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 hysteroscopy done?

Hysteroscopy can be performed for both diagnosis or also for treatment (therapeutic). Hysteroscopy is one of several procedures that any doctor may advocate 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
• Congenital (inborn) anatomical abnormalities of the female genital tract
• Retained placenta or products of conception after a birth or miscarriage
• Polyps or fibroid tumors inside the cervical canal or inside the uterine cavity
• Scarring, or adhesions, from previous uterine surgery or instrumentation such as dilation and curettage (D&C)

Hysteroscopy can also be used to help pinpoint the location of abnormalities in the uterine lining for sampling and biopsy. Hysteroscopy can also be used to perform surgical sterilization.

How is hysteroscopy performed?

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. 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 prostaglandin medications and/or 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 (Tyleno and others) and non steroidal anti-inflammatory medications are generally recommended after the procedure to control any pain or cramping that may occur. Hysteroscopy cannot be performed if a woman is pregnant or has an active pelvic infection. It is also not recommended if a woman has uterine or cervical cancer. Certain conditions may make hysteroscopy more difficult or impossible to perform:

• abnormal position of the uterus,
• obstruction of the cervical canal or uterine cavity, and
• scarring or narrowing of the cervical opening

What are the risks and complications of hysteroscopy?

It is expected 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 outlook 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.

Hysteroscopy at a Glance

• Hysteroscopy is the visualization of the inside of the uterine cavity by inserting special visualization scopes through the vagina and cervical opening.
• Hysteroscopy can be carried out to aid in diagnosis or to perform minor surgical procedures.
• In many cases hysteroscopy can be performed as an outpatient (same-day) surgical procedure.
• Complications of hysteroscopy are rare. The most commonly reported complication is perforation of the uterus.