What is Office Hysteroscopy?
Office hysteroscopy is a minimally invasive procedure that uses a hysteroscope to diagnose and treat abnormalities of the endometrial cavity and the endocervical canal. This procedure is performed in a clinic or office setting and enables direct visualization of the uterus without the need for general anesthesia or an operating room.
A hysteroscope is a thin, flexible fiberoptic tube with a camera and a light attached at the end that allows internal viewing of the structures.
Advancement in technology has led to the development of miniaturized operative hysteroscopes and electrified/mechanical instruments that has enabled surgeons to perform many surgical interventions on the uterine cavity safely and effectively in an office setting.
Indications for Office Hysteroscopy
Office hysteroscopy is most commonly indicated to find causes of abnormal uterine bleeding in women whose menstrual periods are heavier or longer than usual or more frequent than normal.
Office hysteroscopy is also indicated to:
- Diagnose abnormalities in the uterus, such as fibroids or polyps and perform polypectomy
- Remove adhesions or scarring in the uterus that may occur due to past surgery or infection
- Diagnose the cause of recurrent miscarriages
- Locate an intrauterine device (IUD)
- Perform sterilization, in which small implants are placed into a woman’s fallopian tubes as a permanent form of birth control
- To confirm Asherman’s syndrome or congenital uterine anomaly when there is a clinical or ultrasound suspicion
Contraindications for Office Hysteroscopy
Office hysteroscopy is contraindicated in women with:
- Pelvic infection
- Heavy uterine bleeding
- Pregnancy
- Cervical cancer
Preparation for Office Hysteroscopy
Preparation for office hysteroscopy involves the following steps:
- A detailed medical history and clinical assessment is conducted prior to the procedure.
- A bimanual examination is recommended to look for uterine position, shape, and volume.
- Your temperature, blood pressure, and heart rate are monitored.
- Your urine sample is collected to check for pregnancy and infection.
- It is advisable to conduct the procedure within the first few days after the period ends as the endometrium is thin and assessment is easier.
- An informed consent is obtained after explanation of the procedure.
Procedure for Office Hysteroscopy
Office hysteroscopy procedure involves the following steps:
- Your doctor may dilate or open your cervix before hysteroscopy.
- A speculum is placed into the vagina.
- The cervix is cleaned with an iodine or cleansing solution.
- A hysteroscope is inserted through the cervical opening into the uterus.
- Carbon dioxide gas or saline (saltwater) fluid is placed through the hysteroscope into the uterus to expand it.
- The fluid or gas helps your doctor to clearly visualize the uterine lining and fallopian tubes through the hysteroscope and look for any abnormalities.
- If a procedure or biopsy is required, then small miniature instruments are passed through the hysteroscope and the necessary procedure is performed with the aid of images displayed in the monitor.
Post-Procedure Care and Instructions
You should be able to go home shortly after the procedure. You may experience some mild cramping or pain. You may also experience watery discharge or spotting. You may be given medications to alleviate pain and other symptoms. You might also experience bloating due to gas that may last for a day. You must avoid sex for at least two weeks post procedure. If you experience excessive bleeding, cramping, chills, fever, pelvic or abdominal pain, you should seek immediate medical attention. A follow-up appointment should be made to monitor your progress.
Risks and Complications of Office Hysteroscopy
As with any surgery, there may be certain risks and complications associated with office hysteroscopy, such as:
- Pain
- Bleeding
- Infection
- Puncture of the cervix or uterus
- Excess fluid accumulation
- Damage to nearby organs
- Pelvic inflammatory disease