01753 314204 MENU

Common Procedures

Hysteroscopy


Hysteroscopy is a very fine telescope that is introduced through the cervix (neck of the womb). This allows the gynaecologist to see inside the uterus (womb), an examination called a hysteroscopy.


Services

Why is it being performed?

This operation is performed to diagnose or treat:

  • Abnormal uterine bleeding; either irregular in pattern, bleeding occurring after the menopause or unscheduled bleeding whilst taking HRT
  • Heavy/Irregular/Painful periods
  • To remove lesions such as polyps and fibroids
  • To remove lost coils and/or insert new ones
  • In cases of recurrent miscarriage
  • As part of a fertility assessment

What preparations should be made?

Usually a hysteroscopy is done as a day case. If Miss Husain anticipates any possible difficulty with the anaesthetic, she will suggest that you have an overnight stay. You will not need more than a couple of days off work. Miss Husain must be told if you are on any regular medication, have any known allergies and had any problems with anaesthesia in the past. If you are using the oral contraceptive pill, please continue with this.

Please ensure that you do NOT have unprotected intercourse in the cycle that you are scheduled for the procedure.

If you suspect that you may be pregnant, please inform the staff on arrival to the ward.

What happens during the operation?

The operation is done through the vagina and leaves no scarring. Once in the operating theatre your legs will be placed in stirrups (called the lithotomy position) to allow the procedure to be carried out.

A speculum is inserted in the vagina so the cervix can be seen clearly. The cervix is then stretched with a small instrument called a dilator. The hysteroscope is then inserted through the cervix and the cavity of the uterus is then stretched open using fluid (usually saline) so that its shape and appearance can be examined. A sample of tissue is taken from the endometrium (lining of the womb) for examination under a microscope. This involves scraping the lining gently using an instrument known as a curette. Any polyps protruding from the endometrium can also be removed (polypectomy).

Polyps with a wide base or fibroids can also be removed (resection), if they protrude into the cavity of the uterus, using a special hysteroscope, called a resectoscope.

Resection can also be used to cut away a septum, which is like a wall of tissue down the middle of the womb which can be associated with recurrent miscarriage.

What are the possible complications?

Hysteroscopy is a very safe operation, but every operation carried a small risk:

  • Pelvic infection of the womb and tubes can happen after a hysteroscopy. You may experience pain, fever or offensive vaginal discharge and this can be treated with antibiotic. It is uncommon however.
  • Uterine perforation is uncommon and occurs in less than 1% of cases. This is when the dilator or other instrument is pushed through the wall of the womb (perforated uterus). This sounds very alarming but most of the time, the uterus heals itself.
  • However, this may result in a laparoscopy (insertion of a telescope through your umbilicus) or laparotomy (an incision along the bikini line to directly see the uterus) to repair any damage. After a laparotomy, you would need to stay 1 or 2 night in hospital. Both a laparoscopy and laparotomy have a longer recovery.
  • Rarely, the bowel, bladder or blood vessel may be damaged
  • Excessive bleeding, although very rare, would require a blood transfusion
  • Unexpected problems and reactions can arise with anaesthesia.
  • Deep Vein Thrombosis (DVT) or clotting of the blood in the leg which passes to the lungs (pulmonary embolism) can occur after any surgery, but this is rare.
  • Failure to visualise the uterine cavity, this can sometimes happen if the cervix is very tight and cannot be dilated.
  • Perforation risk is slightly higher when a resection is performed but still less than 2%.

Before the operation you must NOT eat any food (including sweets and gums) for 6 hours before your operation. You are allowed to drink clear fluids (water) up to 4 hours before your operation.

Post procedure - What to expect and what needs to be done?

There are very few problems after a hysteroscopy and endometrial biopsy as it is such a short operation. A period- like pain may be experienced for a day or two. Some bleeding and vaginal discharge can last up to 10 days. It is advisable NOT to use tampons during this time.

For period-like cramps, a mild painkiller such as Paracetamol or Ibuprofen should suffice. Return to normal activities is usually after 48 hours. Unless Miss Husain advises otherwise, sexual activity can resume when you’re ready. You may bath and shower as usual.

Miss Husain will tell you about your operation and what was found before you are discharged. If a biopsy has been taken it may take 2 weeks for the results to become available. Miss Husain will review the results and discuss this with you at your follow up appointment.

It is advisable NOT to drive for 48 hours post procedure as your concentration may be impaired.

When should you contact the ward or your doctor?

Please inform Miss Husain via her secretary if you feel any of the following symptoms:

Phone
  • You have a fever for more than a day that does not seem to be settling
  • Your pain is not relieved by the pain medication that you have been given
  • You have chest pain, coughing or shortness of breath
  • You feel faint or dizzy
  • You have heavy vaginal bleeding or moderate bleeding that lasts for more than three days
  • If you have persistent bleeding from the wound.