Hysteroscopy

What Is Hysteroscopy?

Hysteroscopy is a gynecological method that allows the inside of the uterus to be viewed directly with a special camera system, used for both diagnosis and treatment. During the procedure, a thin, illuminated instrument (hysteroscope) is advanced through the vagina into the uterus, and the uterine cavity is examined in detail.

Hysteroscopy makes it possible to see polyps, fibroids, adhesions or structural anomalies inside the uterus directly and, where necessary, to treat them at the same time. With this capability, hysteroscopy offers a clearer, more targeted approach than conventional methods.

Today, hysteroscopy is frequently chosen particularly for abnormal uterine bleeding, infertility investigations and the evaluation of recurrent miscarriage. Because it is a minimally invasive method, it is generally performed quickly and comfortably.

Why Is Hysteroscopy Performed?

Hysteroscopy provides direct visualization of the inside of the uterus, both to establish a diagnosis and to carry out treatment where required. Reasons for performing hysteroscopy include:

• Abnormal uterine bleeding (menstrual irregularity, bleeding between periods, postmenopausal bleeding)
• Evaluation of intrauterine polyps and fibroids
• Investigation of recurrent miscarriage
• Investigation of the causes of infertility
• Evaluation of intrauterine adhesions (Asherman’s syndrome)
• Detection and treatment of a uterine septum

Hysteroscopy does more than establish a diagnosis; in many situations it also allows treatment in the same session. This saves time and reduces the need for additional procedures.

In Which Conditions Is Hysteroscopy Used?

Hysteroscopy has a wide range of applications in the evaluation and treatment of intrauterine pathology. The conditions in which it is used most often:

• Intrauterine polyps: benign growths inside the uterus can be removed by hysteroscopy.
• Submucosal fibroids: fibroids growing into the uterine cavity can be treated with this method.
• Intrauterine adhesions: conditions in which the uterine walls have stuck together can be released.
• Uterine septum: a congenital partition inside the uterus can be cut and corrected by hysteroscopy.

Hysteroscopy is used as an effective method for both the diagnosis and the treatment of these conditions.

What Are the Types of Hysteroscopy?

Hysteroscopy is divided into two main groups according to its purpose:

Diagnostic hysteroscopy:

• Performed to examine the inside of the uterus
• A short and generally simple procedure

Operative hysteroscopy:

• Performed to treat a problem that has been identified
• Structures such as polyps, fibroids or a septum can be removed with this method

Which type of hysteroscopy is performed is decided according to the patient’s situation.

How Is Hysteroscopy Performed?

Hysteroscopy is usually a short, minimally invasive procedure. During the procedure, the hysteroscope — a thin, illuminated instrument — is advanced through the vagina into the uterus, and the uterine cavity is viewed directly.

The steps of the procedure:

• The patient is placed in the gynecological examination position
• The cervix is reached via the vagina
• The hysteroscope is introduced into the uterus
• The uterine cavity is distended with a special fluid to obtain a clearer view
• Intervention is carried out where needed (polyp, fibroid, septum, etc.)

The choice of anesthesia depends on the type of procedure: diagnostic hysteroscopy can generally be performed without anesthesia or with light sedation, whereas operative hysteroscopy is mostly carried out under local or general anesthesia. The procedure is generally completed in 10–30 minutes.

Mild, cramp-like pain may occur during the procedure; most patients tolerate it comfortably, and comfort can be increased with anesthesia.

Preparation Before Hysteroscopy

Before hysteroscopy, the patient’s general condition is assessed and a suitable time for the procedure is planned. Points to consider:

• The procedure is usually performed after menstruation has ended
• Any necessary tests can be planned in advance
• Fasting may be required according to the doctor’s instructions

Proper preparation makes the procedure safer and more comfortable.

After Hysteroscopy

Recovery after hysteroscopy is generally rapid, and patients can return to their normal lives within a short time. What may be experienced after the procedure:

• Light vaginal bleeding
• Cramp-like pain
• Mild discharge

These complaints usually resolve on their own within a short time.

What should be considered after hysteroscopy?

• Sexual intercourse can be avoided for a few days
• Hygiene rules should be followed
• The doctor’s recommendations should be observed

After hysteroscopy, abstaining from sexual intercourse for a few days to a week is generally recommended; this period may vary according to the scope of the procedure performed.

What Are the Risks of Hysteroscopy?

Although hysteroscopy is a safe method, certain complications can rarely occur:

• Infection
• Bleeding
• Injury to the uterine wall (very rare)
• Fluid-balance problems

These risks occur at low rates and are minimized by experienced teams.

The Difference Between Hysteroscopy, Curettage and Laparoscopy

Hysteroscopy:

• The inside of the uterus is viewed with a camera
• Performed via the vaginal route
• A targeted intervention is carried out; diagnosis and treatment can be combined

Curettage:

• The uterine cavity is cleared in a general fashion
• Performed without visualization
• Used mostly for terminating a pregnancy or obtaining a biopsy

Laparoscopy:

• Examines the inside of the abdomen
• Performed through small incisions in the abdomen

Hysteroscopy and laparoscopy are often confused with each other; however, hysteroscopy examines the inside of the uterus, while laparoscopy is a different method that examines the inside of the abdomen.