Different hysteroscopy procedures and how they are used

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Different hysteroscopy procedures and how they are used

What is a hysteroscopy?

A hysteroscopy is a surgical procedure used to examine the inside of a woman’s womb (uterus). It’s carried out using a hysteroscope, a thin telescope with a light source and camera attached at the end. The hysteroscope is inserted into the uterus through the vagina and cervix, without any cuts to the abdomen. Images captured from the telescope are sent to a monitor so a gynaecologist can see abnormalities such as polyps, fibroids or other structural problems within the uterus.

In addition to diagnosing problems, hysteroscopy can also be used to treat certain conditions. During the procedure, the gynaecologist may remove polyps or fibroids, or perform other surgeries to correct issues within the uterus.


Risks of a hysteroscopy

A hysteroscopy is generally a very safe and minor operation but like any surgical procedure, there are potential complications.

Some of the risks associated with a hysteroscopy are:

  • Bleeding: Some women may experience light bleeding after the procedure, but this usually stops within a week.
  • Infection: There is a small risk of infection after hysteroscopy
  • Uterine perforation: The hysteroscope may puncture the uterus, which may require further treatment, this risk is generally low (less than 1%) and usually associated with thin or weakened uterus, or when the procedure is performed for a complex condition.
  • Fluid overload: As fluid is used to expand the uterus during the procedure, there is a small risk of absorbing too much fluid, which can lead to fluid overload and other complications. This is a risk associated with resection of large submucosal fibroids.
  • Reaction to anaesthesia: If you receive general anaesthesia, there is a small risk of an allergic reaction or other complications associated with anaesthesia.

Your gynaecologist will discuss these potential risks with you before the procedure. It is important that you report any unusual symptoms after the procedure, such as fever, heavy bleeding, or severe pain.


Different Types of Hysteroscopy 

There are different types of hysteroscopy procedures. The specific type of hysteroscopy performed will depend on the reason for the examination and the best course of treatment for the individual patient.

Diagnostic Hysteroscopy

Diagnostic hysteroscopy is a procedure that allows for the visual examination of the inside of the uterus, allowing the diagnosis of uterus-related conditions such as uterine fibroidsuterine polyps, abnormal uterine shape, intrauterine adhesions and more. The procedure is generally done in an operating room with general anaesthesia. If there is abnormal uterine bleeding, a sample of the endometrial lining (called endometrial curettage or biopsy) can also be taken for examination by a pathologist.

The most common reasons to perform a diagnostic hysteroscopy are:

  • Abnormal Uterine Bleeding such as bleeding after menopause or bleeding between periods
  • Heavy periods 
  • Infertility
  • Recurrent miscarriage


Operative Hysteroscopy

Operative hysteroscopy is performed when a potential problem within the uterus is already known, usually through imaging such as pelvic ultrasound scan. The hysteroscopy is then performed to confirm the problem (diagnostic) and operated on (operative) at the same time. This is generally performed in the operating room under general anaesthesia.

Medication to help soften the cervix during the operation may be given in the inside cheek of the mouth just before the general anaesthesia. Under general anaesthesia, the operative area is cleaned. The procedure starts with having the cervix slightly dilated to open a pathway for the operative hysteroscope to enter the uterus. Sterile fluid is injected into the uterus for better visualisation. Surgical instruments are then passed through the hysteroscope to remove or treat the problem.

It is used to detect and treat the following:

  • Submucosal fibroids
  • Uterine polyps
  • Intrauterine adhesions
  • Septum resection

In women with pelvic pain suggestive of endometriosis or infertility, a gynaecologist can perform both hysteroscopy and laparoscopy together to identify any potential problems.

Endometrial Ablation

Endometrial ablation can also be performed together with a hysteroscopy. The process is a surgical treatment option for heavy periods, which removes the internal lining of the uterus. This lining is called the endometrium. The goal of this procedure is to minimise blood loss caused by periods. For some women, their periods may stop completely.

Prior to endometrial ablation, the gynaecologist performs a hysteroscopy. The endometrial cavity and lining is then inspected to make sure that the size and shape of the endometrial cavity is suitable for ablation. An endometrial biopsy is also taken to make sure there are no abnormal cells within the endometrium prior to ablation. The ablation is then performed either through first generation (such as rollerball) or second generation (such as NovaSure) methods. The methods and tools may vary depending on the size, shape and suitability to ablate the endometrium.


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