What Is A Diagnostic Hysteroscopy?

Diagnostic hysteroscopy is a minimally invasive procedure that uses a tiny telescope, called a hysteroscope, to examine your cervix and uterus. Hysteroscopy can be a part of the diagnostic process, as well as the treatment process.

This procedure is mostly used to diagnose and treat the causes of abnormal bleeding and can also be used to remove polyps, fibroids, and adhesions amongst other problems. 

 

How Is A Diagnostic Hysteroscopy Performed?

A hysteroscope is a narrow tube or telescope with a light and camera at the end that enables your doctor to clearly see your cervix and uterus.

The vagina and cervix are first cleaned with an antiseptic solution. Fluid is then injected into the uterus to make it easier for your doctor to see inside. The hysteroscope is inserted into your vagina to examine your cervix and the inside of your uterus. Images are projected onto a monitor so that your doctor can see inside your uterus (womb) clearly. If any pathology is seen, special small tools attached to the hysteroscope can be used to remove it.

 

When Should You Have A Diagnostic Hysteroscopy?

The aim of a diagnostic hysteroscopy is to identify structural irregularities in your uterus that may be causing abnormal bleeding, pelvic pain or infertility. Abnormal bleeding could include heavy menstrual bleeding, irregular spotting between periods and bleeding after menopause.

A hysteroscopy is sometimes also used to confirm the results of other tests, such as an ultrasound or hysterosalpingography (HSG). An HSG is an X-ray dye test used to assess the causes of infertility in women. It can determine if your fallopian tubes are blocked, which may make it difficult to become pregnant.

 

Hysteroscopy's Role in Diagnosing and Treating Uterine Conditions

A hysteroscopy can be used to diagnose and correct the following uterine conditions:

Heavy Menstrual Bleeding (Menorrhagia)

Hysteroscopic endometrial ablation is a relatively new procedure that aims to reduce heavy menstrual flow by destroying the lining of the uterus (endometrium). Methods to ablate the uterus (remove its lining) include extreme cold, heated fluids, microwave energy or high-energy radio frequencies.

 

Polyps

The surgical removal of a polyp is called a hysteroscopic polypectomy. Uterine polyps are abnormal growths that occur in the lining (endometrium) of your uterus. They usually form from an overgrowth of endometrial tissue. They are attached to the endometrium by a thin stalk or a broad base and extend into your uterus. Uterine polyps are usually noncancerous (benign) but can cause heavy periods (menorrhagia) or infertility if left untreated.

Fibroids

The surgical removal of a polyp is called a hysteroscopic myomectomy. Uterine fibroids, also called leiomyomas or myomas, are noncancerous growths of the uterus that often appear during childbearing years.

A hysteroscopic myomectomy may be an option if your fibroids are contained inside the uterus (submucosal). This procedure is the most minimally invasive procedure to treat fibroids and is suitable for women who want to have children in the future.

 

Adhesions (Asherman’s Syndrome)

An adhesion is a band of scar tissue that joins two internal body surfaces or organs together. Adhesions develop as the body attempts to repair itself. Although adhesions are usually the result of previous surgery, some can occur following pelvic infection, and in many instances, they accompany more severe stages of endometriosis. Adhesions can affect the ovaries, fallopian tubes, bladder, and the bowel. They can cause a range of problems including infertility, painful intercourse, pelvic pain, urinary tract infections and bowel obstruction.

Hysteroscopic adhesion lysis is the most common and effective option in the treatment of uterine adhesions. It uses cutting tools inside the hysteroscope to release the adhesions.

 

Uterine Septums

Hysteroscopy can help determine whether you have a uterine septum. A septate uterus is a congenital abnormality, occurring when your uterus is divided into two parts by a membrane called the septum. This condition can cause pregnancy complications and miscarriage and can only be corrected with surgery.

A procedure called hysteroscopic metroplasty is the most common treatment for a septate uterus. Using a hysteroscope, surgical instruments are inserted through the cervix and into the uterus. The septum is then cut out and removed from the uterus.

 

Miscarriages

A hysteroscopy may be used to diagnose the cause of repeated miscarriages or fertility problems. If you have had more than two miscarriages in a row, your doctor may recommend a hysteroscopy to look for uterine abnormalities that could be the cause.

 

Locate An Intrauterine Device (IUD)

IUDs sometimes become ‘lost’ or are misplaced. If an ultrasound shows that an IUD is inside the uterine cavity, forceps (with ultrasound guidance) are usually used to remove the IUD. If this fails, a hysteroscopy is usually performed to remove the IUD.

 

Diagnose And Remove Placental Tissue 

If you have symptoms of retained placenta in the days or weeks after birth, your doctor may suspect that a piece of the placenta has remained behind. A hysteroscopy, using a diathermy loop, is an effective way of removing placental tissue.