Hysteroscopy for Abnormal Bleeding of the Uterus

What is a hysteroscopy?

Hysteroscopy is a procedure for looking at the inside of the uterus with a thin, flexible, lighted tube. The lighted tube is called a hysteroscope. The uterus (womb) is the muscular organ at the top of the vagina. Babies develop in the uterus, and menstrual blood comes from the uterus. Hysteroscopy is used to diagnose and treat problems inside the uterus or cervix.

When is it used?

Your healthcare provider may recommend this procedure if you have abnormal bleeding from the uterus, such as:

• heavy menstrual bleeding that goes on for a long time
• bleeding between periods
• bleeding after menopause
• no menstrual bleeding (amenorrhea)

Hysteroscopy can help find the cause of the abnormal bleeding. For example, it may be caused by growths in the uterus called polyps or fibroids. The procedure can be used to take a sample of tissue from the uterus (a biopsy) to check for cancer. It may also be used to treat a problem that is causing abnormal bleeding. For example, polyps or fibroids may be removed. The procedure is quick with a fast and easy recovery. In many cases, it can be done safely in your healthcare provider’s office.

Instead of this procedure, other procedures to find the cause of abnormal bleeding may include:

• an ultrasound scan, which is a way to get pictures of the uterus with sound waves
• D&C (dilation and curettage), which is a procedure for opening the cervix and then scraping or suctioning tissue from the uterus
• a special type of X-ray exam, such as a hysterosalpingogram (putting dye into the uterus so it can be seen with X-rays)
• CT scan or MRI to get pictures of the uterus
• endometrial biopsy (the insertion of a tiny tube through the vagina and into the uterus to remove a sample of the inner layer of the uterine wall)

You should not have this procedure if:

• You are or have just recently been pregnant.
• You have a uterine or pelvic infection. Some vaginal or urinary tract infections may also be a reason to avoid or postpone the procedure.
• You have cancer of the uterus or cervix.
• You have had recent surgery on the uterus.

You may choose not to have treatment. Ask your healthcare provider about your choices for treatment and the risks.

How do I prepare for this procedure?

• Make plans for your care and recovery after you have the procedure. Find someone to give you a ride home after the procedure. Allow for time to rest and try to find other people to help with your day-to-day tasks while you recover.
• Before you have the procedure, you may take medicine that blocks the ability of your body to make estrogen. This will shrink the lining of the uterus.
• Follow your provider's instructions about not smoking before and after the procedure. Smokers may have more breathing problems during the procedure and heal more slowly. It is best to quit 6 to 8 weeks before surgery.
• Some medicines (like aspirin) may increase your risk of bleeding during or after the procedure. Ask your healthcare provider if you need to avoid taking any medicine or supplements before the procedure.
• You may or may not need to take your regular medicines the day of the procedure, depending on what they are and when you need to take them. Tell your healthcare provider about all medicines and supplements that you take.
• Your provider will tell you when to stop eating and drinking before the procedure. This helps to keep you from vomiting during the procedure.
• Your provider may put a laminaria stick (a small rod made of seaweed that absorbs moisture) into the opening of the cervix the day before the hysteroscopy to help soften and gently open the cervix. This can make the procedure easier and safer to perform.
• Follow any other instructions your healthcare provider gives you.
• Ask any questions you have before the procedure. You should understand what your healthcare provider is going to do.

What happens during the procedure?

Hysteroscopy may be done in your healthcare provider's office, at a surgical center, or at the hospital.

You will be given local, regional, or general anesthesia to keep you from feeling pain. Local or regional anesthesia numbs part of your body while you stay awake. With local or regional anesthesia you may also be given medicine to help you relax. General anesthesia relaxes your muscles and you will be asleep.

Your healthcare provider may gently stretch open (dilate) your cervix using tools called cervical dilators. (The cervix is the opening to your uterus.) Your provider will guide the hysteroscope into your vagina, through the cervix, and into your uterus. Gas or fluid may be released through the scope to inflate your uterus. This helps your provider see inside the uterus better. He or she may:

• Take a sample of tissue for tests.
• Remove tissue that is or looks abnormal (fibroids or polyps).
• Use a laser or other device that uses electricity to remove or destroy the endometrial lining of the uterus and improve bleeding symptoms.

What happens after the procedure?

After the procedure you may stay in a recovery area for at least a few hours and then usually you can go home.

After the procedure you may:

• feel sleepy or groggy from the anesthetic
• have some cramps
• have trouble urinating for the first few hours
• have a watery or bloody discharge for 3 or 4 weeks

Ask your healthcare provider:

• how and when you will hear test results
• how long it will take to recover
• what activities you should avoid
• how to take care of yourself at home and when you can return to your normal activities
• what symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup.

What are the risks of this procedure?

Hysteroscopy is a very safe procedure and rarely has complications. Your healthcare provider will explain the procedure and any risks. Some possible risks include:

• Anesthesia has some risks. Discuss these risks with your healthcare provider.
• You may have infection or bleeding.
• Rarely, the uterus may be punctured and need surgery to repair it.
• Rarely, the bowel or bladder may be injured.
• You may have an allergic reaction to the fluid used during the procedure.

There is risk with every treatment or procedure. Ask your healthcare provider how these risks apply to you. Be sure to discuss any other questions or concerns that you may have.