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Houston Fertility Journal

What is A Hysteroscopy?

[fa icon="calendar"] Sep 27, 2017 8:00:00 AM / by Center of Reproductive Medicine   

Center of Reproductive Medicine

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Maybe you just heard of a friend undergoing a surgery called hysteroscopy, or you have been told that this is something that you require yourself. The idea of this procedure can seem intimidating to women at first, but in truth, it is a minimally invasive surgery.

It is called a hysteroscopy because the surgery uses a hysteroscope, a tiny telescope, inserting it through the cervix and into the uterus. This is done so that the uterine cavity can be inspected for any existing abnormalities. To do so, the surgeon will look at the shape of the uterus and determine whether there is any sign of intrauterine pathology (fibroids or polyps).

This procedure is normally done because the patient has experienced a certain set of symptoms that the doctor chooses to examine in order to eliminate the possibility of any great risks to their patients health or suspect for a need for surgery. Read further for more details on hysteroscopy and what you should do and expect if you are planning on going through it yourself.

Why is a Hysteroscopy Performed?

A person will undergo a hysteroscopy if:

  • they experience cramping or abdominal bleeding - the doctor can pass heated tools through the hysteroscope in order to stop the bleeding
  • they are looking for a problem in the shape or size of the uterus or if the area in the uterus could be causing infertility
  • there is a need to examine the uterine openings to the fallopian tubes. The tubes could be blocked -- and if so, the doctor might be able to open the tubes with certain tools that can pass through the hysteroscope
  • there is a need to look for possible reasons for recurrent miscarriages
  • there is a need to extract a misplaced intrauterine device
  • there is a need to discover and extract small fibroids or polyps
  • there is a need to remove problem areas along the lining of the uterus by use of heated tools
  • there is a need to implant a contraceptive into the fallopian tubes to cause permanent sterilization

Hysteroscopy-Hurt-blog-img.pngWill a Hysteroscopy Hurt?

During a hysteroscopy you may experience some discomfort relatable to the discomfort of period cramps. If you are awake, most people don’t feel any pain or discomfort, just some minimal cramping. Some women do experience pain, and at that time the procedure must be stopped.

There are certain things that can determine the level of discomfort, such as:

  • if an anesthesia is used
  • which type of anesthesia is used
  • how large the hysteroscope is, the thinner ones aren’t as painful
  • if the hysteroscope is flexible or rigid
  • if a speculum is used
  • why you are in need of the hysteroscopy
  • if you have given birth before
  • if you have gone through menopause or not

All of these factors can be discussed with your doctor before the procedure is planned and takes place. Make sure to ask your physician about the conditions and options available to you if you are worried about the possibility of pain.

How to Prepare for a Hysteroscopy

When it comes to preparation for a hysteroscopy, your doctor should be able to give you guidance. If you have the option to use a local anesthesia, preparation is usually unnecessary. A general anesthesia will usually require you to not eat or drink for a certain number of hours before the procedure. Some doctors may also advise you to:

  • have tests to make sure it is safe for you to have the procedure (such as blood or pregnancy tests) which could be done by appointment about a week before your hysteroscopy
  • use contraception if you are planning on having this procedure, as a hysteroscopy cannot be done if you are pregnant
  • refrain from smoking, as stopping smoking can reduce your risk of complications from the anesthetic
  • if you already are aware of fibroids before the procedure, you may be given medicine to help shrink them before the hysteroscopy is done

Choosing An Anesthetic

Usually hysteroscopies aren’t done using an anesthetic. The procedure goes by quickly and no incisions or cuts into the skin are involved. As the procedure is not usually painful, any discomfort can be prevented by taking an ibuprofen or paracetamol about an hour beforehand.

Still, at times an anesthetic may be used to numb the cervix during the procedure. If the removal of fibroids is involved, this usually requires the use of a general anesthetic. If this is the case, you will absolutely be asleep during the procedure.

Hysteroscopy-procedure-blog-img.pngA Hysteroscopy Procedure

The actual hysteroscopy procedure takes anywhere between 5 and 30 minutes. The procedure will usually occur in the following fashion:

  • you will start by lying down with your legs in supports and your lower half covered by a sheet
  • an instrument called a speculum will then be inserted into your vagina to keep it held open
  • the vagina and cervix will then be cleaned with an antiseptic solution
  • a hysteroscope (which is a long, thin tube that has equipped with a light and camera) is inserted into your womb -- this is where you may experience some cramping as the hysteroscope passes through the cervix
  • fluid will then be pumped into the cervix so the doctor can see inside
  • the camera on the hysteroscope will send pictures to a monitor in order to help your doctor or nurse identify any abnormalities
  • sometimes a small sample of tissue will be evaluated from the womb for further testing (known as an endometrial biopsy)

Other Procedures that can be Performed

Often gynecologists will use a hysteroscope to examine the lining of the uterus in order to look for intrauterine pathogens that may be causing irregularities or menstrual bleeding. This assessment may also be performed if a woman is having difficulty becoming pregnant.

Procedures that may be performed during a hysteroscope include:

  • the removal of endometrial or cervical polyps
  • the removal of fibroids
  • a biopsy of the endometrial lining
  • the opening of the fallopian tubes
  • the removal of scarring on the uterus
  • the removal of an IUD
  • endometrial ablation (destruction of the uterus lining)

Risks & Complications that accompany a Hysteroscopy

Complications during or after a hysteroscopy are uncommon. The most common complication is the accidental perforation of the uterus. Other rare possibilities for complications include:

  • bleeding
  • infection
  • damage to the urinary or digestive tract
  • medical complications that result from reactions to the anesthetic being used
  • fluid overload or gas embolism (gas bubbles) entering the bloodstream due to the liquid being injected and distending the uterine cavity during the procedure

What to Expect During a Hysteroscopy

A number of minor surgical procedures can be done using hysteroscopy. It is, overall, an extremely valuable diagnostic tool. The prognosis can only depend on the individual woman and her underlying condition or reason for undergoing the hysteroscopy. The recovery usually is quick, with only minor cramping and minimal bleeding following the procedure.

The Cost of a Hysteroscopy

The cost of a hysteroscopy is dependent on how extensive the procedure is. The procedure can range anywhere from being simply diagnostic to one that requires surgery. the cost can go up if the procedure requires a surgery in a hospital and general anesthesia.

Extensive procedures can actually be raised up to $7,000. There are rare health insurance plans that with cover a hysteroscopy if it is considered medically necessary. This average varies by policy.

Hysteroscopy-your-doctor-blog-img.jpgYour Doctor

When in search for a doctor who will perform this procedure for you, make sure to ask them these questions:

  • how many surgical procedures do they performance each month?
  • how many hysteroscopies do they perform each month?
  • how many of those procedures are involving a woman that has issues similar to yours?
  • how many of the surgeries resulted in complications and what kind of complications were they?

If you have fibroids that must be removed, ask your doctor:

  • How will you remove the fibroids? The two surgical treatments for removing fibroids are myomectomy (removes just the fibroids) and hysterectomy (removes the uterus and the fibroids).
  • Are you trained in such minimally invasive procedures? OB/GYNS are usually highly trained and trusted doctors, but you should be sure that you are getting treatment from a surgeon who has received comprehensive training and performs many minimally invasive surgeries to remove fibroids each year.
  • Do you perform robotic myomectomy procedures? Some medical societies have discouraged robotic techniques due to higher costs to patrons without medical advantages, still robots are used in surgeries.
  • Why is morcellation used? Morcellators are still used because they enable many doctors to perform robotic or other normally invasive GYN procedures. It grinds up the tissue so that the surgeon can remove it with smaller incisions.

Post Surgical Questions For Your Doctor:

  • when will I know if the operation has been successful?
  • how or when I find out if any scarring has occurred?
  • when can we start trying to conceive again?
  • what tests should I undergo to find out if my tubes are open or if there is damage to my tubes or ovaries?
  • should I have a 3d ultrasound scan to check for scarring?
  • how soon can I have intercourse with my partner?
  • how can I tell if I developed an infection from the procedure?
  • when can I start IVF (if interested)
  • what are my chances of conception with IVF?

Do you have additional questions about this procedure? Schedule an appointment today with one of our infertility specialists and let's see how we can help.

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Topics: Health, Hysteroscopy

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