Diagnostic & Operative Hysteroscopy: Why is it done, How is it Done

The female reproductive organs include the uterus or the womb where the fetus is implanted, and the ovaries where the eggs are created and stored. Other structures that are associated are the fallopian tubes, cervix, vagina, vulva, and clitoris. A slight trouble in any of these could lead to various troubles such as infertility, unusual bleeding, etc. and hence finding the root cause is very important. To determine that each and every organ of the female reproductive system is working properly, the hysteroscopy is done.

Hysteroscopy is a diagnostic test as well as an operative procedure that is done with the help of a thin instrument called a hysteroscope. It is a telescope-like instrument with a camera and a light on top of it that is inserted right through the vulva, vagina and the cervix to check into the uterus. The test is run to check if there is any problem inside the uterus or on the lining of the uterus.

Hysteroscopy is a procedure that is done exclusively on women to check and also to operate on either of their female reproductive organs, especially on the uterus. Hysteroscopy is not only a diagnostic test, but it is also a operative method that is used to treat several conditions and problems in the uterine region and in any part of the female reproductive system.

Diagnostic hysteroscopy is done to determine the problems and difficulties listed below:

1. Diagnostic Hysteroscopy Procedure Helps in Diagnosing the Cause of Bleeding:

   Diagnostic Hysteroscopy is done in case of severe and abnormal bleeding and also to find the cause of cramping, especially after menopause. However, Diagnostic hysteroscopy is done only when different medications haven’t solved the trouble of heavy and consistent bleeding. Not only after menopause, if a woman is still in her menstrual age and if she bleeds in between her two periodic cycles, diagnostic hysteroscopy is done.

2. Diagnostic Hysteroscopy Helps in Identifying the Cause of Infertility:

   To check if there is any damage or problem in the uterus, if the wall or the lining of the uterus is damaged and whether that damage is the cause of infertility, hysteroscopy is done. In this case, the hysteroscopy can also determine if there is any blockage in the fallopian tubes that is causing the infertility, by not providing favourable condition and space for the egg and sperm to fuse together.

   In some cases, the cause of infertility might be a septum or a malformation of the uterus, since birth. This can be determined with a diagnostic hysteroscopy.

3. Diagnostic Hysteroscopy is Done to Identify Any Cancer or Polyps:

   The doctor may also diagnostic hysteroscopy to check if there are any cancerous cells or malignant development on the walls of the uterus. In case cervical or uterine cancer is found during the test, the doctor might also collect tissue samples of the abnormal endometrial cells through this process. Polyps or small lumps on the lining of the uterus can also be determined in the uterine region, through hysteroscopy.

4. Diagnostic Hysteroscopy Helps in Diagnosing Endometrial Hyperplasia:

   When there is a chance for a uterine or cervical cancer to occur, the uterine lining of the woman becomes too thick and this can be checked by diagnostic hysteroscopy and the doctors can determine this as a precancerous condition.

When diagnostic hysteroscopy determines few conditions or problems that are seen to have developed in the female reproductive system, the operative hysteroscopy is done to treat them. Operative hysteroscopy is a process that can be run along with a diagnostic hysteroscopy in which, as soon as a problem is detected, with the help of a few simple tools, the problems are treated. These tools are sent right through the help of the hysteroscope. Operative hysteroscopy is a very useful method as it does not require a separate surgery.

Operative hysteroscopy helps in treating the following medical conditions:

1. Operative Hysteroscopy Helps Treat Polyps and Fibroids:

   When non-cancerous lumps have developed on the wall of the uterus, they are removed with the help of hysteroscopy.

2. Operative Hysteroscopy Helps Treat Bleeding:

   To treat bleeding between periods, heavy and long menstrual flow and bleeding after menopause, Operative Hysteroscopy is done. In some cases, Endometrial Ablation is done to destroy the wall of the uterus, to make sure that along with the uterine wall, some of the problems too have been destroyed. This is done mostly in those cases, where the woman has had a baby or has reached almost the age of menopause and is not in the need for fertility.

3. Operative Hysteroscopy is Done to Treat Adhesions:

   Adhesion or Asherman’s Syndrome is a condition in which the walls of the uterus stick together and thereby, cause disturbance and changes in the flow of menstrual cycle and also cause infertility. The stuck uterine walls can be separated by the operational hysteroscopy.

4. Treat Septum:

   If there is a malformation in the uterus since birth and if that is causing infertility, it can be treated with this method.

5. Operative Hysteroscopy is Done to Place Contraceptive:

   For different birth control measures, hysteroscopy is a very useful method. It is done to place Essure and other contraceptive implants at the mouth of the fallopian tube, to make sure that it is a permanent sterilization. Sometimes, when the IUD or intrauterine devices are misplaced, hysteroscopy can find them and replace them.

Moreover, if there have been complications in your earlier pregnancies and you are choosing the IVF or In Vitro Fertilisation treatment to conceive the baby, it is very important, rather a must that you have the hysteroscopy. Even if your doctor does not recommend one for you, you must insist on having one, to make sure that your uterus or womb is healthy and ready to have the baby. The benefit of this is that in case of any uterine abnormality or difficulty, it can be treated beforehand, even before the IVF process starts. A good percentage of women, who underwent IVF and still resulted in failure in conception, were found that the problem was with their uterus and they had to start all over again from treating the uterus. Hence, hysteroscopy can pre-determine if there is any problem or not.

Hysteroscopy is an out-patient process that does not require you to stay admitted into the hospital and can be done in the doctor’s clinic. No anaesthesia is required for this process and it only take 2 to 5 minutes to complete it. The steps that follow are:

• Clearing the bladder
• Removing the clothes and wearing a gown and lying on the operational table with the feet in stirrups
• Cleaning the vaginal with an antiseptic solution
• Dilation of the cervix prior to the hysteroscopy
• Insertion of the hysteroscope through the vagina, cervix and the uterus
• A gas or fluid might be inserted to have a clearer and enlarged view
• Sample for biopsy might be collected if needed
• In case a problem is diagnosed, operative hysteroscopy is done
• Upon completion, the hysteroscope will be removed.

Once the hysteroscopy procedure is completed, you can return to normal schedule. If only you are given anaesthesia before undergoing hysteroscopy procedure, you may take a little longer time to return to normal routine.

Medicines are advised for treating soreness following hysteroscopy procedure. A little bleeding for a day or two is natural along with a little temperature. If fever persists with heavy bleeding and heavy vaginal discharge, report to the doctor immediately. Hysteroscopy does not have any risk otherwise, but if the air or fluid that is used to get a clear view of the uterus gets into the blood stream, it might cause serious problems. In such cases, seeking immediate medical attention is a must.