What is a hysteroscopy?

Hysteroscopy is a way to look inside the uterus. A hysteroscope is a thin, telescope-like device that is inserted into the uterus through the vagina and cervix. It may help us diagnose or treat a uterine problem. It is often combined with a curettage, which samples the lining of the uterus.

Why is a hysteroscopy performed?

To diagnose certain problems, we need to look directly into the inside of the uterus. Common reasons for undergoing a hysteroscopy include the assessment of heavy periods, abnormal vaginal bleeding, postmenopausal bleeding, fibroids, polyps or as part of the assessment of fertility. You should have a clear understanding of your reason for this surgery – if not, please ask your doctor.

What are the alternatives?

This depends on the nature of your problem. An ultrasound scan can provide some helpful information. A small sample of the lining of the uterus may be able to be taken in the outpatient clinic to help rule out some problems, however, a hysteroscopy may be the only way to diagnose certain conditions.

How is a hysteroscopy done?

Hysteroscopy is minor surgery that may be done in an operating room. In some cases, little or no anesthesia is needed. The cervix is widened (dilated) and a telescope is passed to look at the inside of the uterus. A sample of the lining is often taken to be examined more closely. It is also possible to remove a polyp or a fibroid with a hysteroscope. This procedure does not involve any cuts or stitches to the abdomen. It takes approximately ten minutes but you can expect to be in theatre and recovery for a number of hours.

What are the risks of undergoing this procedure?

You should be aware that every surgical procedure has some risk although the risks associated with hysteroscopy are low.

There are some specific risks to be aware of in relation to this operation:

• The procedure may not be able to be completed, due to narrowing of the interior of the cervix. Further surgery may then be necessary.
• It is possible to make a small hole in the uterus (uterine perforation). In most circumstances this is of no consequence, however, this may require a laparoscopy and/or laparotomy, and/or longer stay in hospital than expected. In the event of uterine perforation, there is a risk of damage to adjacent organs, such as bowel or bladder, which may require further corrective surgery.
• Infection could be introduced into the uterus or tubes or abdominal cavity. This would require treatment with antibiotics.
• The uterus may bleed excessively. This may require blood transfusion and further surgery.
• If you were to undergo a general anaesthetic there are some further general risks (inherent to all operations).
• Small areas of the lungs may collapse, increasing the risk of chest infection. This may need antibiotics and physiotherapy.
• Clots in the legs with pain and swelling. Rarely part of this clot may break off and go to the lungs which can be fatal.
• You may suffer a heart attack or stroke because of strain on the heart. Death is an extremely rare possibility for anyone undergoing an operation
• Some women however are at an increased risk of complications.
• Women who are very overweight have an increased risk of wound infection, chest infection, heart and lung complications and blood clots.

Smokers have an increased risk of wound and chest infections, heart and lung complications and blood clots.

Preparation for your surgery

It is important that you have all the tests, which your doctor has ordered, prior to coming to hospital.
If you are taking any blood thinning or arthritis medications they may need to be stopped prior to surgery. Please check with your preadmission nurse or pharmacist.
It is necessary that you have nothing to eat or drink (including water, lollies and chewing gum) at least six hours before your operation. You should stop eating and drinking at the following times on the day of your surgery:

• at 12 midnight for a morning procedure
• at 6 am for an afternoon procedure

It is important for you to shower and dress into clean clothes prior to coming into hospital. No skin products are to be used following your shower (e.g. deodorant, perfume, body lotion, powder)

You need to bring with you:

• All X-rays, blood and ECG test results
• Any medications in their labelled containers or Webster pack
• your Medicare Card
• your completed registration form
• underwear, sanitary pads, toiletries

In some circumstances your surgery may need to be rescheduled or cancelled. If you are feeling unwell or have developed an illness we advise you to make an appointment with your GP who can then inform you if you are well enough to have surgery. If your surgery needs to be rescheduled or cancelled due to advice from a medical practitioner or due to unforseen personal circumstances please notify your gynaecologist as soon as possible.

What should I expect after the procedure?

You will stay in the recovery room within the theatre suite after the operation while you wake up from your anaesthetic. You will then be transferred in your bed to the Day Procedure Unit.
During your recovery your nurse will take frequent observations of your vital signs (e.g. temperature, pulse, blood pressure) for several hours after the surgery. As you become fully recovered, these become less frequent but remain regular until you leave hospital later the same day.
You will be given pain relief as needed.
Your doctor will discuss your follow-up appointment and any discharge arrangements that have been made with you.
You should be eating and drinking normally, and be mobilising.

Discharge advice

It is important that you stay in the company of a responsible adult within the Brisbane region for 24 hours and:
do not drive or operate any heavy machinery
do not consume alcohol for the remainder of the day
do not drive a car, motorbike or ride a bicycle
do not sign any legal documents or make any important decisions
do not engage in sports or heavy lifting.
It is normal to expect some pelvic discomfort. You will be given specific discharge medication if required, but you may use Paracetamol/Paracetamol-codeine as required (one to two tablets every four hours up to a maximum of eight tablets per day).
You should be able to return to work the following day, but may require more time off work depending on the procedure performed.
You may continue to bleed lightly for five to seven days after the procedure.
It is important for you to shower rather than bath.
It is important for you to use sanitary pads and not tampons.

What to avoid:

Intercourse, taking a bath, using tampons and swimming for four weeks.