Diagnostic and Surgical Hysteroscopy: how is it done? It hurts?

What is hysteroscopy

Also known as video-hysteroscopy, hysteroscopy is a gynecological procedure with low complication rates designed to investigate the presence of foreign elements in the uterus, and even to remove these elements in a minimally invasive manner.

It is done by inserting a device called a hysteroscope, which allows the doctor to see the inside of the uterus and fallopian tubes and analyze what is wrong.

Types

There are two types of hysteroscopy, with totally different execution procedures and objectives. Are they:

Diagnostic hysteroscopy

Diagnostic hysteroscopy is an examination performed to view two internal parts of the female reproductive system: the endocervical canal, which is located in the cervix, and the uterine cavity, a structure that houses the endometrium. It is done to identify and investigate intrauterine changes, in addition to being part of the list of tests that precede in vitro fertilization. The procedure is simple and can be performed in a hospital outpatient clinic or in the doctor’s office.

Surgical hysteroscopy

As the name suggests, surgical hysteroscopy is a procedure performed within a surgical center, with the application of anesthesia, which can be general or local according to the assessment of the responsible physician.

Unlike diagnostic hysteroscopy, surgical hysteroscopy is performed to treat any significant uterine abnormalities previously diagnosed. That is, it is done aiming at the removal of any foreign body that is disturbing the health of the woman’s reproductive system or causing discomfort.

Among the most common procedures performed through surgical hysteroscopy are the extraction of polyps, removal of fibroids, biopsies and endometrial ablation and removal of uterine synechiae.

What is it for?

Diagnostic hysteroscopy is a gynecological exam indicated to investigate phenomena such as:

  • Infertility;
  • Polyps;
  • Fibroids;
  • Uterine adhesions;
  • Significant changes in the endometrium;
  • Hemorrhages;
  • Adenocarcinomas;
  • Frequent abortions.

In the surgical modality, hysteroscopy is also used to treat some of these cases by removing fibroids and polyps, correcting anomalies in the endometrium and performing biopsies, among other procedures.

How is done

To perform diagnostic hysteroscopy, the patient will be in a gynecological position and will have her cervix dilated through the use of a mechanical dilator.

Then, a hysteroscope will be inserted, an instrument that is 1 to 4 millimeters in diameter and has a light emitter at the tip ensuring visibility. This equipment also has a microcamera, which captures images and allows the doctor to see the uterus from the inside. Fiber optic filaments are responsible for carrying light and also substances that should induce distension of the uterus, such as carbon dioxide or saline.

Some professionals may opt for sedation to perform diagnostic hysteroscopy, to facilitate and ensure more safety to the process. However, this step is not mandatory.

Surgical hysteroscopy follows the guidelines for a surgical procedure. Anesthesia is applied, which can be general or spinal, a local anesthesia used to block pain during the procedure, according to medical advice.

In the vast majority of cases, no type of cut is made – all surgery is done with the use of an endoscope, the same equipment used in endoscopies. The technique ensures that the removal of the foreign body is done with the lowest level of invasion and aggression possible.

When should be done

The doctor should order hysteroscopy when he suspects diseases that are reaching the patient’s uterus.

Contraindications

Pregnant women and women with genital infections are strictly prohibited from performing hysteroscopies. If this is the case, it is important to inform your doctor at the time of requesting the test, if he is not already aware of your situation.

For those who are pregnant, performing hysteroscopy creates the risk of miscarriage. For those who have an infection, there is a risk of complication of the condition.

It is also not possible to perform the procedure on menstruating patients, as menstrual flow significantly impairs visibility during the exam.

Pre-examination and post-examination care

Pre-exam preparation varies depending on the type of hysteroscopy that will be performed. For diagnostic hysteroscopy, it is recommended that the patient not have sex within 72 hours prior to the examination. You will also need to take a pill that prevents colic about half an hour before the procedure, according to guidelines from the responsible medical team.

In the case of surgical hysteroscopy, the patient needs to fast for 12 hours to avoid complications related to the application of anesthesia. One hour before surgery, an anti-inflammatory must be taken. If the woman has a narrowing of the vaginal canal, the team may also apply a vaginal pill.

It is important to note that all guidance on medications and the administration of these will be carried out by the doctor responsible for the examination. Don’t medicate yourself!

After the examination, some patients may experience light bleeding for a few days. If the condition lasts for more than two days or there is evidence of bleeding, it is important to see a doctor.

In general, recovery happens quickly and the patient can return to her normal routine almost immediately. Some gynecologists may recommend that women who have just had a hysteroscopy wait 48 hours to resume intense physical activity. Depending on the reason that led to the examination, some doctors may give special guidance on resuming the patient’s sexual life.

For those who have undergone surgical hysteroscopy, the postoperative is usually simple. After the end of the anesthesia effect, the woman should spend about 40 minutes under observation. After this period, if she is not experiencing pain, cramps or other discomfort, the patient is released. However, in special cases, the doctor may request hospitalization for a maximum of one day after the examination.

Does hysteroscopy hurt?

Post-hysteroscopy sensitivity varies from organism to organism. Most women recover quickly without major side effects. However, some patients may experience pain and discomfort after the procedure. There is also the possibility of experiencing mild cramping during the exam.

Results

The results of hysteroscopy do not have reference values, but analyzes of the symmetry, size and shape of some components of the uterus, taking into account the period of the menstrual cycle in which the patient is.

Among the information contained in the report, there will be a symmetric analysis of the uterine cavity, the appearance of the endometrium and the opening levels of the fallopian tubes. The result will also indicate whether there are signs of tumors, fibroids, lesions and polyps.

Abnormal results can indicate a series of phenomena, from obstruction of the tubes to cancer in the endometrium. Only a gynecologist will be able to assess the situation and request additional tests to confirm the diagnosis.

What can affect the results?

Conditions such as infections and genital inflammation, discharge and distended bladder can alter the test results. In this case, the procedure must be repeated according to medical advice.

Scratchs

Serious complications are rare after hysteroscopy. Post-examination risks include:

  • Bleeding;
  • Infections;
  • False hysteroscope course in the cervix;
  • Water intoxication, a condition in which the person’s body absorbs more liquid than it can bear;
  • Perforation of the uterus;
  • Absence of dilation of the uterine cervix, preventing the passage of the hysteroscope. This complication is more common in patients who are in menopause;
  • Injuries to nearby organs, such as intestinal loops and bladder;
  • Need to repeat the procedure to confirm the results;
  • In the case of surgical hysteroscopy, anesthesia can cause anaphylactic shock or allergic reactions.

However, it is important to note that the procedure is safe in both modalities. Most women experience little or no pain and recover quickly.

Price

In the North, the average price for diagnostic hysteroscopy is R $ 200.00. Surgical hysteroscopy in the same region, on the other hand, can cost around R $ 400.00.

Complementary exams

Hysteroscopy is usually performed in addition to hysterosalpingography , a radiography modality that is performed with the application of contrast and serves to analyze anatomical aspects of the uterus and fallopian tubes.

Hysteroscopic ligation

One of the most widely used techniques in the world today for performing ligation procedures is called hysteroscopic ligation, which basically consists of sterilizing hysteroscopy.

The procedure is simple: through a surgical hysteroscopy, doctors insert two springs about 4 centimeters into the patient’s uterine tubes. These springs create a small controlled inflammation, which prevents the passage of the sperm and, consequently, its encounter with the egg.

Hysteroscopic tubal ligation has become the main surgical contraceptive for women due to its easy recovery and execution, which does not require cuts or complex post-operative processes. After the procedure, the patient may experience only mild discomfort for a few days, which are alleviated with pain relievers. In total, the hysteroscopic ligation lasts only 10 minutes.

Attention!

In February 2017, anvisa determined the suspension of the import, distribution, sale and use of the Essure tubular stent, classifying it as a maximum risk. According to the agency, the implementation of the device can cause unwanted pregnancy, chronic pain, perforation, changes in menstrual bleeding, allergy and migration of the device.


Hysteroscopy is a little-known test, but very important to ensure the health of the uterus. Share this text so that more women have access to this information! If you have any questions, please contact us and we will respond.

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