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Hysteroscopy
Hysteroscopy is a surgical intervention that examines the inside of the uterus. A hysteroscope, that is, an instrument with a camera, is inserted through the vagina into the canal of the cervix and then into the uterine cavity.
Liquid or gas is injected into the uterus to "separate" the front from the back wall so that the entire uterine cavity with the uterus mucosa - endometrium can be analyzed. The camera is connected to a monitor, which shows the inside of the uterus.
Diagnostic hysteroscopy involves only an examination of the canal of the cervix and of the uterine cavity.
Operative hysteroscopy is indicated in cases where a polyp, myoma, adhesions, septum, tissue are left after abortion or childbirth, or a spiral is removed.
When an operative hysteroscopy is performed, a hysteroscope is used with additional instruments that may be connected to a power source to remove the change or stop the bleeding. There is also technique called “shaver” without use of power source that is less invasive, especially for infertility patients.
Tissue removed during hysteroscopy is always sent for histopathological examination.
Indications for hysteroscopy
- infertility;
- examination of repeated spontaneous abortions and failed attempts at in IVF;
- examination of irregular menstrual bleeding;
- examination of bleeding from the uterus in menopause;
- removal of endometrial polyp;
- removal of partitions (septum) in the uterine cavity;
- removal of fibroids located in the uterine cavity;
- operative treatment of adhesions and scar tissue in the uterine cavity (Ascherman syndrome);
- operative treatment of heavy and irregular menstruation when part of the endometrium is removed;
- removal of a spiral that cannot be removed by pulling on the thread of the spiral.
What does hysteroscopy look like at the Gyn-Fertility Clinic Milenković?
- The decision on hysteroscopy is made after a gynecological and ultrasound examination and a consultation with a gynecologist;
- The intervention is performed in the period between day 5 and 12 of the cycle for women in the reproductive period, while for women in menopause it can be performed at any time. When the patient is using birth control pills, hysteroscopy can be done at any stage of the cycle;
- Before the hysteroscopy, the patient fills out a detailed questionnaire about her state of health condition.
- Hysteroscopy can be performed under local or short-term general anesthesia. If it is done under general anesthesia, before the operation, there is a consultation with a specialist in anesthesia and blood tests are performed.
- If there is an additional disease or risk factor, it is necessary to perform additional analyses by a doctor of another specialty, most often an internist.
- Before hysteroscopy, the cervix is swabbed for chlamydia and gonococci, and depending on the clinical picture, some other bacteriological analyses are performed.
- The patient receives an antiseptic shampoo in the Clinic, with which she will shower the night before and the morning before the intervention.
In the Clinic, the patient also receives a tablet containing prostaglandins, which is inserted into the vagina 6 hours before the hysteroscopy to "soften" the cervix, resulting in less tissue trauma during instrument manipulation.
Hysteroscopy is performed as the same-day surgery. The patient leaves the Clinic no later than 2 hours after the surgery. 6-8 hours before the hysteroscopy, the patient stops taking food and liquids.
- Upon arrival at the Clinic, the patient goes to the patient room where she prepares to enter the operating room. A needle is inserted into the vein so that the patient can receive the necessary drugs. Hysteroscopy is performed on the operating/gynecological table. The vagina is treated with a saline solution or an antiseptic agent containing iodine or chlorine.
- After receiving local or general anesthesia, the hysteroscope is "inserted" into the cervix. Considering that the hysteroscope is 5-9 mm in diameter, it is sometime necessary to perform dilatation, that is, to widen the canal of the cervix with instruments so that the hysteroscope can reach the uterine cavity.
- First, the cervical canal is examined, and then the uterine cavity itself, where the shape the upper part or "roof" of the uterine cavity, the endometrium and the openings of the fallopian tubes are analyzed.
- The polyp, myoma, adhesions or septum are removed with hysteroscopic instruments. Sometimes "curettage" of the uterine cavity is performed after hysteroscopy.
The tissue that is removed is sent to a pathologist for analysis. Hysteroscopy lasts from 10-45 minutes. It takes about 45 minutes to remove fibroids and treat heavy bleeding where the endometrium is removed.
- The patient moves to the patient room where she stays for up to 2 hours after the hysteroscopy. First, she gets water, and then a light meal.
- Antibiotics are not necessary, but they are usually prescribed after hysteroscopy. Pain, which is usually in the form of cramps or menstrual pain, is treated with painkillers, most often paracetamol, ibuprofen and diclofenac.
- Sometimes you feel nauseated and tired during the day as a result of anesthesia.
- The patient is not advised to drive a car on the day of the intervention.
- Vaginal bleeding usually stops 2-3 days after hysteroscopy.
- The patient can return to normal activities on the same day or the day after the surgery.
- The use of vaginal tampons, bathing in the bathtub, swimming, as well as sexual intercourse is not recommended while the bleeding lasts.
- The next menstruation will come at the expected time, except when the endometrium is removed due to heavy bleeding, and when the goal is to prevent menstrual bleeding.
The patient will be informed about the result of the histopathological findings 7-10 days after the hysteroscopy.
Hysteroscopy is not performed:
- during menstrual bleeding;
- infections of the genital organs;
- pregnancy.
Complications during and after hysteroscopy
Complications during and after hysteroscopy occur in less than 1% of cases and can be:
- passage of the instrument through the wall of the uterus (perforation) when there may be injury to the intestines, bladder and wall of the uterus;
- heavy bleeding;
- infection of the uterus;
- a scar that remains inside the uterus after operative hysteroscopy;
- complications related to the use of liquid that is inserted into the uterine cavity (extremely rare if the saline solution is used).
Expert advice: frequently asked questions
Answered by: Milan Milenković, MD. PhD
Is hysteroscopy a painful intervention?
Hysteroscopy is performed under local and general anesthesia so that the patient does not feel pain during the surgery. When it is done under local anesthesia, the patient may have an unpleasant feeling, she may feel that something is being done, but she does not feel the pain. Diagnostic and shorter hysteroscopic operations are usually performed under local anesthesia.
After hysteroscopy, pains in the form of cramps similar to menstrual cramps may occur. Pain after surgery responds well to paracetamol, ibuprofen and diclofenac.
Is it ever necessary to repeat the hysteroscopy?
Removal of the larger fibroids in the uterine cavity is sometimes done in two sessions. Also, after the removal of massive adhesions and scar tissue (Ascherman syndrome), it is necessary to perform a control hysteroscopy, the so-called "second look" surgery.
When can spontaneous pregnancy be attempted after hysteroscopy or insemination and in vitro fertilization?
Pregnancy, either spontaneous or insemination and IVF can be attempted in the next menstrual cycle when a diagnostic hysteroscopy is performed or a polyp or minor septum is removed. After surgery for fibroids, adhesions (Ascherman syndrome) and larger septa, you should wait at least two months after hysteroscopy before trying to get pregnant.
What is the cost of hysteroscopy?
For the price of hysteroscopic operations, see the regularly updated price list.
When can I take a shower after hysteroscopy?
You can take a shower immediately after the hysteroscopy, but it is not recommended to take a bath in a bathtub or swim as long as the bleeding continues.
When can I train after hysteroscopy?
You can start training two or three days after the hysteroscopy, that is, when you yourself feel that you can train.
When can I have sex after hysteroscopy?
Sexual intercourse after hysteroscopy is not advised while bleeding continues. If an operative hysteroscopy was performed, a contraception is recommended. Pregnancy, either spontaneous or insemination and IVF can be attempted in the next menstrual cycle when a diagnostic hysteroscopy is performed or a polyp or minor septum is removed. After surgery for fibroids, adhesions (Ascherman syndrome) and larger septa, you should wait two to three months after hysteroscopy to try to get pregnant.
When is the first check-up after hysteroscopy?
The check-up after hysteroscopy is usually done after the next menstruation, although the assessment is individual.
In which acute situations should the Clinic be contacted?
In case of pain, high body temperature and abnormal bleeding, you should call 069 50 22222, send a message to info@drmilenkovic.com or contact the nearest emergency department.
What medicines should be taken in case of pain after hysteroscopy?
After hysteroscopy, pains in the form of menstrual cramps are most often treated with Paracetamol pills, 500 mg 2 pills up to 4 times a day in combination with Brufen, pills 400-600 mg up to 3 times a day, or Paracetamol, pills 500 mg 2 pills up to 4 times a day in combination with Diclofenac or Voltaren pills of 50 mg up to 3 times a day.
If you have additional questions, please feel free to contact us.
You can expect an answer during office hours, from Monday to Friday, between 9 a.m. and 7 p.m.
