Hysteroscopy
Dr G.D. Reid & Dr H.F. Joyce


The hysteroscope is a fine telescope (3mm or 4mm diameter) used to examine the inside of the uterus or womb.

A camera attached to the end of the hysteroscope transmits a high quality image to a video monitor allowing the doctor and the patient (if she is awake) to see inside the uterine cavity


The Purpose of Hysteroscopy
This examination may be done for diagnosis of a problem in the presence of symptoms, or to perform operative procedures within the uterine cavity to cure a certain problem.

1. Diagnostic hysteroscopy

This is most commonly performed in the presence of: In these circumstances a biopsy or sample of the uterine lining would most likely be taken for the pathologist to examine. Hysteroscopy has therefore replaced "cervical dilatation and uterine curettage" or "curette" as it gives much more accurate information, by allowing a direct view of the uterine cavity.

2. Operative hysteroscopy

An increasing number of operations can be performed within the uterine cavity using the hysteroscope. These are done as day procedures whereas in the past, most of these operations involved open surgery. The development of hysteroscopic surgery has therefore been truly revolutionary.

The types of operative procedures that may be performed using the hysteroscope include:
Separate information sheets are available for some of these procedures.


The Examination
This takes only a few minutes and may be done with local anaesthetic injected into the cervix or under a light general anaesthetic. With local anaesthetic some mild cramps may be felt.

A speculum, similar to that used during a Pap smear, is placed within the vagina so that the cervix may be seen. The telescope is gently introduced through the cervical canal that is stretched open using carbon dioxide gas or fluid. This gas or fluid then causes gentle opening of the uterine cavity so that the front and back walls are separated and the uterine cavity can be seen.

An orderly examination of the cavity is undertaken noting any irregularity of shape, the appearance of the uterine lining, the state of the openings into the Fallopian tubes and the canal through the cervix. It is at this point that a small sample may be taken for the Pathologist.


After the Examination
If local anaesthetic is used, the patient may return home as soon as she wishes. As with any medical examination it may be wise to have a friend accompany you to the examination.

When the examination is performed under general anaesthetic, admission to a hospital or day surgery center is needed. Hospitalization is normally from 2 - 4 hours but you would need to be picked up by a friend as you should not drive or operate machinery for 24 hours after any anaesthetic.

It may be necessary to take some simple analgesics for cramps afterwards, and it is normal to have some light bleeding or discharge for a few days after the examination.

A follow up appointment is made to discuss the findings of the examination, to review any pathology samples taken at the time and to consider any further treatment that may be required.


Risks of the Examination
Diagnostic hysteroscopy is a minor procedure and the risk of serious complication is extremely small. It should not be done in the presence of an active infection, and is performed in pregnancy only in rare circumstances.


Conclusion
There are clear benefits that result from such a thorough examination of the uterine cavity. It is nevertheless important for you to discuss the procedure with your doctor, and feel free to ask any questions that you may have. An understanding of the benefits and the risks in your own case is most important.



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Last updated 24th November, 1998