Diagnostic hysteroscopy in Milan
Hysteroscopy: what is it?
Hysteroscopy is a diagnostic and therapeutic gynecologic procedure that allows direct visualization of the uterine cavity and cervix. Using a hysteroscope, a thin, lighted instrument, the physician is able to examine the interior of the uterus to diagnose and, in some cases, treat uterine abnormalities. This instrument is introduced through the vagina and cervical canal, providing detailed images that can reveal the presence of polyps, fibroids, adhesions, and congenital abnormalities, as well as allow the identification of underlying causes of abnormal bleeding or difficulty in conception. This examination is critical in the evaluation of various specific gynecologic problems and as part of infertility diagnostics.
What is it for?
Hysteroscopy finds application in a variety of clinical settings, serving both diagnostic and therapeutic purposes. Diagnostically, it is useful for investigating abnormal uterine bleeding, evaluating the uterus in cases of infertility and recurrent gestational losses, as well as diagnosing the presence of structural abnormalities. Therapeutically, it allows the removal of endometrial polyps, the removal of adhesions (synechiae) or small fibroids, and the correction of congenital abnormalities, such as uterine septum, potentially with positive impacts on a woman’s fertility. Diagnostic hysteroscopy emerges as the gold-standard for diagnosing conditions such as endometrial polyps, submucosal fibroids, intrauterine adhesions (synechiae), and congenital abnormalities of the uterus. In addition, it is always performed for the evaluation of abnormal uterine bleeding. In infertile patients, hysteroscopy is essential to assess the reception of the uterine cavity to embryo implantation.
When should a hysteroscopy be performed?
The decision to resort to hysteroscopy may be motivated by various conditions, including abnormal uterine bleeding (e.g., particularly heavy, prolonged, or irregular menstruation), suspected presence of polyps or fibroids, unexplained pelvic pain, infertility, or the need to remove intrauterine devices (IUDs) that cannot be extracted by conventional methods. In addition, it may be indicated in cases of bleeding after menopause.
How is it done?
A hysteroscopy is performed using a hysteroscope, a thin optical instrument equipped with a camera and light source, which is inserted through the cervix into the uterus. The procedure can be performed on an outpatient basis and generally does not require anesthesia. The hysteroscope transmits images of the inside of the uterus on a monitor, allowing the doctor to inspect the uterine cavity for abnormalities. The examination takes only a few minutes and is generally well tolerated by the patient. However, taking a pain reliever before the procedure may be helpful to increase the patient’s compliance with the performance of the diagnostic exam. In rare cases, it may be necessary to perform diagnostic hysteroscopy under conscious sedation for individuals who are particularly sensitive to the procedure.
Is hysteroscopy painful?
The level of discomfort or pain associated withhysteroscopy varies among individuals. Some patients report cramping sensations or menstrual-like pain during or after the procedure, especially when performed without anesthesia. The use of local or general anesthetics can reduce or eliminate pain during hysteroscopy.
What are the risks?
Speaking of the risks associated with hysteroscopy, it is important to note that although this procedure is widely considered safe and with a low complication rate, as with any medical procedure, there are potential risks that cannot be completely ruled out. These risks vary in severity and frequency, but fortunately, serious adverse events are quite rare.
Starting with infections, we can say that they are a post-procedural concern, but their incidence remains low. The entry of instruments through the cervical canal theoretically opens the door for the introduction of pathogens, however, adopting strict antiseptic practices significantly reduces this risk. Symptoms of infection may include fever, pelvic pain and unusual discharge, necessitating prompt medical intervention to prevent progression.
Bleeding is another potential risk, especially if polyps or fibroids are removed during hysteroscopy. These bleeding episodes are usually mild and self-limiting, but in rare cases they may require further treatment.
One aspect not to be underestimated is the risk of tissue damage to the uterus or cervix, which can occur during the maneuvering of the hysteroscope or the use of surgical instruments. These injuries are usually minor and resolve without complications, but careful monitoring is essential.
Uterine perforation represents a more serious complication, although its incidence is very low. This risk increases with conditions that make the tissues more fragile or during particularly complex procedures, and may require surgery for repair.
The key to minimizing complications is scrupulous patient selection, detailed pre-procedural evaluation, and the use of careful surgical techniques. An open and transparent dialogue between physician and patient regarding the potential risks and benefits of hysteroscopy is essential to enable the patient to make an informed decision regarding the procedure.
Exam preparation
Before ahysteroscopy, you may need to refrain from eating or drinking for a period if anesthesia is planned. It is important to inform your doctor about any medications you are taking, including anticoagulants or supplements, as they may require adjustments. Your doctor may prescribe medication to dilate the cervical canal before the procedure. Usually, hysteroscopy should be scheduled during the first half of the menstrual cycle, when the endometrium is thinnest.
Diagnostic hysteroscopy is a key technique in the diagnosis and treatment of various uterine pathologies, offering the advantage of being less invasive than other surgical procedures. Proper preparation and understanding the potential risks and benefits are essential to approach hysteroscopy with confidence.
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