Hysteroscopy
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What is the test?
Hysteroscopy is a procedure
that allows a gynecologist to look inside your uterus. The hysteroscope
is a long tube, about the size of a straw, which has a built-in
viewing device. Hysteroscopy is useful for diagnosing and treating
some problems that cause infertility, miscarriages, and abnormal
menstrual bleeding. Sometimes other procedures, such as laparoscopy,
are done at the same time as hysteroscopy.
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How do I prepare
for the test?
The time that you schedule
this test can be important. Your gynecologist is able to get
the best view of the uterine lining during the week that follows
your period. If you have regular cycles, it is helpful for you
to anticipate the timing of your next period and plan to have
the hysteroscopy done in the following week.
Tell your doctor ahead
of time if you have ever had an allergic reaction to lidocaine
or the numbing medicine used at the dentist's office. Discuss different
options for anesthesia with your doctor in advance.
If your doctor plans
on giving you any anti-anxiety medicines before the procedure,
or if you are going to have other tests done at the same time
as hysteroscopy, you might be told not to eat or drink for eight
hours or more before the test. Just before the test, you should
empty your bladder.
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What happens
when the test is performed?
You lie on your back
on an examination table, with your knees bent and your feet in
footrests, as you would for a pelvic examination. Your vaginal
area is cleaned with an antibacterial soap.
This procedure can be
done with local, regional, or general anesthesia. Local anesthesia
requires injections of numbing medicine into the tissue surrounding
your cervix, inside your vagina. You remain awake through the procedure
and may feel some cramping in your pelvis.
Regional anesthesia
for hysteroscopy is done with either a spinal block or epidural
block. For this type of anesthesia, a drug is injected through
a needle or tube in your lower back by an anesthesiologist. You
are awake for the procedure, but you do not feel pain from your
pelvic region.
If you are having other
procedures (such as laparoscopy) done at the same time as hysteroscopy,
you might have general anesthesia, which puts you to sleep so
you are unconscious during the procedure. General anesthesia
is administered by an anesthesiologist, who asks you to breathe
a mixture of gases through a mask. After the anesthetic takes
effect, a tube may be put down your throat to help you breathe.
Once the anesthesia
is working, the opening of your cervix may need to be widened.
This can be done with instruments that stretch the opening. Your
gynecologist inserts the hysteroscope through the vagina and
cervix and into the uterus. A liquid or gas is released through
the hysteroscope to expand the inside of the uterus so that your
doctor has a clearer view. A light at the end of the instrument
allows your doctor to see the walls of the uterus and the openings
of the fallopian tubes at the top of the uterus. The doctor may
also insert small surgical instruments through the hysteroscope
to carry out such procedures as taking a sample of tissue (biopsy),
removing a polyp or growth, removing the lining of the uterus with
dilation and curettage (D&C), or treating the lining of your uterus with ablation
electricity to prevent bleeding.
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What risks are
there from the test?
After the procedure,
you may have slight vaginal bleeding and cramps for one or two
days. Sometimes a small amount of the gas used to expand the
uterus can float up to the top of the abdomen and remain there
for a day or two before it dissolves away. This can cause some
shoulder pain. Some patients experience nausea from medicines
used for anesthesia or anxiety.
Some of the procedures
that are done along with hysteroscopy have risks of their own.
You should ask your doctor about special risks that might come
along with additional procedures planned for you.
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Must
I do anything special after the test is over?
If you have the test
done with local anesthesia, you can go home right away. If you
have regional or general anesthesia, you will need to stay for
a few hours to be watched by your doctor. If you have general
anesthesia or anti-anxiety medication, you should not drive or
drink alcohol after the test.
You should notify your
doctor if you have a fever over 101° F, strong abdominal
pain, or heavy bleeding from your vagina.
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How
long is it before the result of the test is known?
Your doctor can tell
you what was seen through the hysteroscope right away. If a biopsy
sample is removed, the analysis might take several days.
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