HYSTEROSCOPY (direct visual examination of the uterus) is a procedure used to investigate reproductive system problems, such as dysfunctional uterine bleeding, uterine fibroids, or suspected uterine cancer. It can be done alone or at the same time as dilation and curettage (D & C).

 

Sometimes areas of abnormal tissue or growths can be missed during D & C or endometrial biopsy (removal and examination of tissue from the uterine lining). Hysteroscopy may detect these missed areas.

 

Like ultrasonography, Hysteroscopy is a method of viewing the inside of the uterus and other reproductive organs – although the technique is different. Think of the hysteroscope as a tiny, thin, lighted telescope, which is inserted through the vagina into the uterus after the patient has received a local anesthetic. Usually she is in the same position as she would be for a pelvic exam: knees bent and feet apart.

 

The doctor looks through the protruding end of the hysteroscope into the uterus. She or he can examine the reproductive organs for abnormalities, and take biopsy samples. The doctor may also remove any growths discovered during endoscopy.

 

The procedure generally takes only a short time in the doctor's office or outpatient ambulatory surgery section of the hospital, and may involve some discomfort.

 

PR Newswire 1996 Aug, 16

 

Hysteroscopy Detects Abnormal Bleeding
(abnormal menstrual bleeding)

 

PR Newswire via NoBlood.com – High-tech instruments are giving new hope to women with abnormal menstrual bleeding.

 

In many cases, the source of the bleeding can now be diagnosed with a hysteroscope, a tiny flexible telescope that allows a doctor to peer into the womb and scrutinize its structure for defects, according to a study published in the July issue of the journal Obstetrics and Gynecology.

 

For many women, a hysteroscopy, which can be done in a doctor's office, may replace the need for an inpatient dilatation and curettage (D&C) – a procedure in which the cervix is dilated and the lining of the uterus is scraped, the British researchers noted.

 

In the study, they succeeded in using the hysteroscope to examine more than 96 percent of the 2,500 women who came to them for help with abnormal bleeding.

 

 

 

 

 

 

 

In most cases, the women needed no anesthesia as the miniature scope was passed through the vagina into the womb, according to the study. Just under 30 percent of the women needed a local anesthetic for discomfort.

 

For more than 50 percent of the women, doctors were able to find a physical defect in the uterus that explained the bleeding problems, the study showed.

 

The most common cause was fibroids – benign tumors in the muscles of the uterus – which were found in 25 percent of the women. When a fibroid bulges into the lining of the uterus, it rubs and causes an area of irritation to develop, leading to chronic bleeding problems.

 

These tumors "are a well-known cause, not only of erratic bleeding, but also of infertility," noted the study's lead author Dr. Fritz Nagele, a researcher at the Minimally Invasive Therapy Unit and Endoscopy Training Center at The Royal Free Hospital in London. Fibroids can be removed under the guidance of the hysteroscope, Nagele added.

 

Another 10 percent of the women had polyps – growths protruding from the uterine lining. And fewer than 1 percent of the women had any signs of cancer, according to the study.

 

As for the 49 percent of women who had no clear physical defect at the root of their bleeding problems, "even a normal hysteroscopic view can be helpful in the management of abnormal uterine bleeding," Nagele noted. "What's nice about this study is the large number of hysteroscopies they analyzed," said Dr. Dennis Hidlebaugh, director of Fallon Fertility Services at St. Vincent's Hospital in Worcester, Massachusetts.

 

"Hysteroscopy is an accurate and well-tolerated office procedure that should replace hospitalization for the evaluation of abnormal uterine bleeding," he said.

 

Before hysteroscopy, the only way to diagnose bleeding problems was with a D&C, according to Hidlebaugh.

 

"A lot of women got hysterectomies and a lot just had protracted problems with bleeding," he added.

Obstetrics and Gynecology (1996;88:87-92)