Hysteroscopy – what is it?

Diagnostic hysteroscopy is an examination in which an optical system called a hysteroscope is introduced into the uterine cavity through the vagina and cervix.

This test is used in the diagnosis and treatment of pathological conditions of the uterus and allows for a precise – under high magnification – assessment of the uterine cavity, its shape, structure of the uterine openings of the fallopian tubes and the structure of the mucosa (colour, thickness, condition of blood vessels) and abnormalities located within it – polyps, fibroids, intrauterine adhesions. During the examination, thanks to the appropriate instruments, it is possible to take tissue specimens in the areas of diagnostic interest, or perform a minor therapeutic procedure (removal of small polyps, adhesions).

Hysteroscopic examination is performed after establishing the medical indications, carefully collecting the medical history, medical history and family burdens, prior gynaecological examination, ultrasound evaluation of the pelvic organs and excluding the infection by bacteriological examination.  Depending on the case, the hysteroscopic procedure does not require anaesthesia or is performed under local anaesthesia. It is a procedure well tolerated by patients with a low risk of complications (0.1% – 1%) such as tissue damage, bleeding from the genital organ, infection or adhesions.

The most common indications for this procedure are:

• Bleeding of unknown etiology.
• Abnormal structures found in the uterine cavity most often during ultrasound/HSG examination.
• Assessment of the uterine mucosa.
• Inability to get pregnant and to keep it.
• Suspicion of uterine defects.
• Suspicion of intrauterine adhesions.

The most common contraindications for hysteroscopic surgery are:

• Pelvic inflammatory disease, acute and chronic.
• Menstrual bleeding or profuse bleeding from the genitals.
• Pregnancy or suspicion of pregnancy.
• The second phase of the cycle in women of reproductive age.

The examination is performed on the treatment chair in the gynaecological position. After proper disinfection of the treatment area, the operator, using sterile instruments and hysteroscopic instruments, introduces the optics through the vagina, the cervix into the uterine cavity, filling it with sterile physiological fluid. The entire procedure, lasting from several minutes up to a quarter, is displayed on the monitor and recorded so that the patient can view the inside of the uterine cavity during the examination. During the examination, tissue material for histopathological examination is collected with the use of special biopsy forceps.

After the procedure, the patient receives a description of the examination together with photo documentation or, on request, a video of the procedure on a DVD. Usually, about 1 hour after the procedure, the patient can go home with the recommendation to rest, avoid bathing in hot water, have intercourse and carry heavy objects during the day. The histopathological result is usually ready within 7-10 days.

At the Medfemina Health Centre in Wrocław, hysteroscopy is performed on the latest generation, high-class endoscopic equipment of the German company Storz.