Hysteroscopy for Uterine Fibroids

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What is a hysteroscopy?

A hysteroscopy is a procedure in which the 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. The provider can guide a tool into the uterus to remove a fibroid tumor. A fibroid tumor is a growth of tissue that is usually noncancerous.

When is it used?

You may have a hysteroscopy to remove a fibroid tumor growing in your uterus. The fibroid tumor can become large enough to press on your bladder or rectum. Or it may take up so much space in the uterus that it can get in the way of a pregnancy or cause abnormal uterine bleeding.

Examples of alternatives to this procedure are:

• Having a D&C (dilation and curettage), in which the provider opens the cervix and scrapes or suctions tissue from the uterus.
• CT scan or MRI.
• Shrinking the fibroid with a hormone (Lupron).
• Having a uterine artery embolization (a procedure that decreases the blood flow to the fibroid and decreases the bleeding and growth of the fibroid).
• Having an abdominal surgical procedure called a myomectomy to remove the fibroids.
• Removing the uterus (hysterectomy).
• Choosing not to have treatment, recognizing the risks of your condition.

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. Try to find other people to help you with your day-to-day duties.

Follow your healthcare 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 body 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 a 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 dilates (opens) your cervix. The provider guides 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 remove the fibroid tumor.

What happens after the procedure?

You may stay at the provider's office or 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

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 tumor from the uterus should relieve the problems it caused. Hysteroscopy is short with a quick and easy recovery. This method avoids the discomfort, hospitalization, expense, and longer recovery period of abdominal surgery, such as a myomectomy.

What are the risks associated with this procedure?

• There are some risks when you have general anesthesia. Discuss these risks with your 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 tumor may not be completely removed.
• The tumor may grow back.
• 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.

Ask your provider how these risks apply to you.

When should I call the provider?

Call the 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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