Diagnostic or outpatient hysteroscopy
We can define the Diagnostic hysteroscopy such as the endoscopic exploratory technique that studies the interior of the uterine cavity and the endocervical canal. It is based on imaging techniques.
It can have both a diagnostic and a treatment aspect, including various minor surgical procedures. Most patients tolerate them well. They constitute a simple, safe and highly effective procedure all with recognize, evaluate and treat intrauterine disorders.
The ideal hysteroscopic examination requires perfect knowledge of the technique, the equipment used, and the patient being examined. All the materials we have, combined with careful training and technique, make diagnostic hysteroscopy a safe procedure. It can be performed in its entirety. without anesthesia.
Table of Contents
Indications
Previous preparation
Choosing the most appropriate moment
Exploration
Risks and complications
Indications for Diagnostic Hysteroscopy
- Bleeding after 1 year without a menstrual cycle, during menopause.
- Disorders of the menstrual cycle.
- Suspected endometrial disease due to some imaging technique (ultrasound, hysterosalpingography, etc.).
- Possible cervical disease.
- Suspected alterations in uterine shape.
- Sterility/infertility study.
- Diagnosis and treatment of retained remains after an abortion.
- IUD removal.
- Diagnosis and monitoring of endometrial hyperplasia or precancerous changes.
- Diagnosis and classification before surgery of endometrial and endocervical cancer.
Previous preparation
The best preparation we can do is to provide the patient with good information about the test she will undergo. It is preferable to offer this information information in the days leading up to it to the performance of hysteroscopy, minimizing fear of it and facilitating patient cooperation.
In certain cases, it will be decided to prescribe, according to the characteristics of the patient, medication to help dilation of the uterine cervix. An analgesic or muscle relaxant in selected cases.
Choosing the most appropriate moment
Outpatient hysteroscopy can be performed on any day of the cycle, although it is not recommended during menstruation since bleeding makes visualization difficult.
It is important to know the phases of the menstrual cycle to establish a correct diagnosis:
- First half of the cycle or before ovulation: It facilitates the diagnosis of alterations in shape, suspected polyps or fibroids... The endometrium is highly vascularized and bleeds easily.
- Second half of the cycle, period immediately before menstruation: The endometrium is developed and bleeds little, allowing the assessment of functional alterations, inflammatory processes, and sterility studies.
Exploration
The patient comes in for the test after a detailed medical history is taken. The indications for the test will be emphasized, as well as factors that may make the examination more or less difficult: history of previous pregnancies and births, previous cervical surgeries, years since menopause, etc.
After placing the patient in the gynecological position, a check will be performed to ensure the proper functioning of all the equipment. The examination will then begin:
Vaginoscopy
It allows vaginal examination and ends with the identification of the ectocervix, visualizing its entire contour.
Endocervix
The characteristics of the endocervix will be assessed both at the beginning and at the end of the procedure. Any possible abnormalities at this level will be evaluated, as well as the possibilities of resolving them in the same procedure.
Once we reach the internal cervical os (ICO), we will attempt to pass through it as gently as possible. This is the most painful part of the examination. We always advise the patient, as, in our experience, this greatly helps improve tolerance of the test.
Uterine cavity
Once in the cavity, it is advisable to wait a few moments for it to relax and clear any materials that could obscure vision.
Next, the exploration will begin. It must be done in a systematic manner so that no corner of the area is left unexplored.
Risks and complications of diagnostic hysteroscopy
It is a diagnostic/therapeutic procedure that can be considered almost harmless if the indication, technique, asepsis and handling have been carried out appropriately.
However, there are risks associated with the technique itself and others associated with each patient's condition.
In summary, outpatient hysteroscopy performed in the office is a safe procedure. It provides great information on the shape and function of the uterus with important applications throughout the life of the woman and her future offspring.
Article written by the Dr. Duque Frischkorn.
If you found this article interesting and would like to be seen by a professional expert in Gynecology and Obstetrics, the Women's Unit at Ruber International Hospital has a specialized unit in this area. You can request more information by calling 917303673. make an appointment for an in-person consultation Or make an appointment for an online consultation if you prefer remote consultations—always with the best specialists.
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