Robert Wood Johnson University Hospital
 

Hysteroscopy

Hysteroscopy

Procedure Overview

What is a hysteroscopy?

Hysteroscopy is the visual examination of the canal of the cervix and interior of the uterus using a thin, lighted, flexible tube called a hysteroscope. The device is inserted through the vagina.

Hysteroscopy may be used for both diagnostic and therapeutic purposes. The hysteroscope allows for easy visual access to the interior of the cervix and uterus to assess the lining of these structures. Therapeutic maneuvers, such as taking a tissue sample (biopsy), removal of polyps or fibroid tumors, or preventing bleeding with cautery (destruction of tissue by electric current, freezing, heat, or chemicals) may be performed during a hysteroscopy procedure.

Diagnostic hysteroscopy may be performed in a physician's office or in an outpatient facility with local or no anesthesia required. More invasive therapeutic hysteroscopy procedures may be performed in the operating room under local, regional, or general anesthesia.

Because the physician is able to see the interior of the cervix and uterus during the procedure, diagnostic hysteroscopy has become a more common procedure than dilation and curettage (D & C), which is performed without endoscopic visualization.

Other related procedures that may be used to evaluate problems of the female pelvic organs include D & C, cervical biopsy, colposcopy, endometrial biopsy, laparoscopy, Pap test, and pelvic ultrasound. Please see these procedures for additional information.

What are female pelvic organs?

Illustration of the anatomy of the female pelvic area
Click Image to Enlarge

The organs and structures of the female pelvis are:

Reasons for the Procedure

Hysteroscopy may be performed in women who have an abnormal Pap test, abnormal uterine bleeding, or postmenopausal bleeding. It may be used to help diagnose causes of infertility or repeated miscarriages. Hysteroscopy may also be used to evaluate uterine adhesions (Asherman's syndrome), polyps, and fibroids, and to locate and remove displaced intrauterine devices (IUDs). Hysteroscopy is also used to place small inserts in the fallopian tubes that are a premanent method of birth control.

Therapeutically, hysteroscopy may be used to help correct uterine problems. For example, small adhesions, polyps or fibroids may be removed through the hysteroscope, often eliminating the need for open abdominal surgery. Endometrial biopsy or ablation (removal of the endometrial lining) may be performed via hysteroscopy. The term "operative hysteroscopy" may be used in these situations.

Hysteroscopy cannot be performed during pregnancy.

There may be other reasons for your physician to recommend a hysteroscopy.

Risks of the Procedure

As with any surgical procedure, complications may occur. Some possible complications of hysteroscopy may include, but are not limited to, the following:

You may experience slight vaginal bleeding and cramps for a day or two after the procedure.

There may be other risks depending upon your specific medical condition. Be sure to discuss any concerns with your physician prior to the procedure.

Certain factors or conditions may interfere with a hysteroscopy. These factors include, but are not limited to, the following:

Before the Procedure

During the Procedure

Illustration of a hysteroscopy procedure
Click Image to Enlarge

A hysteroscopy may be performed on an outpatient basis or as part of your stay in a hospital. Procedures may vary depending on your condition and your physician's practices.

Generally, a hysteroscopy follows this process:

  1. You will be asked to remove clothing and will be given a gown to wear.
  2. You will be asked to empty your bladder prior to the procedure.
  3. An intravenous (IV) line may be inserted in your arm or hand.
  4. You will be positioned on an operating table, lying on your back with your feet in stirrups.
  5. The vaginal area will be cleansed with an antiseptic solution.
  6. The cervix may be dilated prior to the insertion of the hysteroscope.
  7. The hysteroscope will be inserted into the vagina, through the cervix, and into the uterus.
  8. A liquid or gas will be injected through the hysteroscope to expand the uterus, allowing for better visualization.
  9. The wall of the uterus will be examined for abnormalities. Photographs or video documentation may be made. Biopsy specimens may be taken.
  10. If a procedure such as fibroid removal is to be performed, instruments will be inserted through the hysteroscope.
  11. For more detailed or complicated procedures, a laparoscope (a type of endoscope inserted through the abdomen) may be used to view the outside of the uterus simultaneously.
  12. When the procedure is completed, the hysteroscope will be removed.

After the Procedure

Your recovery process will vary depending upon the type of anesthesia that is given. If general anesthesia or a sedative was used, your blood pressure, pulse, and breathing will be monitored until they are stable and you are alert. When stable, you will be discharged to your home. Hysteroscopy is usually performed on an outpatient basis.

Otherwise, there is generally no special type of care following a hysteroscopy.

You may experience cramping and vaginal bleeding for a day or two after the procedure. Report fever, severe abdominal pain, or heavy vaginal bleeding or discharge.

You may experience flatulence (gas in the digestive tract) and pains resulting from the gas administered during the procedure for about 24 hours. You may feel pain in your upper abdomen and shoulder.

Take a pain reliever for soreness as recommended by your physician. Aspirin or certain other pain medications may increase the chance of bleeding. Be sure to take only recommended medications.

You may be instructed to avoid vaginal douching and sexual intercourse for two weeks after the procedure, or for an alternate period of time recommended by your physician.

Other activities and normal diet may be resumed unless your physician advises you differently.

Your physician may give you additional or alternate instructions after the procedure depending on your particular situation.

Online Resources

The content provided here is for informational purposes only, and was not designed to diagnose or treat a health problem or disease, or replace the professional medical advice you receive from your physician. Please consult your physician with any questions or concerns you may have regarding your condition.

This page contains links to other Web sites with information about this procedure and related health conditions. We hope you find these sites helpful, but please remember we do not control or endorse the information presented on these Web sites, nor do these sites endorse the information contained here.

American Cancer Society

American College of Obstetricians and Gynecologists

American College of Surgeons

American Society for Reproductive Medicine

National Cancer Institute (NCI)

National Institutes of Health (NIH)

National Library of Medicine

National Women's Health Information Center

 

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