Hysteroscopy

Hysteroscopy is a procedure whereby a narrow telescope (called a hysteroscope) attached to a camera is passed via the cervix into the uterus to visualize the inside of the uterus (endometrial cavity).

Types of hysteroscopy

There are two reasons why hysteroscopy is performed.

• Diagnostic hysteroscopy – to make a diagnosis of a symptom.
• Operative hysteroscopy – to perform a surgery.

Indications for performing hysteroscopy

The reason for performing hysteroscopy will depend on whether it is for diagnosis or surgery. This is discussed in chapter 37 (diagnostic hysteroscopy) and chapter 38 (operative hysteroscopy).

The best time to perform a hysteroscopy

• Just after menses (before ovulation) – the endometrium is thinnest just after menses and so the cavity can be seen well. This also removes the worry of performing a hysteroscopy during a pregnancy.
• In post menopausal women, hysteroscopy can be performed at anytime
• In patients who have irregular or prolonged bleeding, hormones should be given to stop the bleeding before hysteroscopy is performed. However, if bleeding persists, hysteroscopy should be performed despite the bleeding.

When is hysteroscopy not advisable?

• During menses or per vaginal bleeding – It will be difficult to visualise the endometrial cavity during menses.
• Pregnancy – If pregnancy is suspected hysteroscopy must be avoided because the procedure may injure the foetus.
• Pelvic Inflammatory Disease (PID) – In patients who have PID or are suspected to have PID, hysteroscopy must be avoided to prevent the infection from flaring up.
• Cancer of the cervix – In patients suspected of having cancer of the cervix hysteroscopy should not be done.
• Acute herpes infection
• Heavy vaginal discharge – this may be caused by sexually transmitted disease (eg trichomonas, gonorrhoea, chlamydia). A swab must be taken for culture and treatment must be given before the hysteroscopy.

Complications

Complications can occur during both diagnostic and operative hysteroscopy. Complications can be divided into :

• intraoperative (occurring during the procedure)
• postoperative (occurring after the procedure)