Gynecology - Hysteroscopy
Hysteroscopy uses a hysteroscope, which is a thin telescope that is inserted through the cervix into the uterus. Modern hysteroscopes are so thin that they can fit through the cervix with minimal or no dilation. Because the inside of the uterus is a potential cavity, like a collapsed air dome, 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 setting. More complex operative hysteroscopy procedures are done in an operating room setting.
Unless a woman has major medical problems, we do diagnostic hysteroscopy in the office. We numb the cervix with a local anesthetic. We attach a video camera to the hysteroscope, so our patients can also see, and then insert the hysteroscope into the uterus under direct vision while using either saline or carbon dioxide to fill the uterus. Usually this causes mild cramping. We then can look for fibroids, polyps and other problems that may be causing bleeding. This often takes about a minute or two. The hysteroscope is removed. A small plastic tube may be used to take a sample of the lining of the uterus. That's it! Office hysteroscopy is extremely effective in diagnosing the cause of many types of abnormal uterine bleeding.
By being very gentle, and using local anesthesia, there is usually minimal discomfort during office hysteroscopy. Most women are able to get up and return to their normal activities immediately. If someone is very anxious, it is possible to give a short-acting narcotic intravenously. This makes it very unlikely that the procedure will be uncomfortable.