What is Hysteroscopy?

Hysteroscopy is a method commonly used for the diagnosis and treatment of intrauterine anomalies or pathologies. This procedure can also be utilized for the removal or correction of issues such as intrauterine polyps, fibroids, or adhesions.

During the procedure, a thin, telescopic instrument called a hysteroscope is passed through the cervix and directed into the uterus. With the camera at the tip of the hysteroscope, the doctor can visualize the inside of the uterus. Pathologies within the uterus can be treated using very fine instruments attached to the device.
Hysteroscopy can be performed without anesthesia, with local anesthesia, sedation, or under general anesthesia. Due to its minimally invasive nature, patients experience a rapid recovery process. Typically, the patient is discharged within a few hours after the procedure.

Hysteroscopy can be used for the following conditions:

Diagnosis of intrauterine abnormalities: Hysteroscopy can be used to visualize polyps, fibroids, adhesions, or other abnormal tissues inside the uterus. Additionally, hysteroscopy can be employed for the diagnosis of intrauterine abnormalities. During this procedure, an endoscopic device is inserted into the uterus, allowing detailed visualization of conditions such as polyps, fibroids, adhesions, or other abnormal tissues. With hysteroscopy, problems within the uterus can be easily diagnosed and, in the same session, treated.

Removal of intrauterine lesions: During hysteroscopy, abnormal tissues within the uterus can be removed. These extracted tissues are then sent to the laboratory and analyzed for pathological examination. This allows for a detailed analysis of the collected tissue samples, guiding the patient's diagnosis and treatment process more accurately.

Assessment of miscarriage risk: In women experiencing recurrent miscarriages, hysteroscopy is utilized to determine the presence of intrauterine abnormalities.

Correction of uterine shape abnormalities: Some women may have congenital uterine shape abnormalities. With hysteroscopy, certain uterine shape abnormalities can be corrected, leading to a uterus with a suitable anatomy for pregnancy.

Placement or removal of intrauterine birth control methods: Hysteroscopy is sometimes used during the placement or removal of intrauterine devices (IUDs).
 

What are the Types of Hysteroscopy? 

The types of hysteroscopy can vary based on the techniques used and the purpose of the procedures. The choice of hysteroscopy method for diagnostic or therapeutic purposes is determined by the physician. 

Diagnostic Hysteroscopy: 

It is used to evaluate abnormalities within the uterus, diagnosing conditions such as polyps, fibroids, adhesions, or other abnormal tissues. Operative (surgical) Hysteroscopy, on the other hand, is used to treat or remove abnormal tissues within the uterus. During surgical hysteroscopy, doctors can use small instruments to remove polyps or fibroids, open adhesions, or perform other surgical interventions. 

Controlled Hysteroscopic Endometrial Resection (TCRE): 

This procedure is used to treat conditions such as the growth of the endometrium (inner lining of the uterus). During TCRE, the procedure involves cutting and removing intrauterine tissues using a special electrosurgical tool, thereby expanding the uterine cavity.

Hysteroscopic Myomectomy: 

In this procedure, specialized devices such as a resectoscope or hysteroscopic morcellator are used to remove fibroids (myomas) within the uterus. With this method, fibroids can be directly removed through the vaginal route without the need for abdominal incisions.

Insertion or Removal of Intrauterine Device (IUD):

Hysteroscopy can be used for the insertion or removal of the Intrauterine Device (IUD), and it can also be performed to ensure the accurate placement of the IUD.
 

Hysteroscopy is performed in which cases? 

Hysteroscopy can be used for the diagnosis, evaluation, and treatment of various conditions. Some situations in which hysteroscopy may be necessary include:

Abnormal Vaginal Bleeding: Hysteroscopy is used to detect intrauterine abnormalities such as polyps, fibroids, intrauterine adhesions, or cancer in women experiencing abnormal vaginal bleeding after menopause or during the menstrual cycle. 
Recurrent Miscarriages: In women experiencing recurrent miscarriages, hysteroscopy is a preferred method to assess the presence of uterine structural abnormalities or other potential issues. 
Correction of Uterine Shape Anomalies: Some congenital uterine shape abnormalities can hinder pregnancy. Using hysteroscopy, some of these abnormalities can be corrected in a single session, achieving a normal uterine anatomy conducive to pregnancy.
Infertility: Intrauterine abnormalities can contribute to infertility. Therefore, hysteroscopy plays a significant role in the treatment of infertility in couples, helping to determine the presence of polyps, fibroids, or adhesions within the uterus and providing appropriate treatment. 
Insertion or Removal of Intrauterine Device (IUD): The correct placement and removal of intrauterine devices (IUDs) are crucial. Hysteroscopy is utilized in this regard.
Endometrial Biopsy: Hysteroscopy is utilized to obtain samples from the inner lining of the uterus for the important procedure of endometrial biopsy, which is crucial for diagnosing conditions like endometrial cancer or evaluating other endometrial pathologies.

How is Hysteroscopy Performed?

Hysteroscopy is a surgical procedure performed by a gynecologist. It is sometimes done with local anesthesia or without any anesthesia, and at times, it may be carried out under sedation or general anesthesia. The choice of anesthesia depends on the nature of the procedure and the patient's preference.
With the insertion of the hysteroscope into the uterus, images from the camera are displayed on a screen, allowing for the detection of any abnormalities within the uterus. During hysteroscopy, the doctor can remove or treat abnormal tissues within the uterus. This may involve procedures such as the removal of tissues like polyps or fibroids, or the opening of intrauterine adhesions. Additionally, an endometrial biopsy can be taken, where the doctor collects a tissue sample from the uterine lining to be sent to the laboratory for pathological examination.
When the hysteroscopy procedure is completed, the hysteroscope is removed, and the patient is allowed to rest for a while. In hysteroscopies performed under local anesthesia, patients are typically sent home without much delay, while procedures under general anesthesia may require a few hours of observation. Hysteroscopy is generally a minimally invasive procedure, and patients often experience a rapid recovery. However, your doctor will provide you with instructions regarding pre- and post-procedure care. 

What are the Gains (Advantages) of Hysteroscopy? 

The gains of the hysteroscopy method primarily stem from its minimally invasive nature. Additionally, the ability to perform both diagnosis and treatment simultaneously is a significant feature. 
Typically, a small opening is used to access the uterus, resulting in less tissue damage, reduced blood loss, and a quicker recovery process. The ability of hysteroscopy to accurately identify intrauterine abnormalities is also crucial for the early diagnosis of serious conditions such as cancer. Due to its minimal invasive nature, hysteroscopy generally ensures a faster recovery process. Patients can often return to normal activities shortly after the procedure. These advantages contribute to hysteroscopy becoming a commonly preferred method and widely used for the diagnosis and treatment of intrauterine abnormalities. 

What are the Cases Where Hysteroscopy Should Not Be Performed?

While hysteroscopy is generally a safe procedure, there are certain situations where it should not be performed or needs careful evaluation. For example, hysteroscopy is not performed during pregnancy because it could jeopardize the pregnancy or harm the fetus. Therefore, it is essential to ensure that the patient is not pregnant before undergoing the procedure.
Similarly, hysteroscopy cannot be performed in individuals with an active uterine infection as it may increase the risk of spreading and lead to serious complications. The procedure is approached with caution in individuals with cervical stenosis or those at risk of excessive bleeding or bleeding disorders.
Another group that needs careful evaluation regarding hysteroscopy includes individuals with severe cardiovascular disease or those at high risk. In such cases, a detailed assessment with the doctor before undergoing hysteroscopy is necessary as there may be an increased risk of anesthesia or other medical complications during the procedure. 
It's important to remember that since each patient's condition is unique, the necessity and suitability of hysteroscopy should always be individually assessed by a doctor.

What Are the Possible Complications After Hysteroscopy? 

While hysteroscopy is generally a safe procedure, complications can arise in some cases. These may include uterine infection, bleeding, uterine perforation, burns or damage, adhesions, or complications related to anesthesia. Although these complications are typically rare, they are among the conditions that should be carefully monitored after hysteroscopy. 
 

What Should Be Considered After Hysteroscopy?

After hysteroscopy, patients can generally return to their normal lives immediately. However, some points that need to be considered include: 

•    It is essential to follow the doctor's instructions after the procedure and not neglect post-procedure follow-up appointments. Early recognition and treatment of possible complications after hysteroscopy are important.
•    Mild abdominal pain, cramping, or vaginal bleeding may be normal after hysteroscopy. However, if there is severe or increasing pain, bleeding, or other symptoms, it is important to inform the doctor. 
•    It is important to pay attention to using the medications recommended by the doctor correctly and regularly. 
•    Consuming light and easily digestible foods is important after hysteroscopy. 
•    Unless instructed otherwise by your doctor, it is advisable to avoid sexual intercourse for a period after hysteroscopy. Generally, avoiding vaginal penetration or intense sexual activities is recommended.

What Are the Signs of Infection After Hysteroscopy? 

One of the primary indicators of developing infection after hysteroscopy is the presence of fever. An increase in body temperature after hysteroscopy can be a sign that the body is fighting an infection. Elevated temperatures generally exceeding 38°C (100.4°F) are concerning and should prompt immediate medical attention. While experiencing a normal amount of abdominal pain or cramping is expected after hysteroscopy, severe and increasing pain may indicate an infection. Additionally, urinary tract symptoms such as foul-smelling vaginal discharge, burning sensation during urination, frequent urination, or the presence of blood in the urine, along with fatigue, nausea, and vomiting, are signs of a potential infection. 
If you notice any signs of infection after any hysteroscopy, it is crucial to consult your doctor immediately. Early diagnosis and treatment can help prevent serious complications.
 

Frequently Asked Questions About Hysteroscopy