Hysteroscopy is a medical procedure primarily used to diagnose and treat the causes of abnormal uterine bleeding. During this procedure, the doctor visually examines the inside of the uterus using a special instrument called a hysteroscope—a thin, flexible tube equipped with a light and camera at the tip. The hysteroscope is inserted through the vagina to access and examine the cervix and uterine cavity in detail.
Hysteroscopy can be both diagnostic—to identify the root of the issue—and therapeutic—to treat any abnormalities found during the examination.
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Types of Hysteroscopy
There are two main types of hysteroscopy:
1. Diagnostic Hysteroscopy
This procedure helps identify structural abnormalities within the uterus that may be causing irregular bleeding. It is also used to confirm findings from other imaging tests like ultrasound or hysterosalpingography (HSG).
HSG is an imaging procedure using contrast dye and X-rays to determine whether the fallopian tubes are blocked, which can affect fertility.
2. Operative Hysteroscopy
This is performed to treat abnormalities detected during diagnostic hysteroscopy. In many cases, both diagnostic and operative hysteroscopy can be done in a single session, eliminating the need for a second procedure.
During operative hysteroscopy, doctors use specialized tools to remove or correct issues causing abnormal uterine bleeding. An example is endometrial ablation, a procedure to stop abnormal bleeding by destroying the uterine lining responsible for it.
Why is Hysteroscopy Performed?
Hysteroscopy is commonly recommended to diagnose and treat conditions such as:
- Uterine polyps or fibroids (myomas): Hysteroscopy can detect and remove polyps (polypectomy) or fibroids (myomectomy) from inside the uterus.
- Uterine adhesions (Asherman’s Syndrome): Scar tissue inside the uterus can disrupt menstruation and cause infertility. Hysteroscopy allows doctors to identify and remove these adhesions.
- Uterine septum: This congenital anomaly can affect fertility and pregnancy. Hysteroscopy can help detect and treat this condition.
Hysteroscopy is also useful for:
- Diagnosing recurrent miscarriage or fertility issues
- Locating an intrauterine device (IUD) that is difficult to detect
- Diagnosing and removing retained placental tissue after childbirth
Thanks to its dual function in diagnosis and treatment, hysteroscopy is an effective and minimally invasive solution for various uterine health concerns.
The Hysteroscopy Procedure
If your menstrual cycle is regular, doctors usually recommend performing hysteroscopy during the first week after menstruation ends for optimal visibility. For those with irregular cycles, the timing should be discussed with your doctor.
Post-menopausal women can undergo the procedure at any time.
Before the Procedure
The doctor will:
- Confirm you’re a suitable candidate
- Explain the procedure in detail
- Provide preparation instructions
Preparations may include:
- Reviewing medical history, current medications, and supplements. You may be advised to stop taking blood thinners like aspirin.
- Undergoing a physical exam, pelvic exam, and possibly a pregnancy test or blood tests.
- Instructions about clothing, fasting (if needed), and whether someone should accompany you home afterward.
During the Procedure
On the day of the procedure:
- You’ll be asked to empty your bladder and change into a hospital gown
- You may receive anesthesia or sedation, depending on the procedure’s complexity and setting (clinic or hospital)
You’ll be positioned on an exam table with your feet in stirrups. The steps include:
- Pelvic examination
- Cervical dilation
- Insertion of the hysteroscope through the vagina and cervix into the uterus
- Infusion of a liquid solution through the hysteroscope to expand the uterus and clear the view
- Detailed inspection of the uterine cavity and fallopian tube openings
- If necessary, insertion of small surgical tools through the hysteroscope to remove abnormalities
Duration can vary from 5 minutes to over an hour, depending on whether the procedure is diagnostic or operative and whether additional procedures (like laparoscopy) are performed.
After the Procedure
If anesthesia was used, you will be monitored for several hours in a recovery room. Afterward, you may experience mild cramping or light bleeding for a few days. Some patients report dizziness or nausea, which is generally normal.
Hysteroscopy is considered a minor surgical procedure and usually does not require hospitalization. However, in some cases, an overnight stay may be advised for monitoring.
Benefits and Risks of Hysteroscopy
Benefits:
- Simultaneous diagnosis and treatment
- Minimally invasive and highly precise
- Preserves healthy surrounding tissue
- Short recovery time
Risks are rare but can include:
- Infection
- Heavy bleeding
- Intrauterine scarring (adhesions)
- Reaction to anesthesia
- Injury to the cervix, uterus, bladder, or bowel
- Reaction to the distention fluid used
Despite these risks, hysteroscopy remains a safe and effective method for managing uterine conditions.
Operative Hysteroscopy at Mandaya Royal Hospital Puri
Recently, the medical team at Mandaya Royal Hospital Puri, consisting of Dr. Gracia Merryane R.G Rauw, Sp.OG and Dr. Doddy F.P Gultom, Sp.OG(K), M.Kes, successfully performed an operative hysteroscopy on a patient. The procedure involved the removal of both endometrial and cervical polyps using a hysteroscope, allowing for precise and minimally invasive treatment.
The hysteroscope enables direct visualization of polyp locations, allowing for accurate removal without damaging surrounding tissue. This makes hysteroscopy particularly effective for managing uterine polyps that are often missed during conventional examinations.
Additionally, hysteroscopy allows thorough assessment of the endometrial lining, identifying abnormalities such as thickening or undetected fibroids. If additional issues are found, immediate follow-up procedures like tissue removal can be performed during the same session.
Another key advantage is the quick recovery time—patients can usually resume daily activities shortly after the procedure, with no need for overnight hospitalization. This makes hysteroscopy an efficient, comfortable, and safe option for treating various uterine conditions.
If you would like to learn more about hysteroscopy or consult a specialist, visit Mandaya Royal Hospital Puri.
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