Hysteroscopy
Hysteroscopy is the most accurate examination to assess the anatomy of the uterine cavity - its shape, mucosa, and fallopian tube orifices. As hysteroscopy can reveal abnormalities that are not visible on ultrasound (USG), it is a valuable diagnostic and surgical tool, also in the case of infertility. The examination allows not only diagnosis, but also the removal of certain lesions and makes it possible to take a mucosal slice.
What is a hysteroscopy?
Hysteroscopy is a diagnostic and therapeutic procedure used to assess the shape of the uterine cavity, the condition of the endometrium and the uterine orifices of the fallopian tubes. During the examination with a hysteroscope, the doctor performs a detailed visualisation of the inside of the uterus and can thus see even small pathological changes within the mucosa, such as endometrial polyps, submucosal myomas and intrauterine adhesions.
How to prepare for a hysteroscopy?
Hysteroscopy is most often performed under general intravenous anaesthesia. For this reason, the patient should report for the procedure on an empty stomach.
The hysteroscopic examination is performed in the first phase of the menstrual cycle (before ovulation). Slight spotting occurring towards the end of menstruation is not a contraindication to the procedure.
The following investigations should be done before the hysteroscopy:
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VDRL,
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cytological examination,
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blood group determination,
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cervical canal culture (anaerobic and aerobic),
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Anti-HCV-Ab,
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Anti-HBC IgM,
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HBs Ag
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Anti-HIV-1,2.
Occasionally, it is necessary to perform additional tests, for example an ECG and a chest X-ray in women who are over 40 years of age. Preparation for hysteroscopy may also include the use of hormonal medication, which affects the thickness of the endometrium.
Patients who have a history of allergy symptoms to any medication should inform their doctor before qualifying for the procedure.
Contraindications to hysteroscopic examination
Diagnostic hysteroscopy cannot be performed during pregnancy. The onset of menstrual bleeding is also not an appropriate time to perform the examination. An important contraindication for assessment of the inside of the uterus is ongoing inflammation.
Does a hysteroscopy hurt?
Hysteroscopy is usually a painless examination for most patients, but for the comfort of the woman the examination is performed under general anaesthesia.
Tests required for anaesthesia:
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Blood morphology
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APTT
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Sodium
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Potassium
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Glucose
When is it worth having a hysteroscopy?
Hysteroscopic examination is recommended for women who:
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experience menstrual disorders (especially intermenstrual bleeding),
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have a history of miscarriages,
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are trying unsuccessfully to have a child.
Indications for hysteroscopy are also:
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pathological changes in the endometrium previously detected by ultrasound,
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anatomical defects of the uterus,
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suspected intrauterine adhesions.
Hysteroscopy and endometrial polyps
Endometrial polyps can cause difficulties in getting pregnant. In patients trying for pregnancy, they should be removed. The excised lesions will then be examined histopathologically (statistically 1% lesions of this type are malignant).
Information on uterine polyps can be found on many medical websites, but the most reliable information will be provided by your doctor during your consultation.
Operative hysteroscopy
Operative hysteroscopy, also referred to as operative hysteroscopy, helps in the diagnosis of excessively heavy periods, endometrial proliferations, anatomical abnormalities of the uterus and the aforementioned pathological changes (polyps, myomas and intrauterine adhesions).
The surgical hysteroscopy procedure is performed transvaginally. The continuity of the abdominal lining is not interrupted.
Recommendations and possible discomfort after hysteroscopy
Recommendations
After a surgical hysteroscopy, a woman can go home after only two hours (unless there is a need for daily observation of the patient) and the healing process is much shorter than in the case of a classic transabdominal operation. No lifting or strenuous exercise is allowed during the recovery period.
Ailments
A hysteroscopy of the uterus is a minimally invasive procedure that may, however, cause some discomfort for the patient. The most common are spotting from the genital tract and mild lower abdominal pain. Symptoms that cannot be underestimated include heavy bleeding, fever and severe lower abdominal pain
Price of hysteroscopy
In Invimed clinics, hysteroscopy is performed by experienced medical teams consisting of a gynaecologist, anaesthetist, midwives and nurses. Prices for diagnostic hysteroscopy - depending on the clinic - start from £1,100 and for surgical hysteroscopy from £1,600. Current prices can be found in the price list of the chosen clinic. Hysteroscopy is always performed with anaesthesia (payable separately).
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Medical consultation of the article: Wojciech Rawski, MD, gynaecologist-obstetrician, treating couples at the Invimed clinic in Warsaw. She has extensive experience in endoscopic procedures. Performs surgical and diagnostic hysteroscopies.
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