Obstetrics & Gynecology

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What is a hysteroscopy?
A hysteroscopy is a diagnostic procedure where a lighted scope, called a hysteroscope, is inserted through the cervix into the uterus that lets a doctor view the inside of the uterus. If growths, scar tissue, or other problems are found during the procedure, the doctor can use the information that was gathered during the hysteroscopy, and develop a treatment plan. The tools that a doctor may use during a hysteroscopy may not be limited to a hysteroscope. A speculum, which is the same instrument used during a pap smear, gently widens the vagina, and sometimes the cervix as well. The doctor may use carbon dioxide gas or a liquid that flows through a tube in the hysteroscope, and then into the uterus. This would be used to hold the walls of the uterus apart. Other specially designed surgical instruments can be inserted through the hysteroscope to take samples of the uterine lining, or to remove growths.

Before, During, and After
Before the procedure, be sure to ask your doctor whether you can take medications like ibuprofen, up to an hour before the hysteroscopy begins. A pain reliever may help lessen the uterine cramps that sometimes occur during a hysteroscopy. After filling out a few forms, you will change into a gown and lie down on an examination table, in the lithotomy position, with your feet in stirrups. During the procedure, to lessen discomfort, the doctor might numb your cervix with local anesthesia. If the hysteroscopy is performed in a hospital, your body might be numbed below the waist, using regional anesthesia. You could also be put totally asleep, using general anesthesia. After the anesthesia, your cervix may be gently widened, after which a hysteroscope is inserted. If a video camera is attached, you may be able to view the procedure on the nearby video monitor. After the procedure, menstrual-type cramps and bleeding are common for around 24 hours, so wear an absorbent pad. Avoid tampons and sexual intercourse for a brief period of time after the hysteroscopy is performed. Be sure to ask your doctor how long the time period is. If carbon dioxide gas was used to expand the uterus, some gas may have escaped into your abdomen, which is harmless, but may cause some aching in your shoulders for up to a day or so.

Risks and Complications
Complications from hysteroscopies are rare. The risks involved include problems with anesthesia, infection, or perforation of the uterine wall. Be sure to call you doctor if any symptoms occur after the procedure, such as heavy bleeding, a fever over 100.4F, and increased abdominal pain.

What your Doctor Looks for During a Hysteroscopy
During a hysteroscopy, your doctor looks inside your uterus for anything out of the ordinary. Fibroids, adhesions, and polyps are common problems possibly found during the procedure. Fibriods are round knots of uterine muscle. Fibroids usually grow slowly, but can become rather large over time. They might cause abnormal bleeding, cramping, or even fertility problems. Polyps are single or multiple "fingers" of soft uterine tissue that dangle from the uterine wall. Polyps can cause abnormal bleeding. Adhesions are bands of scar tissue that bind together differrent parts of the uterine wall. Hyperplasia, which is an overgrowth of the uterine lining, along with uterine cancer, are not common, but may be found during the procedure. A small sample, called a biopsy, may be taken of the uterine lining for further laboratory testing and evaluation.

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