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Hysteroscopy Procedure: Types, How to Prepare and Risks

Hysteroscopy is a procedure used for womb examination and helps with the diagnosis & treatment of gynaecological conditions.

Some of the reasons for a hysteroscopy procedure are to remove fibroids or polyps in the uterus or to diagnose & treat fertility problems or abnormal bleeding.

Other purposes of hysteroscopy are to determine:

A woman’s healthcare specialist may use Hysteroscopy to obtain a tiny tissue sample of the uterus lining, especially to know more about an individual’s reproductive health. Hysteroscopy also helps the specialists detect any underlying problems by providing a close up look of the cervix and uterus.

1. Types of Hysteroscopy

  • Diagnostic Hysteroscopy

The doctor may perform this procedure in either an office setting under local anaesthesia or in the operating room under general anaesthesia. The hysteroscope (camera) goes through the vagina and the cervix into the uterus. If there is any problem inside the uterine cavity, it is examined and noted. A physician may also take samples of the endometrial lining using a tiny suction tube in case of abnormal uterine bleeding.

  • Operative Hysteroscopy

The operative hysteroscopy takes place in the operating room under general anaesthesia. In this procedure, the cervix is slightly dilated, providing a passage for the hysteroscope inside the uterus. Sterile fluid is then infused into the uterus to allow better visualisation. To treat and remove certain kinds of polyps or uterine fibroids, the doctor uses an electrical and mechanical hysteroscopic instrument.

Endometrial ablation is a subtype of operative hysteroscopy. This procedure is for women who have completed their reproductive years and still experiencing irregular periods or heavy bleeding.

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2. How to Prepare For The Hysteroscopy Procedure?

The best time for hysteroscopy is during the first week or after your periods. During this time, the health care provider has the best view of the uterus.

2.1 Before the Hysteroscopy Procedure

The steps for the before hysteroscopy prep includes:

  • The specialist may advise against eating or drinking for a certain period of time before the procedure.
  • Women having a hysteroscopy procedure have to undergo routine lab tests in the hospital.
  • The next step requires the woman to have an empty bladder and the vaginal area to be cleaned with an antiseptic.

The next stage before the hysteroscopy test is preparing for anaesthesia.

  • Local anaesthesia: This helps numb the cervix. This type of anaesthesia keeps you awake, and you may experience some cramping.
  • Regional Anaesthesia: Regional anaesthesia is also known as spinal or epidural anaesthesia. It is injected through a tube or needle into the lower back, blocking the nerves that receive sensation from the pelvic region. Although you’ll be awake, you will feel zero discomforts.
  • General Anaesthesia: A dose of general anaesthesia may help with the pain as you won’t be conscious during the procedure. A mask – releasing a mixture of gases – is placed over your mouth & nose. Under the anaesthesia effect, a tube is then inserted down the throat to help you breathe.

Anaesthesia is chosen based on the reason for hysteroscopy. If anything is unclear, or you have questions about the anaesthesia or the procedure, don’t hesitate to clarify it with the healthcare provider.

2.2 During the Hysteroscopy Procedure

A hysteroscopy procedure usually takes approximately 5 to 30 minutes. The hysteroscopy procedure steps are as follows:

  • The patient lies on a couch with the legs held in support and a sheet covering their lower half.
  • The opening of the cervix is dilated or made wider with special instruments.
  • The hysteroscope is then inserted through the vagina & cervix into the uterus.
  • The hysteroscope releases a liquid or gas to expand the uterus, providing the health care provider with a better view of the inside.
  • In case of surgery, the healthcare provider inserts small instruments through the hysteroscope.

Occasionally, a laparoscope and hysteroscope are used to view the inside of the uterus. Carbon dioxide is released into the abdomen to see the inside of the organs. The gas is removed at the end of the procedure. A laparoscopic procedure is likely to take place in a hospital or an outpatient surgical centre.

Note: Make sure to shower or take a bath before the procedure. Do not apply lotions, perfumes, deodorants, or nail polish. Before the procedure, remove all jewellery & piercing. Wear contact lenses if required.

2.3 After the Hysteroscopy Procedure

The recovery time after hysteroscopy depends on the:

  • Anaesthetic: Patients who receive local anaesthetic are usually allowed to go home soon after the procedure. Those who opt for regional or general anaesthesia have a longer observation period. However, they can leave the same day.
  • Some patients may experience shoulder pain post laparoscopy or when carbon dioxide gas helps expand the uterus. Once the gas leaves the body, the discomfort should subsidise.
  • You may feel faint or sick or experience slight vaginal bleeding after a hysteroscopy for 1-2 days.
  • It is normal to experience cramping or bleeding post hysteroscopy for a few days.
  • Report any severe pain, heavy bleeding, vaginal discharge or fever to the healthcare provider immediately.

Note: Do not engage in intercourse for at least two weeks after a hysteroscopy.

You may return to your schedule and diet unless told otherwise by the healthcare provider. Take a couple of days off after the hysteroscopy procedure to rest before returning to normal activities, including work.

Based on the condition, the healthcare provider may give some other instructions, such as:

  • Eat light food as a heavy meal may make you nauseous. This is due to the general anaesthetic.
  • You can shower the same day or have a bath the next day. If you had a general anaesthetic, you may feel slightly dizzy. In such a case, it is a good idea to have an adult around to help you.

3. Hysteroscopy Side-effects and Health Risks

Some of the hysteroscopy side-effects are:

  • Bleeding
  • Infection
  • Pelvic inflammatory disease
  • Tearing of the uterus (rare)
  • Damage to the cervix (rare)
  • Complications from fluid or gas that helps expand the uterus

Some may experience cramps or vaginal pain and bleeding for a day or two after the procedure.

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When is Hysteroscopy needed?

A hysteroscopy procedure is needed in the case of:

It is also used to:

  • Scan and remove polyps or fibroids
  • Identify and remove displaced intrauterine devices (IUDs)
  • Get a small tissue sample
  • Remove the endometrial lining

Note: You cannot have a hysteroscopy if you are pregnant. Also, there may be other reasons the healthcare provider may suggest a hysteroscopy.

What should you not do before a Hysteroscopy?

For hysteroscopy under general anaesthetic, it is advisable to avoid eating or drinking a couple of hours before the procedure. The letter of appointment will state if this applies to you or not. Also, do not use tampons or vaginal medicines for 24 hours before the hysteroscopy procedure.

What can you eat the day before a Hysteroscopy?

You can eat your daily meals the day before a hysteroscopy. However, the healthcare provider may ask you to refrain from eating and drinking anything after midnight – the night before the hysteroscopy procedure.

Is it normal to bleed after a Hysteroscopy procedure? When does the bleeding stop?

It is normal to experience some cramping and vaginal bleeding after the hysteroscopy procedure for a day or two. It is also not uncommon to feel faint or sick. However, if you experience fever, severe abdominal pain, or heavy vaginal bleeding or discharge, visit the clinic at the earliest.

Neha Goel

Neha Goel, a Psychology alumna and MBA graduate from CASS Business School, London, brings together her expertise as a Reiki Practitioner and Practice Manager. She integrates psychology and business strategies to foster holistic well-being and personal development.