Hysteroscopy: A Closer Look

Jordan Nacalaban, BSN, RN

When it comes to women's health, there are several reasons why aches, unexplained symptoms, and changes in the body can affect your daily living.

Searching for answers to these ailments and reproductive concerns leads women to see a healthcare provider for diagnosis and solutions. One procedure that can shed light on your reproductive health is hysteroscopy.

What is Hysteroscopy?

Hysteroscopy is a minimally invasive procedure to examine the uterus and cervix using a flexible, thin, lighted tube called the hysteroscope.

Types of Hysteroscopy

Diagnostic hysteroscopy - to diagnose or investigate the cause of your reproductive health concerns.
Operative hysteroscopy - to treat or correct reproductive health conditions seen during a diagnostic hysteroscopy. With operative hysteroscopy, the procedure is usually done in a hospital.

Reasons you are getting a Hysteroscopy.

Hysteroscopy will help your healthcare provider evaluate your current health and help recommend the best treatment for you.

Your healthcare provider may recommend a hysteroscopy for:

Abnormal bleeding: long or heavy periods, bleeding between periods
Postmenopausal bleeding
Abnormal endometrial thickening
Abnormal Pap Test
Infertility
Repeated miscarriage
Locate an Intrauterine Device (IUD)
Congenital Mullerian anomalies: half-shaped uterus, a woman without a uterus, two cervixes, and other anomalies
Suspicious Intrauterine lesions: cancer screening
Perform sterilization: to place a small implant inside the fallopian tubes
Removal of uterine fibroids, polyps, or adhesions from previous surgery

It is also possible that other reasons for which your healthcare provider will perform a hysteroscopy are for you to discuss together.

Who performs hysteroscopy and where?

An Obstetrician-Gynecologist will perform a hysteroscopy. This procedure can be done in an in-clinic setting or at the hospital. It will be scheduled when you are not bleeding in your cycle.

How is it done?

Your healthcare provider will administer a sedative or anesthetic before the procedure begins. The anesthetics can be local, regional, or general, depending on your case. The healthcare staff may insert an intravenous line (IV) to give the medications needed during the procedure if using general anesthetics.

Once you are prepared for the procedure and medicated, the healthcare provider uses a speculum inserted into the lady parts to hold it open. Next, your healthcare provider may apply numbing medicine to the cervix. A dilator may also be used to widen the cervix; in most cases, dilation is not needed.

Then the hysteroscope will pass through the lady parts and cervix into the uterus. There will be a camera built-in in the scope. In addition, there are other attachment parts to a hysteroscope that will remove growths or tissue samples for a biopsy.

During the hysteroscopy, your healthcare provider will inject gas (carbon dioxide) or fluids into the uterine space to help visualize the area easily.

Risks and Potential Complications of Having a Hysteroscopy

With any surgery comes risks that may include:

Bleeding
Infection
Scarring of the uterus
Tearing of the uterine wall - perforation of the uterus
Excessive fluid
Damage to the cervix
Anesthesia problems

Contraindications to having hysteroscopy:

Not everyone can undergo a hysteroscopy. For example, pregnant people, confirmed uterine cancer/cervical cancer, pelvic infection, moderate-heavy bleeding, and active genital herpes.

How do you prepare for your hysteroscopy?

Your healthcare provider will check your past medical and surgical history. Tell your healthcare provider of any new health changes or new symptoms. Review all the medicines you take at home and review your allergies (medications, latex, iodine, etc.). Blood work may be part of the pre-procedure, but not all the time.

Your healthcare provider will explain the hysteroscopy procedure days ahead of your scheduled procedure.

Thus, communicate any questions and concerns regarding the procedure to your healthcare provider. Also, be prepared with your questions regarding anesthetic or medication use and recovery instructions.

You will need to fill out and sign a hysteroscopy consent.

Your healthcare provider may instruct you not to eat or drink the night before the hysteroscopy. In addition, you may be asked not to have sex or use douche and not use any lady partsl cream.

You may also be offered pain or calming medication an hour before the procedure.

What can you expect after a hysteroscopy?

Diagnostic procedures can be short, and you may be able to go home shortly after. However, if a general anesthetic was used during the procedure, you might be asked to wait until the effects of the medicine wear off.

If your case is complex and you need to stay overnight in the hospital, your healthcare provider will let you know and explain the necessity of your stay.

It's essential to make sure someone can drive you home after the procedure.

Mild cramping and minor spotting/bleeding are normal after hysteroscopy. Your healthcare provider may prescribe you with pain reliever.

You also may feel bloated or experience gas pains on your shoulder or upper abdomen. These are the common symptoms you may experience after the procedure.

Your healthcare provider will likely clear you to return to normal activities 24-48 hours after the procedure.

Until your healthcare provider clears you, don't have sex, use lady partsl creams, tampons, or douche.

Arrange a follow-up appointment with your healthcare provider to discuss the findings.

If by any chance you develop:

fever
chills
foul lady partsl discharge
unrelieved severe abdominal pain
fluid overload (increased swelling, shortness of breath, or significantly high blood pressure readings)
experiencing heavy bleeding

You need to call your healthcare provider immediately or seek medical attention.

Summary:

Now you know what a hysteroscopy entails when your healthcare provider recommends it.

A hysteroscopy may help assess your reproductive health to determine your current condition, assist with diagnosis, and help guide care plans and treatment options.

First, it's essential to understand a procedure you're about to have. Why you need one, the risks and potential complications, and what to expect before and after a hysteroscopy.

Second, be ready to have an open discussion with your healthcare provider, and that includes answering your questions.

Then, work together to develop a health plan that suits you and your healthcare needs.

References

Abnormal Menstruation (Periods) | Cleveland Clinic

Auguste, T., 2020. Bleeding After Menopause Could Be A Problem. Here's What To Know. [online] Acog.org. Retrieved January 25, 2022

Moore, J. and Carugno, J., 2022. Hysteroscopy. [online] Ncbi.nlm.nih.gov. Retrieved January 25, 2022

Santana González, L., Artibani, M., & Ahmed, A. A. 2021. Studying Müllerian duct anomalies - from cataloging phenotypes to discovering causation.

Wilson, E. (2019, March 27). Müllerian anomalies: How to spot and treat an irregularly shaped or missing uterus or cervix | Prevention | Women's Health | UT Southwestern Medical Center. Utswmed.Org.

Uterine fibroids | Office on Women's Health. (n.d.). Womenshealth.Gov.

Hysteroscopy. (2018, October). ACOG.Org.

Hysteroscopy. Hopkinsmedicine.org. (n.d.).