Hysteroscopy
Fig. 1 - HysteroscopyHysteroscopy (fig. 1) is the visualization of the inside of the uterus with a small camera (diameter of the camera is 3- 5mm). The procedure is commonly recommended as an investigation for abnormal uterine bleeding or for investigation of infertility. The camera is passed in through the vagina and cervix with no cutting required. Hysteroscopy procedures are still offered awake under local anaesthesia or asleep under general anaesthesia for patient comfort. The procedure commonly lasts 20-30min. They are day procedures meaning patients can leave hospital the same day as the operation.
RANZCOG hysteroscopy information
Hysteroscopy Dilatation and Curretage
In addition to hysteroscopy the cervix is gently dilated allowing the surgeon to take some endometrium (lining of the womb that is usually shed with a period) for biopsy and diagnosis.
Hysteroscopy + Mirena insertion
A Mirena intrauterine contraception device (IUCD) can be easily inserted at hysteroscopy. The device is coated in progesterone (a natural female hormone) that is gently released around the uterus at a dose lower than birth control pills. A Mirena can be used for contraception but also has added benefits of reducing uterine bleeding and pain associated with periods. It can stay in for five years and be removed at a future pap smear by a trained GP or specialist.
Hysteroscopy Polypectomy
Uterine polyps are abnormal growths that originate from the endometrium (lining of the uterus). They can range from 5mm to a couple of centimeters. Whilst the majority are benign some can turn precancerous or cancerous therefore removal is often recommended. Polyps can cause symptoms of heavy uterine bleeding or an abnormal pattern of uterine bleeding. They are often diagnosed on ultrasound scan.
Hysteroscopic resection of submucosal fibroid
Fibroids are larger than polyps and originate from uterine muscle. Despite the majority being benign (non-cancerous) they can still grow rapidly and become very large. In addition to triggering abnormal uterine bleeding current research also lists submucosal fibroids as a cause of infertility or recurrent miscarriage. Removal of submucosal fibroids (within the uterine cavity) can be performed with hysteroscopy.
Hysterscopic adhesiolysis
Women can develop adhesions and scarring within their uterine cavity, often after previous surgical procedures for miscarriages. Adhesions can cause pain and effect future successful pregnancies. Removal of adhesions can be performed with hysteroscopy.
Hysteroscopy and endometrial ablation
The lining of the uterus can be surgically removed during hysteroscopy. This is performed for women with heavy uterine bleeding who have also completed their family.