Why am I bleeding? Why am I bleeding again! Evaluation for unexplained bleeding often begins with an ultrasound and lab work to see if hormones or something in the uterus is the cause. If the ultrasound sees something unusual, the next step is often a biopsy or to look inside the uterus with a camera.
Looking inside with a camera allows us to directly see any possible abnormalities that could cause bleeding. This can include polyps, fibroids and scar tissue. Hysteroscopy– looking inside with a telescope/camera- can allow us to not only see what is going on, but often to treat the problem.
Hysteroscopy may be done for many different reasons, including:
- To evaluate abnormal bleeding, fibroid (benign, noncancerous) tumors, polyps, scar tissue (adhesions), and possibly cancer of the uterus.
- To look for lumps (tumors) and other uterine growths.
- To get a biopsy or tissue specimen for evaluation.
- To look for causes of why a woman cannot get pregnant (infertility), causes of recurrent loss of pregnancy (miscarriages), or a lost intrauterine device (IUD).
Traditionally this procedure has been done in an operating room with anesthesia. If recent years, with the development of hysteroscopes smaller than a pencil, this procedure can be done comfortable in the office.
Here at the Center for Advanced Gynecology we have always offered in-office hysteroscopy with the smallest hysteroscopy available at 3.7 millimeters wide. Experience (and our small hysteroscope) allow the procedure to almost always be done without a speculum or the need for pain medicine. Dr. Barron is also able to offer treatment at the same time-polyps and adhesions can be removed in the office in one visit.
What’s the advantage of doing the procedure in the office? It may not be for everyone, but it is almost always less expensive for our patients because there is no hospital or surgical co-pay. Also, the overall cost to everyone is less then when the procedure is done in the hospital–good news for those who don’t have insurance, have co-insurance, or a large deductible. Lastly, it saves the hassle of dealing with the hospital (early arrival, parking, new faces!)
What happens during a hysteroscopy?
- We may offer you a pre-procedure medicine to relax you. You may also get a medicine that numbs the area around the cervix (local anesthetic)
- Sometimes, a medicine is placed in the cervix the day before or morning of the procedure. This medicine makes the cervix have a larger opening (dilate). This makes it easier for the instrument to be inserted into the uterus.
- A small instrument (hysteroscope) is inserted through the vagina into the uterus. This instrument is like a pencil-sized telescope with a light.
- During the procedure, saline fluid is trickled into the uterus at low pressure to make it easier to see inside.
- We document what we see with photographs.
- Wire-thin instruments can also be placed through the hysteroscope to remove specimens, take biopsies, or cut out scar tissue.
AFTER THE PROCEDURE
- Recovery tends to be very quick as there are no incisions.
- There may be some mild cramping for a 1-2 days that can be treated with acetaminophen or ibuprofen.
- There may be some light bleeding for up to 7 days depending on what was done.
- You can return to work and normal activities the next day!