- Low risk diagnostic procedure for detecting uterine disorders such as recurrent miscarriages and uterine bleeding
DIAGNOSTIC HYSTEROSCOPY IN IRAN: ALL YOU NEED TO KNOW
Diagnostic hysteroscopy is a type of visual examination method used to diagnose the issues in the female reproductive system. It is also applicable to take a biopsy through direct visualization. This method is utilized to confirm the diagnosis based on the results of related tests such as hysterosalpingography (HSG).
Furthermore, hysteroscopy is performed along with other procedures such as gynecological laparoscopy, it is also operated prior to procedures like dilation and curettage (D&C) and assisted reproductive techniques (ART). Since 15-20% of female infertilities are related to the uterine factor, performing hysteroscopy to rule out any pathology in the female reproductive system has become an essential step before subjecting the infertile couple to ART.
What are the causes of hysteroscopy?
Different complications lead to finding the cause of disease through laparoscopy
• To rule out the cause of abnormal uterine bleedings (heavier, longer, irregular periods, bleeding between periods and after menopause which may be because of benign growths such as fibroids and polyps)
• To determine pelvic pains that makes difficulty in daily activities
• To diagnose and treat scar tissues (adhesions) formed due to infection or previous surgeries
• To detect recurrent abortions and infertility in women
• To determine the location of the displaced intrauterine device (IUD)
• To perform permanent sterilization by inserting implants in the fallopian tubes
What are the preparations for hysteroscopy?
Days and weeks before the procedure, your doctor may advise you to:
• Perform blood and pregnancy tests a week before the procedure
• Use contraceptives as hysteroscopy can’t be performed on pregnant women
• To decline the risk of anesthesia-related and (general anesthesia) recovery complications
• Take medicine to shrink the fibroids if you're having operative hysteroscopy to remove them
What are the risks of hysteroscopy?
Hysteroscopy is relatively a safe procedure. However, there is a small risk of complication development (less than 1%) especially in operative hysteroscopy which is for treatment, not just diagnosis. Possible complications may be as follows:
• Unexpected damage to cervix, uterus and nearby organs such as the bowel, bladder, and ovaries
• Heavy bleeding during or after operative hysteroscopy under general anesthesia
• Uterus infection which can be treated with antibiotics and pelvic inflammatory disease
• To feel faint (occurring in 1 woman in every 200 undergoing the procedure without anesthesia or with local anesthesia)
• Anesthesia-related complications
• Adverse reaction to the gas and fluid used to expand the uterus
• Intrauterine adhesion
What to expect from a hysteroscopy?
Hysteroscopy is an outpatient one-day procedure. It can be done under general, local or without anesthesia. Based on the medial plan and your preferences the procedure may have differed. If you would like to do hysteroscopy or prefer to sleep during the procedure, general anesthesia may be used. Local anesthesia is also used to numb the cervix.
During the hysteroscopy, you will be lying on a couch with a sheet covering your lower half and your legs in the supporters. Your doctor may insert medications and dilators to your cervix and use a speculum to keep your cervix open. Then, the hysteroscope is inserted to your uterus through the cervix. A fluid (saline) or gas is pumped to your uterus to expand it for a more clear vision. A light is shone on the organs so the camera can take images of the uterus and fallopian tubes and send them to a monitor so your doctor can diagnose and treat the issue.
Diagnostic hysteroscopy takes about 5 to 10 minutes. However, operative hysteroscopy can take up to 60 minutes. You won’t feel any pain during the procedure. But, if you are not under anesthesia, you may feel some discomfort similar to menstrual cramps.
If the procedure is done under anesthesia, you will be observed for several hours before going home. You may experience slight vaginal bleeding, cramping, fainting feeling or shoulder pain. This may be considered as normal because of the expansion of the diaphragm due to gas insertion. However, in the case of heavy bleeding, abdominal pain, fever, and infectious discharges you should keep in touch with your surgeon at an earlier time.
1. Is hysteroscopy painful?
The level of pain varies significantly among women. Some may feel no pain while in others pain can be severe. You can talk to your doctor about anesthesia and other pain relief options.
2. How is the recovery process after the procedure?
You can go back to your daily activities the same or the next day and start drinking and eating as usual straight away. However, if the procedure is performed under general anesthesia, take some day off to rest and recover. If you’re experiencing bleeding, avoid intercourse until the healing process is finished which is about one week.
3. Is there any substitution for hysteroscopy?
Pelvic ultrasound (sending sound waves from a probe inserted in the vagina to produce an image) and endometrial biopsy (suctioning a sample of the uterus lining tissue through a narrow tube inserted through the cervix) can be used along with hysteroscopy but can’t be its substitution.
4. What is the usage of MyoSure in hysteroscopy?
MyoSure is a hysteroscope specifically designed to remove fibroids, polyps, and other tissues in the uterus without affecting the function of the uterus.
5. What is Hysteroscopic Polypectomy?
Polyps are finger-like overgrowths of the endometrium. Imaging techniques such as hysteroscopy aren’t enough to distinguish them from fibroids. So, during hysteroscopy, a biopsy is taken to determine the cell type in the laboratory.
If the tumor is a polyp, it is cut at its attachment site to the uterus with an electrode and is removed. This procedure is called hysteroscopic (or resectoscope) polypectomy.
6. What is Dilation and Curettage (D&C)?
In this procedure, the cervix is dilated and the endometrium (uterus lining) is scraped or suctioned to remove the residual of an incomplete miscarriage. In this procedure, the surgeon detects overgrowth and finding the reason for reproductive issues. Hysteroscopy has replaced this technique in diagnostic areas. D&C is performed in adjunct to hysteroscopy and polypectomy.
7. Is hysteroscopy used in the endometrial ablation procedure?
Yes. Before performing endometrium ablation (destroying the endometrium to eliminate heavy bleeding in periods), hysteroscopy is operated to make sure there is no abnormal growth in the uterus.
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