Pronounced: His-ter-OSS-co-peeEn Español (Spanish Version)
Hysteroscopy is the use of a hysteroscope to view the inside of a woman’s uterus. A hysteroscope is a thin lighted viewing tube. This tube can be outfitted with miniature surgical tools. Hysteroscopy is done to explore the uterus (diagnostic). It is also conducted to surgically repair damage and remove disease (operative/therapeutic).
Parts of the Body Involved
Three female reproductive organs are involved in a hysteroscopy.
- Vagina (birth canal)—elastic canal that leads to the cervix. Hysteroscope passes through the vagina on the way to the cervix.
- Uterine cervix—neck-like structure that connects the vagina and uterus. Dilation is often needed to widen the structure so a hysteroscope can pass through.
- Uterus (womb)—muscular cavity in the pelvis that houses a baby while it develops. This organ is examined by the hysteroscope, passed through the vagina into the cervix (‘mouth’ of the womb).
Female Reproductive Organs
© 2008 Nucleus Medical Art, Inc.
Reasons for Procedure
Hysteroscopies are conducted for both diagnostic and therapeutic reasons. A diagnostic hysteroscopy allows the doctors to survey the inner uterus to identify potential problems or abnormalities. An operative/therapeutic hysteroscopy is done to correct anatomic problems and defects in the uterus.
Some reasons a doctor may recommend a hysteroscopy:
Operative / Therapeutic
- Endometrial ablation—removal of uterine lining from the uterus
- Myomectomy—removal of fibrous or muscular tissue (fibroids)
- Removal of polyps (tumors, usually noncancerous)
- Locate and retrieve intrauterine devices (IUDs)
Risk Factors for Complications During the Procedure
The following factors may increase your risk of complications:
- History of pelvic inflammatory disease
- Vaginal discharge
- Inflammation of the cervix
- Distended bladder
- Pregnancy or possible pregnancy
- Allergies to surgical materials (eg, iodine, latex, medications, anesthetics)
What to Expect
Prior to Procedure
Your doctor will likely do the following:
- Explain the procedure
- Ask about medical history, medications, and allergies
- Conduct a physical exam and take blood work
- Allow you to ask questions (You may wish to ask how often he or she has performed hysteroscopies, as experience decreases risk of complications.)
In the days leading up to your procedure:
- Arrange to have someone drive you home, and help with daily tasks.
- Follow instructions given by your doctor.
- Stop/start medications as directed.
The day before your procedure:
- Have a light dinner.
- Do not eat or drink anything after midnight, or the morning of the procedure (including coffee, tea, water, and juice) unless directed otherwise.
The day of the procedure:
- Wear comfortable clothes.
- Bring a sanitary napkin to catch any postprocedure fluids.
- The staff will ask you to use the bathroom.
- Anesthesia will be administered after you have been made comfortable.
Anesthesia numbs the body temporarily. Pain and discomfort are not felt. There are three anesthesia options for hysteroscopy. Your doctor will help you to decide which is best for your procedure and needs. In certain instances you may opt not to have an anesthetic.
- Used for diagnostic hysteroscopy
- Can be applied like a lotion or injected
- Loss of feeling only to the area where the anesthetic is applied
- You are awake
- Used for either diagnostic or operative/therapeutic procedure
- Anesthetic is injected
- Regional loss of feeling (similar to the injection given to numb the pelvic region during childbirth)
- You are awake
- Used for operative/therapeutic hysteroscopy
- Medication is given intravenously (IV)
- Entire body is numbed
- You will be asleep
Description of the Procedure
The doctor will clean the vagina and may dilate (gradually open) the cervix. Cervical dilatation is done to facilitate passage of the hysteroscope into the uterus. The hysteroscope is then fed into the uterus, and the uterus is filled with carbon dioxide gas or a liquid. Filling the uterus causes it to inflate like a balloon, allowing the doctor to get a closer look at its walls. Also, the pressure put on the walls reduces bleeding. The remainder of the procedure depends on the purpose of having the hysteroscopy.
The doctor will examine the uterus for abnormal looking tissue. A biopsy (tissue sample) may be taken, or the uterine walls may be swabbed to gather cell samples. The gathered samples will then be sent to a lab for testing.
Miniature tools are inserted through the hysteroscope. The doctor uses the tools to remove diseased tissue and make repairs. Depending on the procedure, a laparoscope (another type of viewing tube) may be needed to help the doctor monitor the outside of the uterus and detect any possible perforation of the uterus. This tube is inserted through a small cut in the abdomen. Using a laparoscope with the hysteroscope allows the doctor to view the outside and inside of the uterus at the same time.
The doctor may prescribe pain relievers and limit some activities. Also, the following may be experienced:
- Sleepiness (from the anesthetic)
- Difficulty using the bathroom for a few hours following the procedure
- Watery or bloody vaginal discharge for 3-4 weeks
Note: Do not take medications without your doctor’s approval. Some medicines may make bleeding worse. Notify your doctor if you experience a great deal of bleeding or abdominal pain.
How Long Will It Take?
The length of the operation depends on the degree of difficulty. It could take anywhere from 15-45 minutes or more.
Will It Hurt?
Hysteroscopy should not hurt since the anesthesia numbs and relaxes the body. Let your doctor know if you do experience pain during the procedure. After the procedure, pain relievers can be prescribed for mild cramping and soreness.
Complications are more likely to occur during an operative/therapeutic hysteroscopy than diagnostic hysteroscopy.
- Edema—organ swelling that is caused by the excessive absorption of the uterine inflation fluid. Finding a doctor that is experienced with hysteroscopy can reduce risk of edema. The shorter the procedure, the less time organs have to absorb the liquid and swell. If there has been excessive over-absorption of fluid, this can be dangerous More commonly, the fluid is absorbed by the body and passed by urination.
- Allergic reaction—substance used to inflate the uterus, materials used during surgery, and anesthetic can cause an allergic reaction. To reduce your risk, tell your doctor about your allergies.
- Infection—bacterial infection may result from irritating or injuring the uterus. It may also be a result of an existing condition that makes a person more susceptible (eg, pelvic inflammatory disease). Antibiotics may be prescribed prior to surgery for individuals at risk for infection or post-operatively for infections as they arise.
- Organ injury—the bladder and bowel may be injured as a result of the procedure. The uterus may also be punctured and require additional surgery to repair. This injury is very rare. Risk is reduced by the skill of the doctor. However, some injuries may be difficult to avoid depending on the condition.
Average Hospital Stay
Most hospital stays are 1-2 hours. Certain operative/therapeutic hysteroscopies require an overnight hospital stay.
Recovery time is minimal. Daily routines can usually be resumed the day after the procedure. Some individuals may need extra rest and help to perform tasks. Your doctor will give you instructions, and let you know if a follow-up appointment is needed.
Some side effects of anesthesia may be experienced (eg, coughing, chest pain, nausea, and vomiting).
The end result of the hysteroscopy depends on the reason for the procedure and the skill of the doctor. Certain conditions may be rectified immediately, while others (eg, removal of a uterine cancer detected by hysteroscopy) may need further exploration and surgery. More knowledgeable and skilled doctors are more successful at performing a smooth hysteroscopy.
Call Your Doctor If Any of the Following Occurs
It is important for you to monitor your recovery once you leave the hospital. That way, you can alert your doctor to any problems immediately. If any of the following occur, call your doctor:
- Abnormal bleeding (like during a menstrual period)
- Fever develops (greater than 100°F)
- Pain develops in the lower abdomen
- Side effects of anesthesia develop (eg, cough, chest pain, severe nausea, vomiting, shortness of breath)
The American College of Obstetricians and Gynecologists
The Society of Obstetricians and Gynaecologists of Canada (SOGC)
Women's Health Matters
Diagnostic hysteroscopy for abnormal bleeding of the uterus. Health Source–Consumer Edition website. Available at: http://web28.epnet.com . Accessed August 22, 2005.
Gynecologic evaluation. The Merck Manual of Medical Information, Second Home Edition Online website. Available at: http://www.merck.com/mmhe/sec22/ch242/ch242c.html?qt=hysteroscopy&alt=sh#sec22-ch242-ch242c-124 . Accessed August 22, 2005.
Hysteroscopy. St. John’s Mercy Health Care website. Available at: http://www.stjohnsmercy.org/healthinfo/test/gyn/TP117.asp . Accessed August 22, 2005.
Julian T. Hysteroscopic complications. Journal of Lower Genital Tract Disease . 2002;6: 39-47.
Reproductive endocrinology and infertility. Duke University Medical Center website. Available at: http://www2.mc.duke.edu/depts/obgyn/ivf/hysteros.htm . Accessed August 22, 2005.
Last reviewed March 2008 by Ganson Purcell Jr., MD, FACOG, FACPE
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
Copyright © 2011 EBSCO Publishing All rights reserved.