How to Prepare for a Hysteroscopy

Hysteroscopy provides a way for your healthcare provider to look inside your uterus. A hysteroscope is a thin, telescope-like instrument that is inserted into the uterus through the vagina and cervix. This tool often helps a healthcare provider diagnose or treat a uterine problem.

Hysteroscopy is minor surgery which is performed either in your healthcare provider's office or in a hospital setting. It can be performed with local, regional, or general anesthesia—sometimes no anesthesia is needed. There is little risk involved with this procedure for most women.

Uses

Hysteroscopy may be either diagnostic or operative.

Diagnostic hysteroscopy is used to diagnose some uterine abnormalities, and may also be used to confirm the results of other tests such as hysterosalpingography (HSG). Other instruments or techniques, such as dilation and curettage (D&C) and laparoscopy, are sometimes used in conjunction with the hysteroscopy.

Diagnostic hysteroscopy can be used to diagnose certain conditions such as abnormal uterine bleeding, infertility, repeated miscarriages, adhesions, fibroid tumors, polyps, or to locate displaced intrauterine devices (IUDs).

An operative hysteroscopy may be used, instead of open abdominal surgery, to both diagnose and treat certain conditions such as uterine adhesions, septums, or fibroids which depending on the location can sometimes be removed through the hysteroscope.

The hysteroscope is sometimes used with other instruments such as a resectoscope. A resectoscope can be used to remove submucosal firbroids. It can also be used to perform a procedure known as endometrial ablation, after which women can no longer have children, so it is not an option for women who wish to have future pregnancies.

Endometrial ablation is a procedure which destroys the lining of the uterus. The resectoscope is a telescope-like instrument with a wire loop, a rollerball, or a roller cylinder tip at the end. Electric current at the end of the tip is used to destroy the uterine lining. This procedure is usually performed in an outpatient setting.

When Should It Be Performed?

The best time for hysteroscopy is during the first week or so after your period. During this time your healthcare provider is best able to view the inside of the uterus.

Preparation

If you are having general anesthesia in the hospital, you will be told not to eat or drink anything for a certain period of time (usually after midnight the night before) before the procedure.

Routine lab tests may be ordered as well for women having a hysteroscopy in the hospital. You will be asked to empty your bladder and your vaginal area will be cleansed with an antiseptic. Sometimes a drug to help you relax is ordered. Next, you will be prepared for anesthesia:

• Local anesthesia: You will receive an injection of anesthetic around the cervix to numb it, with this type of anesthesia you remain awake and may feel some cramping.
• Regional anesthesia: A drug is injected, through a needle or tube in your lower back, that blocks the nerves that receive sensation from the pelvic region. You are awake with this type of anesthetic but feel no discomfort. Regional anesthesia is also called a spinal or epidural.
• General anesthesia: You will not be conscious during your hysteroscopy when general anesthesia is used. A mask over your mouth and nose allows you to breathe a mixture of gasses. Once you are under anesthesia, a tube may be inserted down your throat to help you breathe.

Your healthcare provider will determine which type of anesthesia is best for you based on the reason for your hysteroscopy. Remember to ask questions if anything is about your procedure or anesthesia is unclear.

During the Procedure

1. The opening of your cervix may need to be dilated or made wider with special instruments.
2. The hysteroscope is inserted through your vagina and cervix, and into your uterus.
3. Next, a liquid or gas is usually released through the hysteroscope to expand your uterus so your healthcare provider will have a better view of the inside.
4. A light source shone through the hysteroscope allows your healthcare provider to see the inside of the uterus and the openings of the fallopian tubes into the uterine cavity.
5. If surgery is required, small instruments are inserted through the hysteroscope.

Sometimes a laparoscope is used at the same time to view the outside of the uterus. When this happens, carbon dioxide is allowed to flow into the abdomen. The gas expands the abdomen so that the healthcare provider can see the organs easier. Most of the gas is removed at the end of the procedure. A laparoscopic procedure will likely be done in a hospital setting or an outpatient surgical center.

After the Procedure

Patients who received a local anesthetic can usually go home soon after the procedure. Those who had regional or general anesthesia require a longer observation period before they are released, but can usually go home on the same day.

Some patients may experience shoulder pain following laparoscopy or when gas is used to expand the uterus. Once the gas is absorbed the discomfort should subside quickly. You may feel faint or sick, or you may have slight vaginal bleeding and cramps for 1-2 days following the procedure.

Risks

Hysteroscopy is a fairly safe procedure. Problems that can occur happen in less than 1% of cases, but include:

• Injury to the cervix or uterus
• Infection
• Heavy bleeding
• Side effects from the anesthesia
• Fluid overload (when too much fluid is administered during the procedure)

Although general anesthesia is sometimes used, in the majority of cases it is not necessary. Hysteroscopy allows your healthcare provider to see inside your uterus and aids in the accurate diagnosis of some medical problems. The procedure and recovery time are usually short.