Download X-Plain Hysteroscopy Reference Summary

X-Plain
Hysteroscopy
Reference Summary
Introduction
A hysteroscopy is a procedure that allows doctors to look inside the uterus. It is the
best way to diagnose and treat certain conditions that seriously affect women’s health.
Your doctor may recommend that you have a hysteroscopy. If your doctor
recommends a hysteroscopy for you, it is your decision whether to have the procedure
or not.
This reference summary will help you better understand the benefits and risks of this
procedure.
Anatomy
The female reproductive
organs include:
• vagina
• uterus
• fallopian tubes
• and ovaries
These organs are located in
the pelvis between the
urinary bladder and the
rectum.
Ovaries
Fallopian
Tubes
Uterus
Vagina
The ovaries have two main functions. One function of the ovaries is to produce special
hormones called estrogen and progesterone.
The other function of the ovaries is ovulation, which is the release of eggs needed for
reproduction. The hormones estrogen and progesterone help to regulate ovulation.
Estrogen and progesterone also prepare the inner lining of the uterus to proceed with a
pregnancy. When the ovaries release an egg, it travels down to the uterus through the
fallopian tube, where it may be fertilized.
TM
This document is a summary of what appears on screen in X-Plain . It is for informational purposes and is not intended to be a substitute for the advice
of a doctor or healthcare professional or a recommendation for any particular treatment plan. Like any printed material, it may become out of date over
time. It is important that you rely on the advice of a doctor or a healthcare professional for your specific condition.
©1995-2007, The Patient Education Institute, Inc. www.X-Plain.com
Last reviewed: 05/07/2007
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If an egg is not fertilized, it is discharged, along with the inner lining of the uterus, to
the outside of the body during the menstrual period.
The uterus is pear shaped and about three inches long. It has 3 layers.
The inner layer is called the endometrium. Once a month, if there are no pregnancies
and the ovaries are working correctly, the endometrium and the egg are discharged to
the outside of the body. This is called the menstrual period.
As menopause approaches, menstrual periods become irregular and eventually stop.
Menopause occurs when the ovaries quit producing hormones and releasing eggs.
If a woman becomes pregnant, the fetus stays inside the uterus until delivery. The
uterus is able to get a lot bigger than its normal size. The middle, muscular layer of the
uterus creates labor contractions that cause the baby to be born.
The lowest part of the uterus is called the cervix. It opens into the vagina, which opens
to the outside of the body between the urethra (the urinary bladder opening) and the
rectum.
Ligament
The uterus is held in place with ligaments.
These ligaments help prevent the uterus
from slipping down into the vagina.
Cervix
The urinary bladder is located in front of the vagina and uterus. The kidneys drain
urine into the bladder through two tubes called
ureters. The intestines and the rectum are
Kidney
located above and behind the vagina and
uterus.
Indications
In Latin, "hyster" means uterus and "scopy”
means to look. Hysteroscopy is a way to look
inside the uterus.
Ureter
Bladder
Urethra
Many conditions can require a hysteroscopy.
This section includes a list of some of these conditions. Your doctor will tell you which
one applies to you.
TM
This document is a summary of what appears on screen in X-Plain . It is for informational purposes and is not intended to be a substitute for the advice
of a doctor or healthcare professional or a recommendation for any particular treatment plan. Like any printed material, it may become out of date over
time. It is important that you rely on the advice of a doctor or a healthcare professional for your specific condition.
©1995-2007, The Patient Education Institute, Inc. www.X-Plain.com
Last reviewed: 05/07/2007
og010302
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Some conditions result in heavy menstrual bleeding, which can cause considerable
blood loss. Significant cramps and abdominal discomfort may happen with the
menstrual cycle.
Benign tumors in the muscular layer of the uterus, known as fibroid tumors, can cause
excessive bleeding. These tumors can get large, causing
cramping, pain and pressure on nearby organs.
Parts of the inner lining of the uterus, or endometrium, may
become as big as a marble and dangle inside the uterus. The
marble-sized parts are called polyps. Polyps are rarely
cancerous but they can cause abnormal bleeding.
Polyp
Malignant cancer may also involve the uterus lining.
Rarely, the uterus is divided on the inside by some tissue. This is called a uterine
septum. A uterine septum can cause miscarriage of a baby. It may need to be taken
out surgically.
Scar tissue can form inside the uterus, which can result in a lot of bleeding, abnormal
periods and inability to get pregnant.
An IUD (IntraUterine Device) is a T-shaped method of birth control that some women
use to prevent pregnancies. It is placed inside the uterus by a gynecologist. A thread
connected to the IUD sticks out of the cervix, into the vagina. If the thread slips into
the uterus, a hysteroscopy is necessary to take out the IUD.
Adenomyosis is a condition where the endometrium, or inner lining of the uterus,
grows inside the middle muscular layer of the uterus. This results in pain, cramping,
and abnormal bleeding.
Alternative Treatments
Blood tests can help diagnose some conditions. Ultrasounds of the uterus, through the
abdomen or through the vagina, can also be done to see the inside of
the uterus.
Hysterosalpingography is an x-ray test where dye is placed in the
uterus and x-rays are taken to see the inside of the uterus and
Fallopian tubes.
Hysterosalpingography
TM
This document is a summary of what appears on screen in X-Plain . It is for informational purposes and is not intended to be a substitute for the advice
of a doctor or healthcare professional or a recommendation for any particular treatment plan. Like any printed material, it may become out of date over
time. It is important that you rely on the advice of a doctor or a healthcare professional for your specific condition.
©1995-2007, The Patient Education Institute, Inc. www.X-Plain.com
Last reviewed: 05/07/2007
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Only a hysteroscopy allows the gynecologist to look directly inside the uterus and take
care of some of the problems found.
Procedure
During a hysteroscopy, a scope is inserted inside the uterus. The doctor looks inside
the uterus. Hysteroscopies can be done in an office or a hospital. Some of the
problems found are taken care of immediately when
possible.
Hysteroscopy is usually done with local anesthesia.
General anesthesia may be used if the surgeon
expects to take care of major problems inside the
uterus. General anesthesia is when the patient is
put to sleep for the operation.
With local anesthesia, only the uterus is numbed
and the patient remains awake for the procedure. Your gynecologist will discuss the
best type of anesthesia for you.
The patient is placed in stirrups. The vagina is then cleaned to prevent infections.
A speculum is inserted into the vagina to keep it open during the procedure. This is
usually not painful but it could be uncomfortable. It is very important to try to relax and
to tell your doctor about any pain or discomfort you feel.
The cervix is numbed with local numbing medicine such as lidocaine. It is then dilated,
or made wider, with special instruments.
Next, a scope is inserted into the dilated cervix and into the uterus. To make it easier
for the doctor to see inside, fluid is pumped through the scope into the uterus. You
may feel this water dripping as it exits the vagina.
The doctor examines the uterus and the openings of the
Fallopian tubes. Polyps and abnormal-looking areas can
be taken out with special instruments. If a uterine
septum is found, it can be divided. Scar tissue can be
cleaned up and lost IUDs can be retrieved.
If needed, the whole inner lining of the uterus, or
endometrium, can be taken out to check for cancer cells.
Scope
TM
This document is a summary of what appears on screen in X-Plain . It is for informational purposes and is not intended to be a substitute for the advice
of a doctor or healthcare professional or a recommendation for any particular treatment plan. Like any printed material, it may become out of date over
time. It is important that you rely on the advice of a doctor or a healthcare professional for your specific condition.
©1995-2007, The Patient Education Institute, Inc. www.X-Plain.com
Last reviewed: 05/07/2007
og010302
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Removing the endometrium can also treat some conditions that cause abnormal
bleeding.
Depending on how much needs to be done during the hysteroscopy, your doctor may
also decide to have another scope inserted into the abdominal cavity. This is usually
done under general anesthesia.
Patients usually go home the same day of a hysteroscopy.
Risks & Complications
This procedure is very safe. There are however, several possible risks and
complications. These are very unlikely, but possible. You need to know about them
just in case they happen. By being informed, you may be able to help your doctor
detect complications early.
The risks and complications include those related to anesthesia
and those related to any type of surgery.
Risks of general anesthesia include nausea, vomiting, urinary
retention, cut lips, chipped teeth, sore throat, and headache. More
serious risks of general anesthesia include heart attacks, strokes,
and pneumonia.
Your anesthesiologist will discuss these risks with you and ask you
if you are allergic to certain medications.
Blood clots in the legs can occur due to inactivity during and after the surgery. These
usually show up a few days after surgery. They cause the leg to swell and hurt.
Blood clots can become dislodged from the leg and go to the lungs where they will
cause shortness of breath, chest pain and possibly death. Sometimes the shortness of
breath can happen without warning.
It is extremely important to let your doctors know if any of these symptoms occur.
Getting out of bed shortly after surgery may help decrease the risk of blood clots in the
legs.
TM
This document is a summary of what appears on screen in X-Plain . It is for informational purposes and is not intended to be a substitute for the advice
of a doctor or healthcare professional or a recommendation for any particular treatment plan. Like any printed material, it may become out of date over
time. It is important that you rely on the advice of a doctor or a healthcare professional for your specific condition.
©1995-2007, The Patient Education Institute, Inc. www.X-Plain.com
Last reviewed: 05/07/2007
og010302
5
Some risks are seen in any type of surgery. These include:
• Infection, in the reproductive organs or inside the pelvis and abdomen.
• Bleeding, either during or after the operation, which may require a blood
transfusion.
Other risks and complications are related specifically to this surgery. These again are
very rare. However, it is important to know about them.
Rarely, structures in the pelvis and abdomen can be injured during the procedure,
especially if there is significant scarring from previous surgeries, endometriosis or
pelvic inflammatory disease (PID).
The uterus and Fallopian tubes can be injured, requiring another operation to fix the
injury. In extremely rare situations, the intestines and blood vessels could also be
affected, necessitating another operation.
It is very rare for the tubes connecting the kidneys to the bladder, as well as the
bladder itself, to be injured. However, if this does happen, another operation may be
necessary and could result in the loss of a kidney.
Similarly, in extremely rare situations, small nerves in the pelvis may be injured
resulting in decreased sensation in the sexual organs. Rarely, this can lead to sexual
dysfunction.
After the Procedure
After the procedure, you will be allowed to recover from the general anesthetic, if it was
used. A tube may be placed in your bladder to help empty urine. This tube will be
removed before leaving the hospital.
Some cramping is expected after a hysteroscopy, as well as some
vaginal bleeding. You should call your doctor if bleeding becomes
excessive or if discharge becomes foul-smelling. These may be
signs of complications.
You should not have sexual intercourse or put anything inside the
vagina until your doctor says it is okay to.
The first menstrual period after a hysteroscopy may not be normal in terms of the
amount of blood and how long it lasts.
TM
This document is a summary of what appears on screen in X-Plain . It is for informational purposes and is not intended to be a substitute for the advice
of a doctor or healthcare professional or a recommendation for any particular treatment plan. Like any printed material, it may become out of date over
time. It is important that you rely on the advice of a doctor or a healthcare professional for your specific condition.
©1995-2007, The Patient Education Institute, Inc. www.X-Plain.com
Last reviewed: 05/07/2007
og010302
6
You will need to take short walks to help blood circulate in your legs and prevent blood
clots from forming.
You should tell your doctor if you develop any of the
following:
• a fever
• a foul-smelling vaginal discharge
• drainage from the incision
• severe leg pain
• any other unusual symptoms
Summary
Hysteroscopy is a very safe and successful procedure. It
often helps doctors diagnose and take care of potentially serious gynecological
conditions.
As you have learned, complications may happen. Knowing about them will help you
detect them early if they happen.
TM
This document is a summary of what appears on screen in X-Plain . It is for informational purposes and is not intended to be a substitute for the advice
of a doctor or healthcare professional or a recommendation for any particular treatment plan. Like any printed material, it may become out of date over
time. It is important that you rely on the advice of a doctor or a healthcare professional for your specific condition.
©1995-2007, The Patient Education Institute, Inc. www.X-Plain.com
Last reviewed: 05/07/2007
og010302
7