Introduction

A woman may encounter several gynaecological conditions in her life-time. While some can be treated with medication and some with home-remedies, others required incisional surgery in the past. However, minimally invasive procedures such as Hysteroscopy offers hope to women who cannot afford the disadvantages that come from incisional surgery and lengthy hospitalization.

Minimally-invasive gynaecological procedures offer the advantages of quick recovery, lesser pain, lesser bleeding, lesser collateral damage to surrounding tissues, smaller or no incisions, brief hospitalization and a quick return to normal life. The procedure is done on an outpatient basis, and also helps women avoid a hysterectomy.

Hysterectomy is a surgical procedure to remove the womb or uterus. Because of the incisional nature of the procedure and the emotional burden of losing the uterus, many women tend to put this off to a later day. In the process, gynaecological conditions that exist can get more complicated with time. By going in for a quick and timely Hysteroscopy, the underlying condition can be diagnosed and treated in time.

Hysteroscopy uses an endoscope, which is a thin, flexible tube (called hysteroscope in this case), fitted with a light and video camera at its end. Needless to say, the camera can relay the video to a computer placed in the endoscopy room, and this helps guide the doctor’s movements.

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Also Read: The importance of Annual Gynecological Health Check-up

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Types of Hysteroscopies

• Diagnostic hysteroscopy (DH): This is used to diagnose any abnormalities in the uterus which may be causing excessive bleeding. It can also be used to confirm the findings of other tests, including ultrasound exams or a special type of X-ray called Hysterosalpingography (HSG). This is generally used to look for blocked fallopian tubes. A DH may also be done when the doctor is not sure of the Pap smear results. DH is also done to biopsy the uterine lining
• Operative hysteroscopy (OH): As the name implies, here, Hysteroscopy is done to treat a particular condition post diagnosis. Examples include endometrial ablation. Endometrium is a thin tissue that lines the uterus. Any abnormality in it can cause bleeding in the uterus. Using a Hysteroscope, the doctor can destroy parts of, or the entire endometrium. Most often, diagnosis and operative Hysteroscopy are combined in one session.

When is Hysteroscopy required / Who requires it

Women suffering from, or suspected to be suffering from one or more of the following conditions are diagnosed through Hysteroscopy.

Menstrual conditions

• Abnormal or heavy bleeding
• Bleeding after menopause
• Spotting (occasional and light bleeding) between periods

Uterine conditions

• Polyps and fibroids: These are abnormal growth or irregular structures found in the uterus. These growths or structures can be removed using Hysteroscopy.
• Asherman’s syndrome: In this, small bands of scar tissue start appearing in the uterus. This can cause infertility, changes in menstrual patterns and other issues. A hysteroscopy is then done to locate and remove such tissue, which are called uterine adhesions or uterine synechiae.
• Septums: Uterine septum is a congenital anomaly or a defect present since birth. In this, a long and thick membrane runs through the entire length of the uterus up to the cervix, dividing the uterus into two. Hysteroscopy can help confirm the condition, and once confirmed, it can be used to treat the condition. The septum is carefully shaved off in multiple iterations till it is no longer present.

Others

• Diagnose why a woman is having miscarriages again and again
• Why a woman is not able to conceive (fertility issues)
• Locate an IUD or intrauterine device, which is a contraceptive
• To correct or remove a problematic IUD
• To first diagnose the presence of placental tissue after childbirth and then remove the same

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Also Read: Is post-menopausal bleeding risky?

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Who is not a candidate?

Pregnant women and those with a pelvic infection are not suited for a Hysteroscopy.

The Procedure

Preparing for a Hysteroscopy

• The first step is a physical examination of the person followed by a pelvic exam and pregnancy test if that is relevant. This will be followed by a blood-test and other lab-tests depending on the specific condition.
• Personal and family medical history: The doctor will ask questions to know if any of the close relatives have or had similar conditions in the past, to rule out genetically inherited conditions. Then the patient must list-out drugs and medication being taken currently for various conditions. This includes vitamins and supplements too.
• In case one of the medications includes blood-thinners and anticoagulants such as aspirin, the patient will be asked to discontinue them.
• Then the doctor will give detailed instructions around diet, what to eat/drink, and what to avoid, the previous day and night of the procedure.

During the procedure

• Once the patient arrives at the hospital on the scheduled day and time, she will be asked to empty then bladder and then change into a gown.
• Then she will be anaesthetized using local, general or regional anaesthesia depending on what the condition is, where the procedure is being conducted and if any follow-up procedures will be required.
• The person will lie down on a table and the legs placed in stirrups.
• This will be followed by a pelvic examination.
• The cervix is then dilated after which the hysteroscope is inserted through the vagina and cervix, into the uterus.
• A liquid is then pumped through the hysteroscope and into the uterus. This will expand the uterus slowly and clear any blood or mucus. This makes it easy for the doctor(s) to view the uterus, the endometrium and fallopian tubes.
• The uterine cavity and mouth of the fallopian tubes are examined in detail.
• Surgical instruments are inserted through the hysteroscope if required. This will help remove any abnormalities.

Hysteroscopy can take up to an hour depending on whether it’s just DH or DH followed by OH. Sometimes, the Hysteroscopy may be followed by a laparoscopy, depending on the diagnosis.

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Also Read: WHAT IS PERIMENOPAUSE

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Post-procedural recovery

In case of a Diagnostic Hysteroscopy, the patient is discharged the same day, and must be preferably driven home any another person. In case of Operative Hysteroscopy, the doctor will take a call whether the patient must be discharged the same day or the next day. In case of hospitalization, the patient’s vitals and reaction to anaesthesia will be closely monitored.

The patient may experience light bleeding or cramps for a few days following the procedure. However, this is not serious and in case of a working woman, she can get back to work almost immediately. Non-working women can get back to their regular routines soon.

 

Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai (Alwarpet & Vadapalani), Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and pediatric trauma care.

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