Hysteroscopy is the method which allows the direct inspection of the endometrial cavity (diagnostic hysteroscopy) and / or the treatment of endometrial lesions (therapeutic hysteroscopy) with the use of a thin telescope (hysteroscope) and distension medium (usually normal saline).
Directed biopsies can be performed during diagnostic hysteroscopy as indicated.
Indications
After menopause (> 12 months from your last period or age> 55 years):
- Vaginal bleeding and thickened endometrium on transvaginal ultrasound scan (> 4mm)
- Persistent vaginal bleeding irrespectively of the ultrasound scan findings
- Transvaginal ultrasound with findings compatible with endometrial polyps
- Thickened endometrium> 9mm on transvaginal ultrasound in the absence of vaginal bleeding
Before menopause:
- Intermenstrual vaginal bleeding and transvaginal ultrasound with pathological findings
- Large and / or persistent endometrial polyps on transvaginal ultrasound
- Abnormal Uterine bleeding in the presence of fibroids which protrude into the endometrial cavity (submucosal fibroids)
- Congenital abnormalities of the uterus
- Part of investigations for infertility
What you need to know – Preparation
To undergo a hysteroscopy, pregnancy must be confidently excluded. For this reason, in premenopausal women, it is essential that there has been no unprotected intercourse since the first day of your last period.
The ideal time during the menstrual cycle to undergo hysteroscopy is immediately after the end of the menstruation.
If there are findings and symptoms compatible with bacterial vaginosis (i.e. offensive vaginal discharge) hysteroscopy is best performed following treatment to avoid the risk of spread to the endometrial cavity and pelvis (endometritis, pelvic inflammatory disease).
Possible complications
Hysteroscopy is very safe when performed by experienced health professionals.
Rare, possible complications are:
- Ascending infection in the intrauterine cavity / pelvis (<1%)
- Uterine perforation. The probability depends on the complexities of the particular procedure and the characteristics of the woman, however, is typically very low. Should a uterine perforation occur, it is almost always treated conservatively with the patient staying in the hospital overnight for observation.
- Heavy bleeding either during surgery (usually because of the nature of the abnormalities being investigated and treated) or at a later stage caused by endometrial infection
You may experience mild vaginal bleeding and period cramps for a few hours or days following the surgery.