OG04 Fig1

What is Hysteroscopy?

Hysteroscopy provides a way for your physician to look inside your uterus. A hysteroscope is a thin, telescope-like instrument that is inserted into the uterus through the vagina and cervix. This tool often helps a physician diagnose or treat a uterine problem. Hysteroscopy is minor surgery which is performed either in your physician’s office or in a hospital setting. It can be performed with local, regional, or general anesthesia–sometimes no anesthesia is needed. There is little risk involved with this procedure for most women.

When is hysteroscopy used?

Hysteroscopy may be either diagnostic or operative. Diagnostic hysteroscopy is used to diagnose some uterine abnormalities, and may also be used to confirm the results of other tests such as hysterosalpingography (HSG). Other instruments or techniques, such as dilation and curettage (D&C;) and laparoscopy, are sometimes used in conjunction with the hysteroscopy. Diagnostic hysteroscopy can be used to diagnose certain conditions such as abnormal uterine bleeding, infertility, repeated miscarriages, adhesions, fibroid tumors, polyps, or to locate displaced intrauterine devices (IUDs). An operative hysterocopy may be used, instead of open abdominal surgery, to both diagnose and treat certain conditions such as uterine adhesions, septums, or fibroids which can often be removed through the hysteroscope. The hysteroscope is sometimes used with other instruments such as the resectoscope to treat some cases of abnormal bleeding; however after this procedure, known as endometrial ablation, women can no longer have children so it is not an option for women who wish to have future pregnancies. Endometrial ablation is a procedure which destroys the lining of the uterus. The resectoscope is a telescope-like instrument with a wire loop, a rollerball, or a roller cylinder tip at the end. Electric current at the end of the tip is used to destroy the uterine lining. This procedure is usually performed in an outpatient setting.

When should hysteroscopy be performed?

The best time for hysteroscopy is during the first week or so after your period. During this time your physician is best able to view the inside of the uterus.

How will I be prepared for hysteroscopy?

If you are having general anesthesia in the hospital, you will be told not to eat or drink anything for a certain period of time (usually after midnight the night before) before the procedure. Routine lab tests may be ordered as well for women having a hysteroscopy in the hospital. You will be asked to empty your bladder and your vaginal area will be cleansed with an antiseptic. Sometimes a drug to help you relax is ordered. Next you will be prepared for anesthesia:

Local anesthesia:

You will receive an injection of anesthetic around the cervix to numb it, with this type of anesthesia you remain awake and may feel some cramping.

Regional anesthesia:

A drug is injected, through a needle or tube in your lower back, that blocks the nerves that receive sensation from the pelvic region. You are awake with this type of anesthetic, but feel no discomfort. Regional anesthesia is also called a spinal or epidural.

General anesthesia:

You will not be conscious during your hysteroscopy when general anesthesia is used. A mask over your mouth and nose allows you to breathe a mixture of gases. Once you are under anesthesia, a tube may be inserted down your throat to help you breathe. Your physician will determine which type of anesthesia is best for you based on the reason for your hysteroscopy. Remember to ask questions if anything is about your procedure or anesthesia is unclear.