Understanding hysteroscopy: Uses, procedure, and risks

Hysteroscopy is a minimally invasive surgical procedure that allows doctors to examine the inside of a woman's uterus. It is a valuable diagnostic and therapeutic tool used to diagnose and treat various gynaecological conditions. In this article, we will delve into what hysteroscopy entails, its uses, procedure details, potential benefits, and risks associated with it.

What is hysteroscopy?

Hysteroscopy involves the insertion of a thin, lighted tube called a hysteroscope through the vagina and cervix into the uterus. The hysteroscope comes with a camera that offers a distinct perspective of the uterine cavity displayed on a monitor. This procedure can be performed either in an outpatient setting or as a day surgery procedure under anaesthesia.

Uses of hysteroscopy

Diagnostic hysteroscopy: This is performed to investigate the cause of abnormal uterine bleeding, infertility, repeated miscarriages, or other uterine abnormalities. It helps in identifying conditions such as uterine fibroids, polyps, adhesions (scar tissue), or structural abnormalities within the uterus.

Operative hysteroscopy: In addition to diagnosis, hysteroscopy can also be used to treat various uterine conditions. During operative hysteroscopy, specialised instruments are passed through the hysteroscope to perform procedures such as removing polyps or fibroids, correcting uterine septum (a wall of tissue dividing the uterus), or removing adhesions.

The procedure

Before the procedure, the patient may be given medication to help relax the cervix and reduce discomfort. Depending on the complexity of the procedure and the patient's preference, hysteroscopy can be performed under local anaesthesia, sedation, or general anaesthesia.

Insertion of the hysteroscope: The hysteroscope is gently inserted through the vagina and cervix into the uterus. Carbon dioxide gas or a saline solution may be used to expand the uterus, allowing for better visualisation.

Examination and treatment: Once the hysteroscope is in place, the doctor examines the uterine cavity and identifies any abnormalities. If necessary, therapeutic interventions such as polyp or fibroid removal are performed using specialised instruments passed through the hysteroscope.

Completion and recovery: After the procedure is completed, the hysteroscope is removed, and the patient is observed for a short period in the recovery area. Most women can go home the same day and resume normal activities within a day or two.

Benefits of hysteroscopy

• Minimally invasive: Compared to traditional open surgery, hysteroscopy is minimally invasive, resulting in less pain, shorter recovery times, and lower risk of complications.

• Accurate diagnosis: Hysteroscopy provides a direct and clear view of the uterine cavity, allowing for accurate diagnosis of uterine abnormalities.

• Therapeutic intervention: In addition to diagnosis, hysteroscopy allows for simultaneous treatment of uterine conditions, avoiding the need for separate procedures.

• Fertility preservation: For women experiencing infertility due to uterine abnormalities, hysteroscopy can help correct these issues, potentially improving fertility outcomes.

Risks and considerations

While hysteroscopy is generally safe, like any medical procedure, it carries some risks. These may include:

• Infection: There is a slight risk of infection following hysteroscopy, especially if surgical instruments are used or if there is an underlying uterine infection.

• Uterine perforation: In rare cases, the hysteroscope or surgical instruments may puncture the uterine wall, leading to bleeding or injury to nearby organs.

• Fluid overload: If a saline solution is used to expand the uterus during hysteroscopy, there is a risk of fluid overload, particularly in women with heart or kidney conditions.

• Anaesthesia risks: There are potential risks associated with anaesthesia, including allergic reactions, respiratory problems, or adverse reactions to medications.