Hysteroscopy

Test Overview

A hysteroscopy is a procedure to find and treat problems with your uterus. It may be done to remove growths from the uterus, such as fibroids or polyps. It may also be used to diagnose and treat abnormal bleeding or fertility problems.

The doctor will guide a lighted tube through the cervix and into the uterus. This tube is called a hysteroscope, or scope. The doctor will fill your uterus with air or liquid. This makes it easier to see the inside of your uterus with the scope. The doctor may also put tools through the scope to treat a problem.

During this procedure, the doctor may take out a small piece of tissue for study. This is called a biopsy. Or the doctor may gently scrape tissue from the inner wall of the uterus. This is called a dilation and curettage, or D&C.

If your doctor filled your uterus with liquid, most of it will flow out when the scope is removed.

You will most likely go home the same day. And you will probably be able to go back to work the next day. But it depends on what was done and the type of work you do.

Why It Is Done

A hysteroscopy may be done to:

• Find the cause of severe cramping or abnormal bleeding. Your doctor can pass heated tools through the hysteroscope to stop the bleeding.
• See if a problem in the shape or size of the uterus or if scar tissue in the uterus is the cause of infertility.
• Look at the uterine openings to the fallopian tubes. If the tubes are blocked, your doctor may be able to open the tubes with special tools passed through the hysteroscope.
• Find the possible cause of repeated miscarriages.
• Find and remove a misplaced intrauterine device (IUD).
• Find and remove small fibroids or polyps.
• Check for endometrial cancer.
• Use tools to remove problem areas in the lining of the uterus (endometrial ablation).

How To Prepare

Preparing for the procedure

• Schedule your test for when you won't be having your period. Your doctor may suggest that the test be done soon after your period ends and before your ovary releases an egg (ovulates). This timing allows your doctor to see the inside of your uterus better. It also avoids doing the test when you could be pregnant.
• Your doctor may give you medicine to take before the test that will help open your cervix. This medicine may be placed in your vagina or taken as a pill. Or you may go to your doctor's office on the day before the procedure so that your doctor can put a small sponge in your cervix. This also helps to open your cervix.
• You may be asked not to douche, use tampons, or use vaginal medicines for 24 hours before the hysteroscopy.
• Ask your doctor if you will need someone to take you home. Anesthesia and pain medicine can make it unsafe for you to drive or get home on your own.
• Understand exactly what procedure is planned, along with the risks, benefits, and other options.
• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your procedure. Your doctor will tell you if you should stop taking any of them before the procedure and how soon to do it.
• If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your procedure. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don't have one, you may want to prepare one. It lets others know your health care wishes. It's a good thing to have before any type of surgery or procedure.

How It Is Done

Hysteroscopy is usually done by your gynecologist in the operating room of a hospital or surgery center. You will probably go home the same day. In some cases, the procedure can be done in your doctor's office.

You may be given medicine (anesthesia) to help you relax, to numb the area, or to help you sleep.

You will take off all of your clothes and wear a gown for the test. You will empty your bladder before the test. You will then lie on your back on an examination table with your feet and legs supported by footrests.

Your doctor may place a lubricated tool called a speculum into your vagina. The speculum gently opens the vaginal walls so your doctor can see inside the vagina.

The hysteroscope will be placed at the entrance to your vagina and gently moved through the cervix into your uterus. Air or liquid will be put through the hysteroscope into your uterus. It helps your doctor see the lining clearly. Your doctor looks through the hysteroscope at a magnified view of the lining of your uterus. Your doctor can also see the uterine openings of the fallopian tubes. A video screen may be used during the test.

If a biopsy or other procedure is done, your doctor will use small tools through the hysteroscope.

Right after the test, you will be taken to a recovery area where nurses will care for and observe you until you go home.

How It Feels

If you are given a sedative or local or regional anesthesia, you may have some cramping during the test.

If you had general anesthesia, you will be asleep and won't feel pain during the procedure.

Risks

If a fluid is used during the test to help your doctor see the uterine lining clearly, you may absorb some fluid and feel bloated. It may also change the level of sodium in your blood. If air is used, you have a small risk for an air bubble (air embolism) in a blood vessel, though this is very rare.

Hysteroscopy can cause injury to the uterus or cervix, an infection, or bleeding. In rare cases, the uterus, bladder, or bowel can be punctured during the test and require surgical repair. If general anesthesia is used, there is a small risk of problems from the anesthesia.

Results

Hysteroscopy results

Normal:	The inside of the uterus looks normal in size and shape.
	No polyps, fibroids, or other growths are present.
	Openings to the fallopian tubes look normal.
Abnormal:	The size or shape of the inside of the uterus does not look normal.
	Scar tissue is present in the uterus.
	Uterine polyps, fibroids, or other growths are present.
	A misplaced intrauterine device (IUD) is found and removed.
	The uterine openings to one or both fallopian tubes are closed.