Hysteroscopy for Removal of Intrauterine Adhesions
What is a hysteroscopy?
A hysteroscopy is a procedure in which your healthcare provider uses a hysteroscope to look at the inside of your uterus. A hysteroscope is a thin tube with a tiny camera. The uterus is the muscular organ at the top of the vagina. Babies develop in the uterus, and menstrual blood comes from the uterus. Your provider can guide a tool into the uterus to remove adhesions (bands of scar tissue) from the uterus.
When is it used?
You may have a hysteroscopy when your healthcare provider suspects you have adhesions in your uterus. Parts of the wall of the uterus may stick together, causing pain, abnormal bleeding, or trouble carrying a pregnancy. With this procedure your provider can cut and remove the adhesions, which may relieve these problems.
Examples of alternatives include:
- having a D&C (dilation and curettage), in which the healthcare provider opens the cervix and scrapes or suctions tissue from the uterus
- CT scan or MRI
- removing the uterus (hysterectomy)
- choosing not to have treatment
You should ask your provider about these choices.
It should not be used if you are pregnant, have a pelvic infection, cancer of the uterus or cervix, or recent surgery on the uterus.
How do I prepare for a hysteroscopy?
Plan for your care and recovery after the procedure, especially if you are to have general anesthesia. Allow for time to rest and try to find other people to help you with your day-to-day duties.
Follow your provider's instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery. For this reason, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6 to 8 weeks before surgery. Also, your wounds will heal much better if you do not smoke after the surgery.
Follow any other instructions your provider gives you. If you are to have general anesthesia, eat a light meal, such as soup or salad, the night before the procedure. Do not eat or drink anything after midnight or the morning before the procedure. Do not even drink coffee, tea, or water.
Your provider may put a laminaria (a small piece of seaweed that absorbs moisture) into the cervix the day before the hysteroscopy to help soften and dilate the cervix.
What happens during the procedure?
Hysteroscopy may be done in your healthcare provider's office or in an operating room.
You are given a local, regional, or general anesthetic. A local or regional anesthetic numbs part of your body while you remain awake. It should keep you from feeling pain during the procedure. You may also be given a sedative to relax you. A general anesthetic relaxes your muscles, puts you to sleep, and prevents you from feeling pain.
The provider may dilate (open) your cervix. The provider will guide a hysteroscope through the cervix into the uterus. The uterus is then inflated with fluid or gas. (This allows the provider to view the inside of your uterus more closely.) The provider uses a laser or an electrocautery resectoscope to cut and remove the adhesions.
If the adhesions are thick and extensive, you may have a laparoscopy at the same time. For a laparoscopy, your provider will make a small cut in your abdomen and put another scope through that cut to see the outside of the uterus. This will help your provider avoid putting a hole through the uterus as he or she removes the adhesion.
What happens after the procedure?
You may stay at your provider's office or the hospital about 1 or 2 hours. In rare cases you may stay at the hospital overnight.
After the procedure you may:
- feel sleepy or groggy from the anesthetic
- have some cramps
- have trouble urinating the first few hours after the procedure
- have a watery or bloody discharge for 3 or 4 weeks
Your provider may insert an IUD (intrauterine device) for you to keep in your uterus for several months after the procedure. Your provider may also recommend estrogen (hormone) therapy for several months.
Ask your provider what steps you should take and when you should come back for a checkup.
What are the benefits of this procedure?
Removing the adhesion may relieve the pain or other problems you are having. The procedure is short with a quick and easy recovery.
What are the risks associated with this procedure?
- There are some risks when you have general anesthesia. Discuss these risks with your healthcare provider.
- A local or regional anesthetic may not numb the area quite enough and you may feel some minor discomfort. Also, in rare cases, you may have an allergic reaction to the drug used in this type of anesthesia. In most cases local or regional anesthesia is considered safer than general anesthesia.
- The adhesions may return.
- You may have infection or bleeding.
- Rarely, the uterus could be punctured and need surgery to repair it.
- Rarely, the bowel or bladder may be injured.
- You may have an allergic reaction to the fluid used during the procedure.
You should ask your healthcare provider how these risks apply to you.
When should I call my healthcare provider?
Call your provider right away if:
- You start to bleed a lot (like a menstrual period).
- You develop a fever over 100°F (37.8°C).
- You have a lot of pain in your lower abdomen.
- You have a vaginal discharge with a bad odor.
Call the provider during office hours if:
- You have questions about the procedure or its result.
- You want to make another appointment.
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Published by RelayHealth.
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