Hysteroscopy is used to examine the inside of the uterus. The hysteroscope is a thin instrument with a lens and a light source and a camera attached to one end. This allows very careful and thorough examination of the uterine cavity.
When is hysteroscopy used?
Hysteroscopy may be performed to examine abnormal uterine bleeding such as:
- heavy menstrual bleeding
- bleeding between periods
- bleeding after menopause
Hysteroscopy can help discover causes of the bleeding, such as polyps or fibroids. It can be used to perform a biopsy of the uterus to check for cancerous growth, especially in postmenopausal women. In some cases the procedure may be used to treat the underlying problem. For example, small polyps or fibroids may be removed.
How do I prepare for a hysteroscopy?
Be sure to eat a healthy breakfast the morning of your appointment. Ideally the procedure should be scheduled in the first seven days after your period has ended. This is not always possible due to irregular menstrual cycles. If your periods are irregular, you may need to take a hormonal medication once daily until your appointment. You will be given a prescription for this as needed. Take 800 mg of Ibuprofen (Motrin or similar) by mouth the night before and 1 hour prior to the procedure.
If you have not been able to tolerate Ibuprofen in the past you can take one Percocet or Tylenol #3 by mouth 1 hour prior to the procedure. If you have not delivered a child through the birth canal you will be given a prescription for a medication that will soften your cervix. You will be given a prescription and asked to take two pills by mouth the night before the procedure. You will be asked to provide a urine sample for a pregnancy test if appropriate.
What happens during the procedure?
Hysteroscopy will be performed in the office on a regular examination table. The hysteroscope is gently placed into the vagina and sterile water that flows through the hysteroscope is turned on. There may be some water flowing out of the vagina, which is normal. The water is used to separate the walls of the uterus, which normally touch each other. The hysteroscope is then gently inserted through the cervix and into the uterus under direct vision. You can watch this on the TV monitor if you wish.
Once inside the uterus the whole uterine cavity is examined for potential abnormalities. You are encouraged to ask what you are seeing during the procedure. This will take approximately 3-5 minutes. Occasionally, the cervix does not open easily. In this case the cervix needs to be dilated with specialized instruments. If the cervix needs to be dilated, a local anesthetic is injected into the cervix since the dilation can otherwise be relatively painful. The average pain score during office hysteroscopy is 2 to 3 on a scale from zero to 10, where zero is no pain and 10 is worst pain ever.
What happens after the procedure?
After the procedure you may have some cramps, similar to menstrual pains, or experience a watery or bloody discharge for 3 or 4 weeks.
What are the benefits of this procedure?
The doctor sees the condition of the inside of your uterus and can make a better diagnosis. It may be possible to treat the problem at the same time. The procedure is short with an easy recovery.
What are the risks associated with this procedure?
- A local or regional anesthetic may not numb the area quite enough and you may feel some minor discomfort. Also, in rare cases, you may have an allergic reaction to the drug used in this type of anesthesia. In most cases, local or regional anesthesia is considered safer than general anesthesia.
- You may have infection or bleeding.
- Rarely, the uterus could be punctured and need surgery to repair it.
- Rarely, the bowel or bladder may be injured.
- You may have an allergic reaction to the fluid used during the procedure.
You should ask your doctor how these risks apply to you.
When should I call the office?
Call the office if:
- You start to bleed heavily (like a menstrual period or more)
- You develop a fever over 100°F (37.8°C)
- You have a lot of pain in your lower abdomen
- You have a vaginal discharge with a bad odor