Introduction to Hysteroscopy and D and C For Patients

Hysteroscopy procedure can help find out if there is an abnormality causing symptoms such as unusual vaginal bleeding including heavy periods and bleeding after the menopause. Usually no disease is found and you can be reassured. Pre-operative ultrasound examination is frequently arranged. Hyteroscopies can also be used to check for certain womb conditions such as polyps (small growths of tissue in the womb lining), fibroids (benign growths of muscle in the womb), heavy periods or early signs of womb cancer. Abnormalities of the endometrial cavity can be responsible for infertility or problems with recurrent miscarriage.

During the procedure your surgeon may take a biopsy for microscope examination, and/or treat the inside of your womb.

If you have a biopsy or polyps removed, you may need to wear a sanitary towel to absorb any vaginal bleeding.

If you have general anaesthesia, you will need to rest until the effects of the anaesthetic have passed. You will need to arrange for someone to drive you home. You should try to have a friend or relative stay with you for the first 24 hours.

What is meant by  D and C?

D and C involves the dilatation of the cervix (neck of the womb) and curettage (a curette is a surgical spoon) to "scrape" representative samples of the lining of the womb (endometrium). These "curettings" are sent to the laboratory and examined under the microscope. These days most gynaecologists combine the D and C with hysteroscopy. Polyps or fibroids distorting the cavity of the womb may be diagnosed or excluded. The D and C is generally recommended to ensure that the lining of the womb is not seriously abnormal (for women aged 40 or more) before commencing medical treatment.

For many years it was believed that the D and C had a therapeutic effect. It is now recognised that the first period after a D and C may be lighter but there is no long-term improvement. It should be emphasised that the D and C, like a blood test or an x-ray, is a diagnostic procedure and not a treatment.

What is Hysteroscopy

Hysteroscopy uses an instrument called a hysteroscope, which is a thin telescope that is inserted vaginally through the cervix and into the uterus. Modern hysteroscopes are so thin that they can fit through the cervix with minimal or no cervical dilation. This minimally invasive endoscopic procedure allows for the diagnosis of intrauterine pathology (disease) and serves as a method for surgical intervention (operative hysteroscopy). Although hysteroscopy dates back to 1869, gynaecologists have been slow to adopt them into clinical practice. Because the inside of the uterus is a potential, but collapsed, cavity, it is necessary to fill (distend) it with either a liquid or a gas (carbon dioxide) in order to see. Diagnostic hysteroscopy and simple operative hysteroscopy can usually be done in an office or out-patient setting. More complex operative hysteroscopy procedures are performed in an operating theatre. Hysteroscopy - Hysteroscope in Uterine CavityA video camera is attached to the hysteroscope and the picture displayed on a monitor to provide excellent vizulisation of the endometrial cavity.

Indications for hysteroscopy

Hysteroscopy is useful in a number of gynaecological conditions including:

  • Gynecologic bleeding
    • Heavy periods
    • Intermenstrual bleeding (bleeding between periods)
    • Postmenopausal bleeding
  • Endometrial polypectomy.
  • Infertility
  • Recurrent miscarriage
  • Asherman (Asherman's) syndrome
  • Uterine fibroids
  • Uterine malformations

Method

The hysteroscope is an optical instrument connected to a video unit with a fibre optic light source, and to the channels for delivery and removal of a distention medium - either fluids or CO2 gas. Fluids can be used for both diagnostic and operative procedures.

For diagnostic hysteroscopy, a thin hysteroscope can be used and usually not even local anaesthetic is required. For operative hysteroscopy, the cervix has to be dilated and general anaesthetic is usually employed. To make it easier, the cervix may be ripened pre-operatively and the prostaglandin called misoprostol is becoming popular.0801

A hysteroscope is in fact a modification of the traditional resectoscope, which has been used for transurethral resection of the prostate ove many years. It has a double-channeled sheath allowing for continuous flow of fluid or gas media into the uterus through the larger channel, while allowing for less outflow through the smaller channel. With modern optical technologies, hysteroscopes are getting smaller in diameter yet remain able to provide larger and brighter images for the surgeons' convenience.

After cervical dilation, the hysteroscope is guided into the uterine cavity and an inspection is performed. If abnormalities are found, an operative hysteroscope with a channel to allow specialized instruments to enter the cavity is used to perform the surgery.

Typical procedures include:

  • Endometrial polypectomy.
  • Endometrial ablation.
  • Submucosal fibroid resection - myomectomy.
  • Female sterilisation.
  • Uterine Adhesions (Asherman’s syndrome).
  • Remove stuck or misplaced intrauterine devices (IUCDs).
  • Resection of uterine septum.

Risks

A potential problem is uterine perforation when the instrument pierces the wall of the uterus. This can result in bleeding and damage to other organs. Furthermore, cervical laceration, intrauterine infection (especially in prolonged procedures), electrical and laser injuries, and complications caused by the distention media. The overall complication rate for diagnostic and operative hysteroscopy is 2% with serious complications occurring in less then 1% of cases.

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This is the personal website of David A Viniker MD FRCOG, retired Consultant Obstetrician and Gynaecologist - Specialist Interests - Reproductive Medicine including Infertility, PCOS, PMS, Menopause and HRT.
I do hope that you find the answers to your women's health questions in the patient information and medical advice provided.

I do hope that you find the answers to your women's health questions in the patient information and medical advice provided.

The aim of this web site is to provide a general guide and it is not intended as a substitute for a consultation with an appropriate specialist in respect of individual care and treatment.

David Viniker retired from active clinical practice in 2012.
In 1999, he setup this website - www.2womenshealth.com - to provide detailed
information many of his patients requested. The website attracts thousands of visitors every day from around the world.
Website optimisation (SEO) has became more than an active hobby. If you would like advice on your website, please visit his website Keyword SEO PRO or email him on david@page1-on-google.com.




 

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