A hysteroscopy is a simple and safe gynecological test which many women today are still unaware of. It serves to detect, diagnose and correct uterine problems and, furthermore, can help to understand what the cause of infertility is in women who have been trying to get pregnant for more than a year.
HOW IS A HYSTEROSCOPY PERFORMED?
Hysteroscopy is a procedure in which the interior of the cervix and the uterus is examined using an optical system which transmits images. For the procedure, the woman lies down on gynecological couch in the required position, or lithotomy (birthing) position. The gynecologist will insert a speculum to widen the vagina and clean the vagina and cervix with a disinfectant iodine solution. A hysteroscope, a long thin tube with a light and camera, is then introduced through the cervix.
To dilate the uterine cavity and give a better visibility of the area, carbon dioxide or a physiological liquid is gently pumped into the uterus. This enables the gynecologist to see images of the inside of the uterus on a monitor, to study the womb in detail and arrive at a diagnosis.
It is a relatively simple technique that doesn’t leave scars or wounds. Usually, recovery is quick, it is performed as an out-patient procedure and allows the patient to go about her normal life later the same day.
WHY IS A HYSTEROSCOPY ORDERED?
Hysteroscopy serves to visualize, diagnose and treat various anomalies that can occur inside the uterus. Among these, the following can be found:
- Cause of miscarriage: this technique can provide vital clues as to why a woman has suffered a minimum of two repeat miscarriages.
- Reasons as to why pregnancy has not been achieved (female infertility): hysteroscopy can help to understand why the woman has not managed to get pregnant after more than a year of trying.
- Cause of abnormal bleeding: to diagnose the cause of abnormally heavy bleeding during menstruation, bleeding between periods or bleeding in menopause (postmenopausal metrorrhagia).
- Detect and remove fibroids and polyps: these are two types of abnormal uterine growths that, although not usually cancerous, are better to have examined.
- Remove scar tissue form the uterus: this tissue can be formed from possible secondary traumas from surgeries such as myomectomy (a surgical procedure to remove uterine fibroids) and it can be advisable to have them removed.
- Put in or take out an intrauterine device (IUD): an device used as a long term contraceptive method which is placed in the uterus and stops the woman from becoming pregnant. It can be removed at a patient’s request or because of expiry.
- Before starting any fertility treatment: in this case the objective is to check that everything is correct before starting treatment and pregnancy.
Despite its simplicity, the hysteroscopy is considered to be an invasive technique and, as such, is not included in the routine fertility study if it is not necessary (according to each individual case).
TYPES OF HYSTEROSCOPY
This simple test can take between 15 minutes to an hour, depending on the technique employed. There are two types of hysteroscopy:
Used to diagnose endometrial abnormalities (adhesions, polyps, endometrial neoplasm…) or those in the uterus (fibroids or deformities). It is a quick test, which is done in the gynecologists consulting room and does not require anesthesia, as it is minimally invasive. However, in certain cases local anesthesia or mild sedation may be used to avoid the patient’s discomfort. If the professional sees small anomalies during the procedure, they may remove them for biopsy.
This is carried out when the patient has a previous diagnosis of a uterine or endometrial alteration that can be corrected through surgery. It is performed in the surgical theatre under general anesthesia, as a larger hysteroscope and other gynecological instruments are used.
HOW CAN I PREPARE FOR A HYSTEROSCOPY?
For a hysteroscopy, a woman should not be menstruating, to avoid incorrect results. She should also not be pregnant, as the test could damage the fetus. In addition, douching and vaginal creams should be avoided during the 24 hours previous to the examination.