What is hysteroscopy?


Hysteroscopy is a common procedure used to identify, diagnose or treat several issues in the woman’s uterus. The procedure is conducted using a piece of equipment known as a hysteroscope, a thin and flexible tube fitted with a camera and a light. It is a similar instrument to the ones used in keyhole surgery and other investigative procedures. Although it is natural to be nervous before undergoing a hysteroscopy, it is not something you should unduly worry about.

A hysteroscopy can be performed in a hospital, although some fertility clinics in Bangkok also perform the procedure. It is important that when your doctor has advised you that you need a hysteroscopy, that you choose the right hospital or clinic to conduct the operation as those with modern equipment will give a far more accurate diagnosis. It is covered by many health insurance policies, so you should speak to your provider or broker before undergoing any treatment.

What happens prior to a hysteroscopy?

Once it has been decided that you require a hysteroscopy, your doctor will advise what, if any, medication your need to take beforehand. Some people may be given a sedative, a tablet that will help them remain calm; others may have a local anaesthetic where the vagina and lower abdomen will be numbed, usually by an injection. In some cases, although it is becoming increasingly rare, they may be given a general anaesthetic, which will mean that you will be asleep during the operation. Your doctor will talk to you about which is most appropriate for you.

What does a hysteroscopy entail?

A hysteroscope is used to inspect the uterine cavity and will enter via the cervix. It is frequently used to diagnose intrauterine pathology and would be classed as a surgical procedure. After you have been given one of the medications outlined above, the doctor will insert a speculum (a medical tool that looks similar to the bill of a duck) into the vagina, thus allowing easy access to the cervix and finally the uterus.

Once the hysteroscope is in place, the uterus will be filled with a harmless gas called carbon dioxide, or a fluid such as saline solution (salt water) and this is done via the hysteroscope. The purpose of this is to expand the uterus, which will make it easier for the doctors to view the uterus’ lining and the entrance to the fallopian tubes. The amount of gas or fluid in the uterus will be monitored throughout the procedure. The hysteroscope can be used to pass small tools into the uterus allowing the doctor to perform a biopsy or other surgical procedures.

Why might a doctor suggest a hysteroscopy?

Your doctor may suggest a hysteroscopy if you have been experiencing problems such as heavy menstrual cycles, cramping, or having problems conceiving. In many cases, it may be a combination of these problems that leads the doctor to believe that it needs further investigation. However, a hysteroscopy may be suggested for various other complaints, including bleeding between cycles, experiencing bleeding after you have been through the menopause, or checking for the presence of polyps, fibroids or scarring in or on the uterus.

In some cases, a hysteroscopy may be a follow-up procedure such as returning abnormal results from a Pap test, taking a biopsy (a small amount of tissue) from the uterus for further analysis, to investigate fertility issues or why the female has experienced more than one miscarriage. Sometimes a hysteroscopy may be suggested if contraceptive devices such as an IUD or coil has become misplaced or is causing discomfort. If the lady decides that she wishes to undergo permanent birth control, the doctor may suggest that the sterilisation procedure be conducted using a hysteroscope.

What should I expect after a hysteroscopy?

In most cases, you will be allowed to go home a few hours after the procedure once the doctors are satisfied that you have suffered no adverse reaction. If a sedative has been used, you will be allowed to go home once it has worn off, but if a local anaesthetic were used, you would need to make arrangements for someone to collect you. In most cases where a general anaesthetic is used, you will be required to stay overnight at the hospital or clinic and again be collected the following day.   

Mild cramping and minor bleeding are to be expected for up to a week after undergoing the procedure, and gas or fluids may be involuntarily released for 24 hours. Your doctor will likely issue you with medication to help with pain relief. You should avoid vaginal intercourse for a minimum of two weeks following a hysteroscopy. You will be advised on a more personal level of what you may expect and how you should look after yourself by a member of the medical team when you are discharged.

Are there any risks involved?

Unfortunately, all medical procedures carry an element of risk, but all efforts are made to minimise them. Some relatively common complications reported include a reaction to the anaesthesia, although this is usually only when the patient has undergone a general anaesthetic and infection of wounds. Other rare complications include pelvic inflammatory disease, physical damage to organs located close to the uterus such as bladder, bowel, or ovaries, and tears or other damage to the cervix.

It is vital that if you experience heavy bleeding, a fever (meaning a temperature of above 37.5 degrees Celsius) or severe abdominal pain that you seek immediate medical attention. Any of these problems could signify a problem that will need to be investigated by a medical professional and treated appropriately.

What can be done if the hysteroscopy revealed a fertility issue?

If you have been diagnosed with a fertility problem, don’t worry; it doesn’t necessarily mean that you can’t have children. As the leading fertility clinic in Bangkok, we will be able to discuss the available options. It may include in-vitro fertilisation (IVF) or a series of other treatments that we can offer. A member of our team will talk you through each procedure, allowing you to make an informed choice on how you will proceed.