Hysteroscopy
A diagnostic hysteroscopy is a procedure in which a narrow tube with a camera attached is used to look into your uterus. This is a simple Day-Stay procedure performed under General Anaesthesia. An Endometrial Biopsy (biopsy of the uterus lining) is also performed. This tissue sample is sent off to the pathologist.
A Hysteroscopy will assess the shape of the uterus and whether there is any other pathology, including
polyps,
fibroids and
intra-uterine adhesions.
The procedure takes 15 minutes. You may experience light bleeding or mild cramps for 24 hours. Most women will take the next day off work. You are advised to avoid swimming and intercourse for 48 hours post-procedure.
Complications are very rare and minor. Complications can include infection or light bleeding. Uterine perforation is rarely seen. If this occurs, the small area will heal spontaneously. Antibiotics are given.
Hysteroscopic Polypectomy
Endometrial Polyps are removed under direct vision using a device called Myosure. The procedure is performed as a day-stay procedure under General Anaesthesia. A narrow instrument is inserted into your uterus. The Endometrial Polyp is visualised.
The Polyp is removed, and the specimen is collected in a bag and sent to the pathologist.
The recovery after this procedure is very fast. You may experience minor cramps or light bleeding for 24 hours. You are advised to avoid swimming and intercourse for 48 hours post-procedure. Complications are infrequent and minor. Complications can include infection or light bleeding.
This technique of Endometrial Polyp removal has many advantages. It is performed under direct vision—a picture of the uterus is viewed on a large screen. The Polyp is removed in its entirety to minimise the risk of re-growth.
Hysteroscopic Myomectomy
This is performed to remove a fibroid growing into the uterine cavity. It is a Day-Stay procedure performed under General Anaesthesia. A Hysteroscopy is performed, and a detailed image of the uterine cavity and fibroid is obtained. A special Resectoscope is used to remove the fibroid progressively. The specimen is collected in a bag and sent to the pathologist. The procedure lasts about 10 minutes to 50 minutes. A second procedure may be required for a larger fibroid (greater than 5.5cm in diameter).
The recovery after this procedure is speedy. You may experience minor cramps or light bleeding for 24 hours. You are advised to avoid swimming and intercourse for one-week post-procedure. Complications can include fluid overload. Fluid is used to distend the uterus cavity and can be absorbed. If this occurs, it will be necessary to stay overnight.
Hysteroscopy - Division Of Uterine Septum
A uterine Septum is a relatively uncommon abnormality of the uterine cavity. There is a wall of tissue dividing the uterus into two parts. This can be associated with recurrent pregnancy loss – including the first trimester and second trimester. A Uterine Septum can be associated with pre-term onset of labour, malpresentation of the fetus (including breech presentation) and increased risk of Caesarean delivery.
Diagnosis of a Uterine Septum is by Pelvic Ultrasound or Sonohysterogram. The note is made of the size of the Septum and the distance between the septum and the associated uterine muscle. The note is also made of the Uterine Shape.
Division of the Uterine Septum involves a Hysteroscopy to visualise the area of abnormality. The procedure is performed as a day-stay procedure under General Anaesthesia. A needlepoint diathermy is used to divide the septum. The fluid pressure in the uterus also works to divide the Septum. A Myosure device can occasionally be used to divide a Septum. The procedure takes about 20-30 minutes.
Recovery After Hysteroscopy
The recovery after this procedure is speedy. You may experience minor cramps or light bleeding for 24 hours. You are advised to avoid swimming and intercourse for one-week post-procedure. Complications can include fluid overload. Fluid is used to distend the uterus cavity and can be absorbed. If this occurs, it will be necessary to stay overnight.
Hysteroscopy - Division Of Adhesions
Adhesions can form in the uterus following infection or repeated curettes (e.g., for miscarriages or TOPs). These can vary from minor adhesions (called synechiae) to complete occlusion of the cavity of the uterus (Ashermann’s Syndrome). Symptoms can vary from lighter periods to difficulty conceiving to a complete absence of periods.
Intra-uterine adhesions can be diagnosed with Sonohysterogram.
Division of intra-uterine adhesions involves a Hysteroscopy to visualise the area of abnormality. The procedure can be performed using ultrasound to assist with entering the cavity of the uterus if there are significant adhesions. The adhesions can be divided under direct vision with Hysteroscopic Scissors. High-dose oestrogen is given post-operatively to facilitate the laying down of new Endometrial lining. Various devices can be used to ensure the cavity remains open, including a small balloon or a non-hormonal IUCD. You may be given antibiotics for one week following the procedure to minimise the risk of infection.
Recovery After Hysteroscopy
The recovery after this procedure is speedy. You may experience minor cramps or light bleeding for 24 hours. You are advised to avoid swimming and intercourse for 5 days post-procedure. Complications can include fluid overload. Fluid is used to distend the uterus cavity and can be absorbed. If this occurs, it will be necessary to stay overnight.
Hysteroscopy - Novasure Endometrial Ablation
This procedure is performed for Heavy Menstrual Bleeding in a woman who has no plans for a further pregnancy. A Hysteroscopy is performed, and a detailed image of the uterine cavity is obtained. An Endometrial Biopsy is taken. If an Endometrial Polyp or Fibrroid is present, it is removed.
An Endometrial Ablation is then performed. This is a Day-Stay procedure performed under General Anaesthesia. An instrument with netting is inserted into the uterus. The netting expands to fill the cavity of the uterus. The netting is then heated for about one minute, and the Endometrial lining of the uterus is destroyed. This prevents the lining from growing and shedding each month with the monthly menstrual cycle.
Following the ablation, a hysteroscopy confirms that the cavity has been evenly treated. The total operating time is about 30 minutes.
Recovery After Novasure
The recovery after this procedure is very fast. You may experience minor cramps for 24 hours. You are advised to avoid intercourse and swimming for one-week post-procedure. You may notice brown vaginal loss or light bleeding for several days. 50% of women in the long term do not have any further periods. Overall, 95% of women find their bleeding is lighter.