Hysteroscopy

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 containing a video camera 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, removal of adhesions or scar tissue, or preventing bleeding with cautery (destruction of tissue by electric current, freezing, heat, or chemicals) may be performed during a hysteroscopy procedure (also see Endometrial Ablation).

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.

What is a diagnostic hysteroscopy?
A diagnostic hysteroscopy is a procedure typically done in the office to evaluate the uterine cavity (lining of the uterus). A very thin, lighted flexible tube containing a video camera called a hysteroscope is inserted through the cervix and into the uterus.  The hysteroscope is introduced through the vagina. The uterus is filled with fluid so the uterine cavity can be visualized. 

This procedure is typically done in the office and takes only a few minutes. Patients can experience some cramping during the procedure. Taking ibuprofen before the procedure can help reduce the cramping. Usually once the procedure is done, the cramping goes away. 

What is an operative hysteroscopy?
An operative hysteroscopy can be done on the office or in the operating room with anesthesia.  A thin, stiff tube containing a video camera is inserted through the vagina into the cervix and uterus. 

Operative hysteroscopy can be used to treat some fibroids, endometrial polyps, adhesions (scar tissue), a uterine septum, or retained tissue from a prior pregnancy. Endometrial ablation can also be performed through an operative hysteroscopy.  Depending on the particular situation, an operative hysteroscopy can be performed in the office or in the operating room with anesthesia. 

What are the reasons for a hysteroscopy?
Hysteroscopy may be performed in women who have abnormal 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).

Therapeutically, hysteroscopy may be used to help correct uterine problems. For example, some fibroids, polyps, uterine septums or adhesions may be removed through the hysteroscope, often eliminating the need for more invasive surgery. Endometrial biopsy or ablation (removal of the endometrial lining) may be performed via hysteroscopy.

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

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