Hysteroscopy

Hysteroscopy is a minimally invasive gynaecological procedure used to examine the inside of the uterus with a thin, lighted instrument called a hysteroscope. It allows a gynaecologist to directly view the uterine cavity and, when required, take a tissue sample or treat certain problems during the same procedure.

Doctors may recommend hysteroscopy when symptoms, an ultrasound scan or fertility evaluation suggests a problem inside the uterus. It can be used to investigate abnormal uterine bleeding, heavy periods, bleeding after menopause, uterine polyps, certain fibroids, scar tissue and other abnormalities affecting the uterine cavity.

What Is a Hysteroscopy Procedure?

During a hysteroscopy, a narrow hysteroscope with a small camera is gently passed through the vagina and cervix into the uterus. Sterile fluid is introduced into the uterine cavity to improve visibility, allowing the doctor to examine the uterine lining and identify abnormalities.

Depending on the reason for the procedure, the doctor may perform a diagnostic hysteroscopy to examine the uterus, or an operative hysteroscopy to carry out treatment. A biopsy may also be taken for laboratory examination.

Why Is Hysteroscopy Done?

A doctor may recommend hysteroscopy to investigate or treat:

• Heavy or abnormal menstrual bleeding
• Bleeding between periods
• Bleeding after menopause
• Endometrial polyps
• Certain submucosal fibroids
• Thickening or abnormalities of the uterine lining
• Uterine scar tissue or adhesions
• Some abnormalities identified during ultrasound or other investigations
• Problems related to infertility or recurrent pregnancy loss
• Removal of a displaced intrauterine contraceptive device when its threads cannot be located

Hysteroscopy can be particularly useful when a problem is suspected within the uterine cavity and direct visual assessment is needed.

Diagnostic Hysteroscopy

Diagnostic hysteroscopy is primarily performed to look inside the uterus and identify abnormalities. It may be recommended when symptoms or imaging tests do not provide enough information about the uterine cavity.

If an abnormal area is identified, a doctor may take a biopsy or, depending on the circumstances, proceed with treatment. Hysteroscopy is considered a definitive method for diagnosing and treating many intrauterine conditions.

Operative Hysteroscopy

An operative hysteroscopy combines examination with treatment. Special instruments can be passed through the hysteroscope to remove selected uterine polyps, treat suitable submucosal fibroids or address certain forms of scar tissue.

The exact treatment depends on the size, location and nature of the abnormality, as well as the patient's symptoms and overall health. Tissue removed during the procedure may be sent to a laboratory for examination.

Hysteroscopy and Infertility

Hysteroscopy may form part of an infertility evaluation when a uterine cavity abnormality is suspected. Conditions such as endometrial polyps, submucosal fibroids and intrauterine adhesions can affect the uterine cavity and may require further assessment.

For patients undergoing fertility treatment, the decision to perform hysteroscopy should be based on the individual's medical history, examination and other test results. Hysteroscopy can diagnose and treat certain intrauterine abnormalities, but it is not a treatment for every cause of infertility.

How to Prepare for Hysteroscopy

Preparation depends on whether the hysteroscopy is being performed as an outpatient procedure or with sedation or general anaesthesia.

Before the procedure, your healthcare team may discuss:

• Your symptoms and medical history
• Current medicines and relevant medical conditions
• The reason for the hysteroscopy
• Pain-relief or anaesthesia options
• Pregnancy status
• Whether a biopsy or treatment may be performed during the procedure

A hysteroscopy should not be performed if pregnancy is possible, so patients should follow their healthcare provider's instructions regarding contraception and pregnancy testing.

Is Hysteroscopy Painful?

The level of discomfort varies from person to person. Some patients experience period-like cramps or discomfort during or after the procedure. Pain-relief options can vary depending on the type of hysteroscopy and the healthcare setting.

Patients who have previously experienced painful pelvic examinations or who are concerned about discomfort should discuss their concerns and available pain-management options with their healthcare provider before the procedure.

Hysteroscopy Recovery

Recovery depends on the type of hysteroscopy and whether treatment or anaesthesia was involved. After an outpatient procedure, many patients can return to normal activities later the same day or the following day, depending on how they feel and their doctor's advice.

Mild cramping and vaginal bleeding or spotting can occur after hysteroscopy. These symptoms generally settle as recovery progresses. Patients should follow their healthcare provider's instructions regarding exercise, sexual activity, bathing and other activities.

Risks and Possible Complications

Hysteroscopy is generally considered a safe procedure, but complications can occur. Possible risks include infection, heavier vaginal bleeding, injury to the cervix or uterus, and uterine perforation. In some cases, the procedure may need to be stopped or repeated if the uterine cavity cannot be adequately visualised.

Patients should seek medical advice if they develop heavy or worsening bleeding, severe abdominal or pelvic pain, fever, or foul-smelling vaginal discharge after the procedure, as these may indicate a complication requiring assessment.

When Should You Consult a Gynaecologist?

If you have persistent abnormal bleeding, unusually heavy periods, bleeding after menopause, unexplained fertility problems, or an abnormality detected during an ultrasound examination, a gynaecologist can determine whether hysteroscopy is appropriate.

The decision to undergo hysteroscopy should be based on your symptoms, examination findings, previous investigations and individual treatment needs. A specialist can also explain alternative diagnostic or treatment options where appropriate.

Frequently Asked Questions About Hysteroscopy

What is hysteroscopy used for?

Hysteroscopy is used to examine the inside of the uterus and can help diagnose or treat conditions such as abnormal uterine bleeding, endometrial polyps, selected fibroids and intrauterine abnormalities.

How long does a hysteroscopy take?

The duration varies according to the type of procedure and whether a biopsy or treatment is performed. Some diagnostic hysteroscopies may take around 10 to 15 minutes, while procedures involving treatment can take longer.

Can hysteroscopy remove polyps?

Yes. When appropriate, polyps inside the uterine cavity can be removed during an operative hysteroscopy. The removed tissue may be sent to a laboratory for examination.

Can hysteroscopy treat fibroids?

Hysteroscopic treatment can be used for selected fibroids that project into the uterine cavity, particularly submucosal fibroids. Suitability depends on the fibroid's size, location and other clinical factors.

Is hysteroscopy used for infertility?

It can be used when a uterine cavity abnormality is suspected during an infertility evaluation. However, not every infertility problem requires hysteroscopy, and the appropriate investigation depends on the individual patient.

How long does it take to recover from hysteroscopy?

Recovery varies depending on whether the procedure was diagnostic or operative and whether anaesthesia was used. Mild cramps and bleeding or spotting may occur for several days. Your healthcare provider will advise when you can resume normal activities.

Is hysteroscopy better than an ultrasound?

They serve different purposes. Ultrasound is commonly used to assess the uterus and surrounding pelvic structures, while hysteroscopy provides direct visual assessment of the inside of the uterine cavity and can also allow biopsy or treatment during the procedure. Your doctor will recommend the most appropriate investigation based on your symptoms and clinical findings.