Hysteroscopy can be defined as an inspection of the cavity in the uterus with the help of endoscopy. It is accessed through the cervix. It is done for the diagnosis of the intrauterine pathology and serves as a way of surgical intervention as well. It is executed through the endoscope which carries light and optical fibres. The hysteroscope is introduced like a sheath providing an inflow as well as outflow channel to insufflate the uterine cavity. Sometimes, operative channels are also used for introducing necessary equipment like scissors, biopsy tools and graspers. The method of hysteroscopic resectoscope works like transurethral resectoscope and allows access to the electric hook for shaving off unwanted tissue such as fibroids inside the uterus. The diagnostic hysteroscopy is the most accepted and the most preferred way of diagnosing the problems present in the uterus. It is often used in close conjunction with other procedures including dilation and curettage or laparoscopy. There are two variants of hysteroscopy, namely, the diagnostic hysteroscopy and the operative hysteroscopy. Operative hysteroscopy is used for treating the problems of the uterus.
There are two variants of hysteroscopy- one is operative, and the other is diagnostic. In the case of diagnostic hysteroscopy, the gynaecologist inserts a slender tube with a fitted camera into the abdomen for viewing the uterine cavity. It is also performed for ensuring the results of other tests including HSG (hysterosalpingogram). If the gynaecologist finds any abnormalities while performing the diagnostic hysteroscopy, he may proceed to correct it through operational hysteroscopy. In this method, miniature tools are used for correcting the condition. The anaesthesia used for the process comes in three forms: local, regional and general anaesthesia. In the case of the local anaesthesia, a small part of the body is numbed for a short time while regional anaesthesia helps in numbing the body for hours together. The process of hysteroscopy does not involve any cuts or sutures in the abdomen or any other region, and it doesn’t take much time to complete it. But you may have to be in the operation theatre for some hours for recovery. The expert may also choose to opt for general anaesthesia if other processes are performed along with the hysteroscopy where the patient must not feel anything for the whole procedure.
Your doctor may consider you eligible candidate for the hysteroscopy treatment if you have fibroids and polyps in the uterus, adhesions, septums and abnormal bleeding. The hysteroscopy can be used for the removal of a non-cancerous growth in the uterus. In some instances, the doctor may also choose to remove it through operational hysteroscopy. Hysteroscopy can help the doctor to determine if there are any adhesions in the uterus and remove them. These adhesions are a group of scar tissue which forms in the uterus and paves the way for abnormal menstrual flow and infertility.
Even though there are several benefits of the hysteroscopy treatment, it may not be for all. There are several factors that play a role in determining whether the treatment would be suitable for a particular patient or not. Thus, it is always recommended to consult with a reputed gynaecologist who can evaluate your condition and determine whether the hysteroscopy treatment is right for your or whether you must look for some other alternatives.
If the regional or general anaesthesia is given during the process, then the patient would be observed for several hours before releasing from the healthcare facility. It is common to have slight cramping and even vaginal bleeding after the process is completed and it can last for up to 2 days. If gas was used during the process, then you may also experience some pain in your shoulder. Some patients also feel fatigued and sick after undergoing hysteroscopy, and it is normal. But you must immediately call your doctor if you see symptoms like fever, unbearable pain in the abdomen and heavy vaginal discharge.
Hysteroscopy is a relatively safe procedure, but there is always a probability of certain complications. That is why it is always important to stick to the guidelines instructed by the gynaecologist. You will have to stay in the hospital for at least 4 hours after the treatment. You can start taking meals and drinks right after the treatment and take shower the same day of the treatment. But it is important to avoid having sex for a week or so or until the vaginal bleeding stops. Your doctor would tell you the results of the treatment if they have found anything unusual while diagnosing.
It is always recommended to take rest whenever you can. The side effects including cramps and vaginal discharge are normal, but you should seek your doctor’s attention immediately if they become unbearable. It is important to consult with the doctor if you feel shortness of breath, nausea, severe pain in the pelvic region. Most women report that they can return to their normal activities the day following hysteroscopy treatment. But you may need to take rest for a few days if you have undergone removal of fibroids.
The exact cost of the diagnosing hysteroscopy cannot be assessed as it depends on several factors. But it is fairly affordable and costs about Rs. 20,000. However, it can vary according to the quality of the treatment offered at the healthcare facility, your individual health condition, and other factors. For more information, your doctor would be able to guide you better.
Like all other treatments, hysteroscopy also has some alternatives. For instance, your doctor can take a small sample of the lining of the uterus to find out if there are any abnormalities. Also, ultrasound scans help in offering an insight to the uterus of the patient. But you should note that there are certain conditions which can only be diagnosed and cured through hysteroscopy and thus, you must consider it.
Infertility is a emerging health concern today. According to the Indian Society of Assisted Reproduction, around 10-15% of Indian women are affected by infertility. The rate goes up in urban areas where every one in six women is diagnosed infertile. Around 27 million couples in India require assistance to reproduce.
What is hysterolaparoscopy?
This is an endoscopic procedure, where small telescope is introduced in abdominal cavity. Reproductive organs like uterus, ovaries, fallopian tubes, pouch of douglas are examined under magnified view. It can be diagnostic or operative scopy in case of any pathologies. Tubal patency can be confirmed using methylene blue dye (diluted one).
Just one session can clear questions relating to tubal patency, ovarian morphology, uterine abnormalities and undetected pelvic pathology. Moreover, other procedures like hysteroscopy guided tubal cannulation, lateral or fundal metroplasty, biopsy, polypectomy, adhesiolysis, septal resection and myomectomy can all be performed in the same sitting.
Which infertility patients benefit from Hystero laparoscopy?
Unilateral or bilateral tubal block
Pelvic inflammatory diseases
T shaped cavity
Hysterolaparoscopy is an efficient way to optimize fertility. It is usually done when simple treatment modalities fails to achieve pregnancy or when SSG (Sono salpingo graphy)/HSG(hystero salpingo graphy) suggests tubal block or for other associated pathologies listed above or in cases of unexplained infertility.
Hysteroscopy deals with pathologies in uterine cavity, so plays vital role for women going for IVF, especially those with recurrent miscarriages, thin endometrium, h/o recurrent implantation failures, submucous myomas. Cases with Asherman's Syndrome or big submucous myomas may need second look hysteroscopy. This is a daycare procedure, whereas Laparoscopy needs at least 24 hour hospital stay. The procedure requires advanced equipments & skilled surgeon. It offers speedy recovery and minimum number of stitches on the abdomen. All this has made hysterolaparoscopy, an important tool in the evaluation of infertility.
Abnormal uterine bleeding, also known as AUB, is one of the most common causes requiring gynecologic evaluation. Hysteroscopy is a procedure wherein a thin camera called hysteroscope is introduced into the uterus via the vagina and this light helps in a thorough examination of the uterus. In cases where there are cysts or fibroids or even cancerous growths, this is used to get more details on the lesions. However, hysteroscopy also has a therapeutic use in that it is used to treat conditions like abnormal uterine bleeding. Read on to know more about AUB and how hysteroscopy helps in treatment.
Causes of Abnormal Uterine Bleeding: Vaginal bleeding that occurs more often than 21 days and farther apart than 35 days is known as abnormal uterine bleeding. The bleeding is also abnormal if it lasts longer than 7 days and more than 80 mL of blood is lost during each cycle.
Some causes include:
When a woman has abnormal bleeding, further diagnosis is required to confirm the exact cause of the bleeding. This is where the hysteroscopy comes into the picture. Hysteroscopy, literally translates to viewing the uterus from inside directly through a camera.
How it is done:
Hysteroscopy is done as an outpatient procedure and normally takes about 3 to 4 hours. General or spinal anesthesia may be used depending on complexity and overall patient health. The uterus is filled with a fluid like saline or glycerin and a thin lighted instrument called the hysteroscope is inserted through the vagina, up the cervix, and into the uterus. This tube is flexible and so can be moved across the uterus to identify any areas of abnormality. It also has a camera and so can be used to take pictures of suspicious areas.
Causes for infertility may also be detected using hysteroscopy. Small knives can also be used to remove the lesion like fibroid or polyp. These are often the cause of abnormal bleeding. Samples can also be taken for biopsy to confirm if any cancerous growth is detected.
Hysteroscopy is a safe and effective way to examine the cervical canal and uterine cavity. It is better to accompany D&C with hysteroscopy instead of going for blind dilatation and curettage, especially in women who are peri or premenopausal. Hysteroscopy is a safe procedure if done by a doctor, specialised in gynecological endoscopy and helps in both diagnosis and treatment of abnormal uterine bleeding. If you wish to discuss about any specific problem, you can consult a Gynaecologist.
Fibroids are the most frequently seen tumors of the female reproductive system. Fibroids, also known as uterine myomas, leiomyomas, or fibromas, are firm, compact tumors that are made of smooth muscle cells and fibrous connective tissue that develop in the uterus. It is estimated that between 20 to 50 percent of women of reproductive age have fibroids, although not all are diagnosed. Some estimates state that only about one-third of these fibroids are large enough to be detected by a doctor during a physical examination.
In more than 99 percent of fibroid cases, the tumors are benign (non-cancerous). These tumors are not associated with cancer and do not increase a woman's risk for uterine cancer. They may range in size, from the size of a pea to the size of a softball or small grapefruit.
Causes: While it is not clearly known what causes fibroids, it is believed that each tumor develops from an aberrant muscle cell in the uterus, which multiplies rapidly because of the influence of estrogen.
Some women who have fibroids have no symptoms, or have only mild symptoms, while other women have more severe, disruptive symptoms. The following are the most common symptoms for uterine fibroids:
Heavy or prolonged menstrual periods
Abnormal bleeding between menstrual periods
Pelvic pain (caused as the tumor presses on pelvic organs)
Low back pain
Pain during intercourse
A firm mass, often located near the middle of the pelvis, which can be felt by the doctor on examination
Diagnosis: Fibroids are most often found during a routine pelvic examination. This, along with an abdominal examination, may indicate a firm, irregular pelvic mass to the physician. In addition to a complete medical history and physical and pelvic and/or abdominal examination, diagnostic procedures for uterine fibroids may include:
Transvaginal ultrasound (also called ultrasonography). An ultrasound test using a small instrument called a transducer, that is placed in the vagina.
Magnetic resonance imaging (MRI). A non-invasive procedure that produces a two-dimensional view of an internal organ or structure.
Hysterosalpingography. X-ray examination of the uterus and fallopian tubes that use dye and is often performed to rule out tubal obstruction.
Hysteroscopy. Visual examination of the canal of the cervix and the interior of the uterus using a viewing instrument (hysteroscope) inserted through the vagina.
Blood test (to check for iron-deficiency anemia if heavy bleeding is caused by the tumor).
Treatment: Since most fibroids stop growing or may even shrink as a woman approaches menopause, the doctor may simply suggest "watchful waiting." With this approach, the doctor monitors the woman's symptoms carefully to ensure that there are no significant changes or developments and that the fibroids are not growing.
In women whose fibroids are large or are causing significant symptoms, treatment may be necessary. Treatment will be determined by the doctor based on:
Your overall health and medical history
Extent of the disease
Your tolerance for specific medications, procedures, or therapies
Expectations for the course of the disease
Your opinion or preference
Your desire for pregnancy
In general, treatment for fibroids may include:
Hysterectomy. Hysterectomies involve the surgical removal of the entire uterus.
Conservative surgical therapy. Conservative surgical therapy uses a procedure called a myomectomy. With this approach, physicians will remove the fibroids, but leave the uterus intact to enable a future pregnancy.
Gonadotropin-releasing hormone agonists (GnRH agonists). This approach lowers levels of estrogen and triggers a "medical menopause." Sometimes GnRH agonists are used to shrink the fibroid, making surgical treatment easier.
Anti-hormonal agents. Certain drugs oppose estrogen (such as progestin and Danazol), and appear effective in treating fibroids. Anti-progestins, which block the action of progesterone, are also sometimes used.
Uterine artery embolization. Also called uterine fibroid embolization, uterine artery embolization (UAE) is a newer minimally-invasive (without a large abdominal incision) technique. The arteries supplying blood to the fibroids are identified, then embolized (blocked off). The embolization cuts off the blood supply to the fibroids, thus shrinking them. Health care providers continue to evaluate the long-term implications of this procedure on fertility and regrowth of the fibroid tissue.
Anti-inflammatory painkillers. This type of drug is often effective for women who experience occasional pelvic pain or discomfort. In case you have a concern or query you can always consult an expert & get answers to your questions!
Infertility is a condition where a couple, trying to conceive in a natural way is not able to do so even after one year of trying. It is also a matter of worry for patients who are over the age of 35 years and those who are not able to conceive naturally even after 12 months of trying constantly.
Causes: There are many causes of infertility. It may be down to a condition present in one or both partners. Ovulation and fertilisation are the main elements of the conception process and any condition in the female or male can upset either function, which can make it difficult to conceive.
While abnormal sperm production and transport may be a common condition that leads to infertility in males, other factors like side effects of cancer treatments and too much exposure to toxins and chemicals can also play an important role in this regard. For females, the causes of infertility may range from ovulation disorders, uterine and fibroid tumours, uterine and cervical anomalies, damage to or blockage of the fallopian tubes, endometriosis, primary ovarian insufficiency and pelvic adhesions.
Infertility Symptoms in Women
In women, changes in the menstrual cycle and ovulation may be a symptom of a disease related to infertility. Symptoms include:
Treatment: Female patients can turn to medication that will stimulate ovulation, intrauterine insemination, and surgical processes to correct a uterine septum and remove endometrial polyps, or even a hysteroscopy surgery. Male patients can go through a treatment for any existing infections, hormonal injections and medication, surgical options like vasectomy reversal and art or assistive reproductive technology.
If these methods fail, the patient or the couple can always turn to methods like in vitro fertilisation. For other mild reasons, lifestyle changes along with a stress free environment can help in increasing the chances of conception. If you wish to discuss about any specific problem, you can consult a gynaecologist.
While some couples conceive with ease, conceiving a child can be extremely difficult for others. In cases where a woman is not able to get pregnant despite having regular intercourse in tune with her biological cycle, infertility tests may be suggested to investigate the reason behind this. In most cases, these tests are suggested if a year has gone by without intercourse resulting in a pregnancy. Women may also be said to be infertile, if they cannot carry a foetus to full term.
Infertility can affect both men and women and can be triggered by a number of different reasons. In some cases, it is treatable while in others, alternative ways of having a family may need to be discussed. Hence, it is very important to understand the different types and triggers for infertility and to undergo complete infertility investigations. Some of the common types of infertility investigations are as given below.
Infertility treatment depends on the cause identified by the above tests and hence it is important for both partners to undergo complete testing. If you wish to discuss about any specific problem, you can consult a gynaecologist.