specific areas or actually see fibroids, polyps, or structural abnormalities.

When used for treatment, the hysteroscope is used with other devices to remove polyps, fibroids, or IUDs that have become embedded in the wall of the uterus.

The procedure is not performed on women with cervical cancer, endometrial cancer, or acute pelvic inflammation.

Diagnostic hysteroscopy is performed in either a doctor's office or hospital. Before inserting the hysteroscope, the doctor injects a local anesthetic around the cervix. Once it has taken effect, the doctor dilates the cervix and then inserts a narrow lighted tube (the hysteroscope) through the cervix to reveal the inside of the uterus. Ordinarily, the walls of the uterus are touching each other. In order to get a better view, the uterus is inflated with carbon dioxide gas or fluid. Hysteroscopy takes about 30 minutes, and can cost anywhere from $750 to $4,000 depending on the extent of the procedure.

Treatment involving the use of hysteroscopy is usually performed as a day surgical procedure with regional or general anesthesia. Tiny surgical instruments are inserted through the hysteroscope, and are used to remove polyps or fibroids. A small sample of tissue lining the uterus is often removed for examination, especially if there is any abnormal bleeding.

If the procedure is done in the doctor's office, the patient will be given a mild pain reliever before the procedure to ease cramping. The doctor will wash the vagina and cervix with an antiseptic solution.

If the procedure is done in the hospital under general anesthesia, the patient should not eat or drink anything (not even water) after midnight the night before the procedure.

Many women experience light bleeding for several days after surgical hysteroscopy. Mild cramping or pain is common after operative hysteroscopy, but usually fades away within eight hours. If carbon dioxide gas was used, there may also be some shoulder pain. Nonprescription pain relievers may help ease discomfort. Women may want to take the day off and relax after having hysteroscopy.

Diagnostic hysteroscopy is a fairly safe procedure that only rarely causes complications. The primary risk is prolonged bleeding or infection, usually following surgical hysteroscopy to remove a growth.

Very rare complications include perforation of the uterus, bowel, or bladder. Surgery under general anesthesia causes the additional risks typically associated with anesthesia.

Patients should alert their health care provider if they develop any of these symptoms:

A normal, healthy uterus with no fibroids or other growths.

Using hysteroscopy, the doctor may find uterine fibroids or polyps (often the cause of abnormal bleeding) or a septum (extra fold of tissue down the center of the uterus) that can cause infertility. Sometimes, precancerous or malignant growths are discovered.

Anon. "Looking Inside the Uterus." Harvard Women's Health Watch 4, no. 5 (January 1997): 4-5.

Fibroid — A benign tumor of the uterus

Polyp — A growth that projects from the lining of the cervix, the nose, or any other mucus membrane.

Septum — A condition present at birth in which there is an extra fold of tissue down the center of the uterus that can cause infertility. This tissue can be removed with a wire electrode and a hysteroscope.