The vast majority of endometrial polyps are bening and very rarely can be associated with cancer. They can cause irregularities in the menstrual cycle or infertility. The polyp is easily removed under direct vision by using a hysteroscope ( camera) while the patient is asleep (general anaesthetic).
A hysteroscopy is a simple procedure usually carried out on an outpatient or day-case basis. This means you won’t normally need to stay in hospital overnight.
A hysteroscopy is not usually carried out under anaesthetic, as it’s a relatively quick procedure and does not involve making cuts (incisions) in your skin.
Taking painkillers such as ibuprofen or paracetamol about an hour beforehand can help reduce discomfort after the procedure.
Occasionally, a local anaesthetic may be used to numb your cervix (entrance to the womb) during the procedure.
Longer or more complicated procedures, such as the removal of fibroids, may be done under general anaesthetic. This means you’ll be asleep while the operation is carried out.
Fibroids are almost always benign growth’s arising fro the muscle layer of the uterus. Depending on their location and size they can cause different symptoms like pain, heavy or irregular menstrual bleeding, infertility or pressure symptoms. For fibroids that protrude by >50% in the uterine cavity treatment is by hysteroscopic resection.
The Uterus is formed embryologically by the fusion of two tubes, if the process is incomplete then a septum can arise. Its what we often call “heart shaped uterus”. If the septum is small it usually doesn’t cause any problems but bigger septae can be associated with infertility or recurrent miscarriages. Septae can be removed by hysteroscopy. Care should be taken post surgery to make sure that adhesions dont form at the operation site. Various methods can be used like the coil or a balloon combined with estrogen to rebuilt the endometrium.
It is well establsihed in the literature that endometrial injury is beneficial in terms of improving implantation rates. During hysteroscopy an assesment of the uterine cavity is performed and at the same time small cuts are performed at the fundus of the uterus “implantation cuts” and a gentle curretage. The overall effect is improved implantation raets and often we see spontaneous pregnancies just after such a hysteroscopy.
Sometime the contraceptive coil threads cannot be visualised via speculum or the coil is embedded in the uterine wall. In such cases direct visualisation of the endometrial cavity via hysteroscopy can be used to remove the coil.
Previous intrauterine infections such as chlamydia or repeat curretage ( D&C) can sometime slead to intrauterine adhesions ( Ashermans). Adhesions can cause infertility and/or changes in the menstrual pattern ( i.e oligomennorhoea). This can be treated by experienced surgeons hysteroscopically.
Post menopausal bleeding is associated with endometrial hyperplasia or endometrial cancer in around 10% of patients who present with it. Endometrial biopsy and sometime hystroscopy and D&C is required to confirm or exclude the diagnosis.