Diagnosis And Treatment Of Abnormal Vaginal Bleeding

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Hysteroscopy Procedure


What Is A Hysteroscopy?
What Does It Test For?
What Can It Treat?
How Is It Done?
What Are The Risks Associated With Hysteroscopy?
What Is A Hysteroscopic Myomectomy?
Personal Stories

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What Is A Hysteroscopy?

A hysteroscopy is a procedure used to diagnose and treat problems inside the uterus (womb). During the procedure a clinician inserts a thin, lighted tube (with a camera) called a hysteroscope through the vagina and cervix and into the uterus. This technique can be used both to diagnose and treat problems. It is usually performed on an outpatient basis (you go home same day) under local anesthesia (the vaginal area only is numbed). A regional (lower body) or general anesthesia (completely unconscious) is necessary when it is used for treatment purposes.

What Does It Test For?

It is usually ordered because the woman is suffering symptoms that suggest there is a problem with her womb. These symptoms might include:

• Abnormal vaginal bleeding (bleeding between periods)
• Heavier periods than normal
Irregular periods
• Bleeding after menopause
• Pelvic pain
• Repeated miscarriage
• Unusual vaginal discharge.

What Can It Treat?

It can be used to treat abnormal growths, if found, in the womb such as:

Uterine polyps: Small growths that can grow in the lining of the womb and cause irregular or heavy periods.
Uterine fibroids: Benign growths that can grow in the womb causing pain, heavy periods and even infertility.
• Adhesions and scar tissue: These can cause missed periods and infertility.

It can be used to remove an IUD device that has become lodged in the womb. It can also be used for tubal ligation (having your tubes tied to prevent pregnancy). In this procedure a probe is passed through the scope and a small electric current is emitted which burns and seals the fallopian tube openings. This technique is known as electrocautery.

How Is It Done?

Diagnosis Purposes

When a hysteroscopy is performed for diagnostic purposes, it can be done in a gynecologist’s office. You will be asked to remove clothes from your lower half and lie back on the examination couch. Your legs will be placed in stirrups to keep them widened and a speculum is inserted to keep the walls of the vagina open. The doctor will inject a local anesthetic around the cervix, which may initially be a little painful. After a few minutes, when the area is numb, a narrow lighted tube (with camera) is passed through the cervix and into the womb. The doctor will carefully view the area on a video monitor. Hysteroscopy is used for similar diagnostic reasons as a D&C, only that hysteroscopy is much better because the whole womb can be viewed on monitor. The complete procedure takes about half an hour.

Treatment Purposes

If a hysteroscopy is performed for treatment purposes, it is done in an operating theatre and regional or general anesthetic is used. Gas may be injected to inflate the womb to give the surgeon a better view. If your surgeon plans to remove growths, surgical instruments will be inserted through the hysteroscope to snip or scrap out the tissue. This type of surgery can take several hours, depending on what needs to be done. No overnight hospital stay is necessary.

Recovering From Hysteroscopy

• You may have light bleeding and cramping for a few days after your hysteroscopy, this is normal. You can take painkillers to deal with the pain (the same sort of painkillers you would take for a period pain).
• You may have some temporary shoulder pain if gas seeped into your tissues.
• You should be able to return to work the next day.
• Avoid having sexual intercourse for 2 weeks.

What Are The Risks Associated With Hysteroscopy?

Very rarely (1 in 250 cases) an infection of the uterus will occur. Or, there may be some accidental damage to the cervix or womb which needs further surgery to correct (1 in 135 cases). Hysteroscopy performed in an operating theatre under regional or general anesthesia carries the additional risks associated with these medications. Overall, hysteroscopy is considered a relatively safe procedure.

What Is A Hysteroscopic Myomectomy?

A myomectomy is a surgical procedure to remove uterine fibroids. There are several ways of performing myomectomy. One involves making an incision across the tummy (abdominal myomectomy laparotomy). Another involves smaller incisions in the tummy (laparoscopic or robotic myomectomy). A hysteroscopic myomectomy utilizes hysteroscopy procedure, removing the fibroids through the vagina. That is the technique described in this article. Hysteroscopy is more suitable for removing small fibroids.

Personal Stories

I had a hysteroscopy done recently to remove a uterine polyp after a failed IVF cycle. I was having a brown discharge between periods and problems getting pregnant. During the surgery they also found a fibroid, and removed it along with the polyp. It turns out that the polyp or fibroid was causing the brown discharge. I’m so happy that I had it done. I don’t have any more breakthrough bleeding and the pressure in my lower abdomen is gone. My period has also changed. I used to have heavy periods in the past and now they are normal. I’m hoping I’ll get pregnant now too.
Zusie, Kentucky

I had a fibroid removed by hysteroscopy a few months ago. It took about a week to recover, but the doctor told me no sex or baths for 2 weeks. Showers only, no tampons or douching. I had cramps for about 3 days and some spotting. But I was back at work within 24 hours. It took about 2 days for the anesthesia to work its way out of my system. The surgery took 2 hours and I spent 4 hours after in the recovery room before going home.
Juliet, Lexington

After my first pregnancy I started getting abnormal Pap smear test results. I was offered a hysteroscopy but as there was a risk of miscarriage I put it off (I was pregnant with my second). I had an ultrasound instead and the nurse discovered a lot of scar tissue on my womb. After delivery, I had a hysteroscopy to confirm what the ultrasound scan showed. There was scar tissue and they removed it. I’ve had normal Pap results since and a third child!
Charlie, Dallas

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