HYSTEROSCOPY

What is a hysteroscopy?

Hysteroscopy is a procedure that is done to look and treat abnormalities inside the uterine cavity. A thin telescope, called a hysteroscope, is inserted into the uterus through the vagina and cervix. Fluid is inserted into the uterine cavity to open up the cavity to allow your doctor to see inside. There are no cuts in the vagina or on the abdomen.

Why is a hysteroscopy done?

There are many uses of hysteroscopy. You might have this procedure if you have:

• Infertility

• Abnormal uterine bleeding

• Polyps

• Fibroids

 
My doctor says I need a hysteroscopy. What should I expect?

A hysteroscopy is a common procedure. You will be able to go home the same day. You should arrange for someone to pick you up from the hospital.

• There are different options to control your pain during surgery. You should talk to the anesthetist (the pain doctor) to help decide which is best for you. You can have a general anesthetic where you would be asleep the entire surgery. Another option is a regional anesthetic, like a spinal anesthetic. This is where pain medication is inserted through a needle in your back. You will be awake but the medication will numb the region where you have your surgery.

• Your legs will then be placed into leg holders.

• A speculum is then inserted into the vagina to let your doctor see your cervix.

• Your cervix is then dilated to 5-10mm.

•  The hysteroscope is then inserted through the cervix into your uterus.

•  Fluid is then used to open up the uterine cavity to allow your doctor to see and perform the surgery.

•  Sometimes there might be bleeding from the cervix and a small, dissolvable stitch may be placed to stop the bleeding.

Who will be involved in my surgery?

On the day of surgery, you will meet the surgical team. This will include:

• Your doctor

• Surgical assistants: these are usually trainees supervised by your doctor. They can include:

  • Fellows (doctors who are licensed obstetricians and gynecologists and are doing extra training to perform minimally invasive surgery)

  • Residents (doctors who are training to become obstetricians and gynecologists)

  • Medical students (these are students learning to become doctors)

• Nurses

• Anesthesiologist (doctors who manages your pain during surgery)

What do I need to do to get ready for surgery?

Cervical Preparation: your surgery might mean that your cervix has to be softened to let your doctor dilate your cervix more easily. If this is the case, your doctor will give you a prescription for a medication called Misoprostol. You will need to put these tablets in the vagina as high up as possible, the night before your surgery. If you do not have any cramping or vaginal bleeding over night, then you will need to repeat it the morning of your surgery. You might have some side effects from the misoprostol like cramping, vaginal bleeding, a slight fever, upset stomach and diarrhea. You can take acetaminophen or ibuprofen to help with the cramping.

How long will it take me to recover?

Right after surgery, you will be in the recovery room. If you have a general anesthetic, you will feel sleepy. Some women might feel sick and vomit. If you have a regional anesthetic, you might feel numb and have some difficulty with urinating and walking. In both cases, you will need someone to drive you home.  Most of the time you will go home on the same day as the surgery. For a few days after the surgery, you might feel tired and have some discomfort. You should still move around at home. You might feel some cramping that can be treated with pain medication. You will also notice some vaginal bleeding and/or pink watery discharge that could last up to 4 to 6weeks. Most women are fully recovered after 1-2 days. You can shower and lift. Your doctor will let you know when you can get back to regular activities. Usually, your doctor might recommend avoiding sex, hot tubs, swimming pools, and baths for up to 4 to 6 weeks. Avoid driving until you are no longer taking narcotic pain medication and you are mobile (although most women do not require narcotics for pain after hysteroscopy).

When should I be concerned?

While it is normal to have some pain, discharge and bleeding after surgery, you should see your doctor or go to the emergency room right away if you have any of these symptoms:

• Abdominal pain that is getting worse

• Heavy vaginal bleeding (changing 2 to 4 pads over 2 hours)

• Fever

• Chest pain or difficulty breathing

• Severe pain, swelling and redness in on or both legs

• Unable to urinate

• Severe nausea (feeling sick to the stomach) and vomiting

What are the risks of hysteroscopy?

Hysteroscopy is a safe procedure, but there is a risk of:

• Bleeding, rarely requiring transfusion

• Infection

• Injury to the cervix

• Perforation of the uterus (making a hole in the uterus). If this happens, you might need a laparoscopy to ensure that there is no injury to the organs around the uterus, which may require you to stay in the hospital overnight

• Scarring of the uterine cavity, which may affect future fertility

• Injury to the nerves in the legs from the positioning during surgery

• Electrolyte imbalance from the absorption of the fluid used to open the uterine cavity (this means that you can absorb too much water, through the uterus, which can create an imbalance in the amount of salt in your body). Your doctor will monitor the amount of fluid that you are absorbing during the procedure and might stop the procedure before it is completed to prevent your body from absorbing too much fluid.

• A false passage in the cervix may be created, which means we cannot get into the cavity of the uterus (the womb). If this happens we may not be able to carry out the procedure we intended and you may need a second surgery

• Problems from the anesthesia