Hysteroscopy or uterine endoscopy

Hysteroscopy or uterine endoscopy is a diagnostic and surgical procedure that allows the inside of the uterus to be assessed without the need for an abdominal incision.

This method uses a hysteroscope, a narrow tube equipped with a camera. The images are transferred to a computer to display a close-up of the uterus.


What is diagnostic hysteroscopy?

Diagnostic hysteroscopy is a method of examination for diagnosing uterine diseases.

It can also be used to confirm other test results, such as those of a hysterosalpingography.
In a hysterosalpingography, a contrast agent is injected and then X-rays are taken to analyze the uterus and fallopian tubes.
Diagnostic hysteroscopy can be performed frequently.

The examination is usually carried out on an outpatient basis in a hospital or clinic.
Hysteroscopy can also be performed in combination with other procedures, such as laparoscopy or before scraping.
In laparoscopy, the doctor inserts an endoscope (a thin rod with fiberglass optics) into the patient’s abdomen to visualize the outside of the uterus, ovaries, and fallopian tubes.
The endoscope is inserted through a small incision in or below the navel.

What is surgical hysteroscopy?

Operative hysteroscopy is used to correct a disease detected during diagnostic hysteroscopy.
If, for example, a tumor is detected during diagnostic hysteroscopy, it can usually be removed directly, thus avoiding a second surgical procedure.
In surgical hysteroscopy, some small instruments are inserted to remove the diseased tissue (e.g. fibroma or polyp of the uterine lining).

When is a hysteroscopy performed?

Hysteroscopy is used for the following complaints or questions:

  • Look for the cause of severe cramping or bleeding.
  • The doctor may insert instruments through the hysteroscope to stop the bleeding.
  • Determine whether there is a malformation of the uterus, for example, a uterus septus (division of the uterine cavity), or whether the scar tissue of the uterine cavity is the cause of infertility.
  • Assessment of the connecting openings between the uterus and fallopian tubes. If the fallopian tubes are occluded, the doctor can open them with special tools inserted through the hysteroscope.
  • search for possible causes of recurrent miscarriage; other studies may be carried out for this purpose.
  • Search and repositioning of misplaced spirals.
  • Search and removal of minor fibromas and polyps.
  • Control examination for endometrial cancer.
  • Use of instruments (laser or other) that significantly increase the temperature of the endometrium to remove problematic areas of the uterine lining (endometrial ablation).
  • Insertion of a contraceptive into the fallopian tubes, a method of permanent sterilization.

With the help of hysteroscopy, a malformation of the uterus can be diagnosed, for example:

  1. Unicornine uterus: the uterus is unilateral, only half of the normal uterine cavity is present and the fallopian tubes are located only on one side.
  2. Uterus bicornis: there are two uterine cavities.
  3. Uterus didelphys: characterized by a complete double installation of the uterus, that is, with two cervixes and two uterine cavities.
    In most cases, there is also a double vagina.
  4. Uterus septus, complete or incomplete: the uterine cavity is separated by a septum (fibrous membrane) that extends from the uterine fundus and extends to the cervix. In an incomplete septum or subseptum, the uterine cavity is not completely divided.
  5. Uterus arcuatus: the uterine fundus is dented, it is a mild form of malformation.

Preparing for a hysteroscopy

The surgeon will explain to the patient how to prepare for the procedure.
For example, smokers should take a break from smoking because the smoke from cigarettes increases the risk of chest infection and thus delays healing.
Hysteroscopy should not be performed during pregnancy.
Diagnostic hysteroscopy is usually performed on an outpatient basis. This means that no overnight stay in the hospital and no anesthesia are necessary. The surgeon may recommend taking a painkiller such as acetaminophen about half an hour before the procedure.

An alternative is a procedure under general anesthesia, i.e. the patient sleeps during the operation; in this case, the patient must be fasting, i.e. from midnight of the previous day (about 6-8 hours before the hysteroscopy) she must not eat anything.
In any case, it is important to follow the doctor’s instructions.
Some examinations may be carried out in the hospital, such as checking pulse rate, blood pressure and urinalysis.

How is a hysteroscopy performed?

In some hospitals, an ultrasound examination is performed before hysteroscopy.
A hysteroscopy can be performed under general anesthesia, which means that the patient sleeps during the procedure.
Or a local anesthetic is injected, then the patient stays awake.
A sedative can help the patient relax.
Under local anesthesia, the patient can follow the images coming from the hysteroscope on the monitor if desired.

For some people this is out of the question, others find it very interesting.
The doctor may use a speculum (an instrument used to spread natural body orifices, which is also used in a smear examination) to examine the cervix. The doctor then inserts the hysteroscope into the uterus through the cervix.

The hysteroscope is connected via a video camera to a screen on which the inside of the uterus is displayed.
The uterus is expanded and unfolded by introducing fluid or gas.
Now the doctor can examine the uterine lining.
Then a tissue sample (biopsy) can be taken from the uterus, which is then examined under the microscope in a laboratory. Sometimes polyps are located that can be removed directly.

Finally, the hysteroscope is carefully removed.
A hysteroscopy takes 5 to 30 minutes.
When waking up, cramping discomfort may occur in some moments. Many women have no or minimal pain.

Is hysteroscopy painful?

The sensation of pain varies from case to case, for some women the procedure is just a little unpleasant, others report a stabbing pain when it is done without anesthesia.
This depends on the width of the cervix and the personal pain threshold.
Those who have already given birth feel less pain than a woman without childbearing experience.

Risks and complications of hysteroscopy

As with any other surgical procedure, there are certain risks.
Possible complications of hysteroscopy include:

  • Infection
  • Bleeding
  • Inflammation of the organs of the small pelvis
  • Uterine perforation (rare) or cervical lesions
  • Complications caused by the fluid or gas introduced to stretch the uterus

One to two days after the procedure, mild vaginal bleeding and cramping may occur.
Depending on the disease present, there may be other risks.
If there are some concerns about hysteroscopy, these should be discussed with the doctor beforehand.
Certain factors or conditions are incompatible with hysteroscopy, including:

  • Inflammation of the organs of the small pelvis
  • Discharge
  • inflamed cervix
  • Bladder elongation

The menstrual period after a hysteroscopy may be slightly stronger or occur late, which is quite normal.

After the procedure

The patient can usually be discharged home on the day of the hysteroscopy.
If general anesthesia has been performed, the patient usually remains in the hospital until the effect has passed.
At home, the patient has to take care of herself.
Some women experience menstrual-like cramps after hysteroscopy.
There may also be pain in the shoulder, which is an effect of the gas or fluid used to stretch the uterus.
Cramps and pain would have to subside over the course of a few days. In the meantime, painkillers can be taken.

Most women feel fit enough the day after hysteroscopy to start work and everyday activities.
Others need a few days of rest.
The necessary recovery time depends on whether the surgeon has also performed surgical hysteroscopy (for example, to remove a fibroma or a polyp).

In this case, it is quite possible that bleeding will occur after the procedure.
Sexual intercourse should be avoided for 2-3 days.

Sometimes a sanitary sanitary napkin must be used until the bleeding subsides.
Even after a purely diagnostic hysteroscopy, vaginal bleeding may become noticeable. This is completely normal and usually subsides after a few days, sometimes only after a few weeks.
Tampons should be avoided for at least a month because of the risk of infection.
Follow the rules of conduct recommended by the doctor regarding physical activity, sexual intercourse and contraception.

Are the results available immediately? How long are the waiting times?

If polyps or fibromas are checked and removed during hysteroscopy, the surgeon has the results immediately. You can see them directly on the screen.
If a biopsy has to be performed, the results can take a while.
The examination results can be sent directly to the patient’s home or the attending physician hands them over personally.

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