Hysteroscopy: An expert's guide

In his latest online article, renowned consultant gynaecologist Mr Johnson Amu delves into hysteroscopy. He explains the purpose of a hysteroscopy, the amount of discomfort during the procedure, and what it can diagnose.

What is a hysteroscopy, and what is its purpose in gynaecological care?

A hysteroscopy is a procedure performed to assess the inside of the womb cavity. It involves using a small telescopic camera to examine the womb's interior properly. This procedure is typically conducted when there are concerns, primarily with irregular bleeding, and particularly in women who have undergone menopause. The purpose is to ensure there are no underlying issues causing the bleeding.

Hysteroscopy is also used in women who haven't experienced menopause but have noticed changes in their bleeding patterns. Additionally, it can be part of the assessment for women undergoing fertility investigations.

Is a hysteroscopy painful, and what can I expect during the procedure?

A hysteroscopy can be performed in two ways. One is under anaesthesia, where the patient feels nothing at all. The other method is while the patient is awake in a gynaecological clinic, where some women may experience discomfort or mild pain. The level of discomfort varies among individuals; while some liken it to menstrual discomfort, others find it a bit uncomfortable but manageable.

Generally, most women undergo this procedure while awake. However, we recommend taking simple painkillers at least an hour before the procedure. Having someone to talk to, such as nurses, and having hand-holding support during the procedure significantly helps women cope. The procedure is short, typically lasting about five to ten minutes, so most women can manage within this time frame.

What are the common conditions or issues that a hysteroscopy can diagnose or treat?

The primary purpose of hysteroscopy is to assess the womb cavity, often due to irregular bleeding or thickening of the womb lining detected via ultrasound, which might indicate a polyp. A hysteroscopy helps confirm these findings, and if a polyp is present, it can be removed during the procedure.

Additionally, it allows for a proper assessment and biopsy if there's thickening. A hysteroscopy can also locate misplaced IUCD or COIO after insertion and can be part of certain procedures for women undergoing fertility investigations.

Are there any risks or complications associated with hysteroscopy?

When performed while awake, serious complications are exceedingly rare due to the patient's consciousness limiting the procedure's extent, especially if pain arises. However, under general anaesthesia, risks include mild cramping and some watery bleeding for a few days. Infection is a possibility, but it's typically manageable with antibiotics.

The rare but serious complications might involve injury to the womb, such as perforation. In extremely rare cases, this could extend to affect surrounding organs. This necessitates additional procedures or surgeries. Nevertheless, these complications are uncommon.

How should I prepare for a hysteroscopy, and what is the recovery process like?

If the hysteroscopy is performed while under general anaesthesia, you will be given a scheduled time to arrive at the hospital. The procedure usually takes less than half an hour from start to finish, allowing you to go home the same day. Recovering from a hysteroscopy under general anaesthesia might take a day or two.

However, for procedures performed while awake, the recovery time is shorter, often allowing patients to resume their normal activities after the procedure. Painkillers may be needed based on the level of discomfort experienced. It's advisable to:

• seek advice from those who have undergone the procedure
• consider bringing a supportive family member or friend with you
• and take simple painkillers at least an hour before the procedure, such as two paracetamol or ibuprofen

If you would like to book a consultation with Mr Johnson Amu, you can do so today via his Top Doctors profile.