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Hysteroscopy

Information for Patients

Hysteroscopy is a procedure that allows the gynaecologist to see the inside of the uterus.  A hysteroscope is a small telescope.  It is passed through the cervix, so no incision (cut) is required.  Because the walls of the uterus are usually pressed together, a solution of fluid is required to distend the cavity so that a good view can be obtained. 

Examination of the uterine cavity using a hysteroscope allows the gynaecologist to determine the size and dimensions of the uterine cavity, and to detect abnormalities such as polyps, other thickenings of the lining of the uterus, fibroids that have grown into the uterine cavity, and cancers of the uterus.

Hysteroscopy is usually performed as a day-only procedure.

Anaesthesia for hysteroscopy

Hysteroscopy is usually performed under general anaesthesic or sedation.  In some circumstances, it is possible to perform a hysteroscopy and take small samples under local anaesthetic – however, if any sort of operating is required within the uterus your doctor will often arrange for general anaesthesia.

How a hysteroscopy is performed

The patient will usually be placed on the operating table with legs placed in supports, allowing the gynaecologist access to the cervix.  An antiseptic solution is used to clean the area.  An instrument called a speculum is passed into the vagina to find the cervix.  The cervix is then held with a small grasping instrument.  The hysteroscope is passed through the entrance of the cervix.  In some cases, when the entrance of the cervix is tightly closed, instruments called dilators are used to open the canal enough to allow the hysteroscope to pass. 

If something abnormal is found, the opening of the cervix may be dilated to allow instruments to pass through, so that samples may be taken or larger lesions (such as polyps) can be removed for analysis.

It is important to recognize that a hysteroscope can only see the inside of the uterus.  It is not possible so see elsewhere in the pelvis, such as the ovaries or other structures.

View a YouTube video clip of a hysteroscopy here:

Potential complications of hysteroscopy

It is important to recognize that hysteroscopy is a common and safe procedure.  However, no surgical procedure is risk-free. 

The potential complications of hysteroscopy can be listed as follows:

Perforation of the uterus

The uterus is usually a small muscular organ, with a relatively thin wall, and it is possible that the hysteroscope or other instruments might accidentally pass through the wall.  This is called a perforation.  Even if this occurs, the uterus will generally heal completely and quickly.  Very rarely, further measures may be necessary to correct it.

In very rare cases, usually when extensive surgery is being performed within the cavity of the uterus, instruments may pass through a perforation and cause injury to other organs, such as blood vessels, the bladder or bowel.

Bleeding

Any surgical procedure has the potential for bleeding.  It is normal to have some blood-stained discharge after the procedure. 

Infection

Infection is a potential complication of any surgical procedure.  The commonest form of infection is urinary infection (cystitis). 

Looking after yourself after a hysteroscopy

When you wake from the anaesthetic, it is normal to feel disoriented and sleepy.  Some patients will experience nausea or vomiting, but these feelings should pass quite quickly.

There might be some crampy pain in the pelvis, but this will usually pass quite quickly.

Depending on the complexity of surgery and the length of the operation, you will feel tired and have abdominal discomfort for a few days.  There is usually some vaginal discharge, and this may persist for several days, depending on the complexity of the procedure performed within the uterus.

You should not put anything in the vagina until the discharge has completely cleared for about 48 hours.

It is important to notify the hospital or your doctor if you have:

  • Pain that is worsening, not improving.
  • Pain or other problems passing urine.
  • Bleeding that is increasing, not settling.
  • A fever or temperature.
  • You feel that you are not recovering relatively quickly.
  • Any other symptoms that you are concerned about. 
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