Hysteroscopy is a method of visualizing the inside of the womb with a special tiny camera called a hysteroscope, which is fitted with a light source and passed from the vagina, through the cervix, and into the womb. A clear fluid is then inserted into the womb, to open it up, and to allow for better visibility. The images are magnified and projected on a screen for the doctor to see and make assessments. With other small devices attached to it, the same camera can be used to perform surgical procedures on the inside of the womb. It is a type of minimally invasive surgery.

There are two types of hysteroscopy performed:

• Outpatient OR Diagnostic Hysteroscopy: This is done as an investigation, to examine the uterine cavity and help to make a diagnosis. It is usually done as an office procedure, and takes just about 5 to 10minutes. It is not done in the operating theatre, and there is no anaesthesia required for it. It is not unusual to be offered a diagnostic hysteroscopy in the clinic to see if you require an operative one or not.

• Operative Hysteroscopy: This is a procedure that is done to treat a specific condition. It is done in the theatre; either under general anaesthesia (where you are put to sleep), or under spinal anaesthesia (where an injection is given into your back to make you feel numb from the waist down). The average duration of this procedure is about 30 minutes, and it is done as a day case. This means you will be able to go home on the same day, after being on admission for a few hours. It takes one or two days to recover from this procedure, and some people are actually able to go back to work the next day.

Some of the procedures that can be done with hysteroscopy include the following:

• Investigation for infertility

• Investigation for abnormal uterine bleeding

• Removal of submucosal fibroids (fibroids that are located inside the womb) – Hysteroscopic myomectomy

• Removal of polyps – Hysteroscopic Polypectomy

• Treatment of intrauterine adhesions – Hysteroscopic Adhesiolysis

• Retrieval of ‘lost’ IUCD

A hysteroscopy is best done within the first two weeks of the menstrual cycle, after the period has stopped. This is the best time to have it done because after the period, the lining of the womb (endometrium) is very thin, thus making it easy to see any abnormality clearly. By the third week of the cycle, the lining has begun to thicken again.

In preparation for the procedure, you will need to have some tests done, to ensure that it is safe to go ahead. These tests are done at a clinic visit on a separate day before the procedure. The doctor will explain to you in more detail what is going to happen and answer any questions you have, after which a consent form (a document stating your agreement to the procedure) will be signed.

For an operative hysteroscopy, you will be instructed not to eat or drink anything from 12 midnight of the surgery day. While you can come into the hospital on your own on the morning of the surgery, you will need to make arrangements for someone to take you home afterwards. You will be given a medication called Misoprostol at least an hour before the surgery starts, to relax your cervix, and thus make the procedure easier. You might experience some lower abdominal cramps in response to the drug. After the procedure, in some cases something called a balloon is left inside the womb for 2 weeks, or a Copper IUCD (coil) for a bit longer, to allow the womb to heal properly, without the formation of scar tissue (adhesions).

After an operative hysteroscopy:

• You would be able to go back to work the following day or within a couple of days

• You will be discharged home with antibiotics and pain relieving tablets

• You will be seen again in the clinic for a review, usually after 1, 2, or 4 weeks, depending on the findings at surgery

• You might have light vaginal bleeding or spotting for a few days. Some people spot for as long as two weeks, and very few people will spot until they have another period.

• Sometimes the first period after the procedure may be heavy or painful, but this will settle down eventually.

Diagnosis and treatment of Infertility