Hysteroscopy for dysfunctional uterine bleeding

Exam Overview

Hysteroscopy is a diagnostic and surgical procedure that makes examining the inside of the uterus possible without making an abdominal cut (incision). During hysteroscopy, a lighted viewing instrument called a hysteroscope is inserted through the vagina and cervix and into the uterus. Treatment can also be done through the hysteroscope during the same procedure.

Hysteroscopy usually takes 30 to 45 minutes and is done as an outpatient procedure. General anesthesia is usually used, although local or spinal anesthesia can be used instead. You should not eat or drink for at least 4 to 8 hours before having the test. A gynecologist or surgeon performs the procedure.

The uterus is filled with a fluid, such as normal saline or glycine. The hysteroscope is inserted through the cervix into the uterus so the inner surface of the uterus can be examined. Hysteroscopy can locate the cause of bleeding for many women.

Why It Is Done

Hysteroscopy is used both to diagnose and treat abnormal vaginal bleeding. If areas of bleeding are found during the procedure, the tissue may be destroyed by laser beam or electric current (electrocautery) or surgically removed at the same time.

Hysteroscopy is done to:

• Locate and evaluate the cause of uterine bleeding, such as uterine fibroids, when blood loss is severe.
• Confirm a diagnosis before starting treatment with medicines that have significant side effects, such as danazol or a gonadotropin-releasing hormone analogue (GnRH-a).

Results

Results of hysteroscopy may include the following.

Normal

No abnormalities are found.

Abnormal

Abnormal tissue growths, uterine fibroids, areas of active bleeding, or scar tissue is found in the uterus. Hysteroscopy provides an accurate diagnosis of fibroids or other abnormal conditions within the uterus.¹

What To Think About

Hysteroscopy may be used to determine the cause of undiagnosed uterine bleeding before starting treatment with medicines or surgery. It is important to find the cause of the bleeding before starting treatment with medicines that have significant side effects, such as danazol or a GnRH-a.

Hysteroscopy may be used both to diagnose and treat fibroids, which can cause heavy vaginal bleeding.

Complications occur in 3% to 6% of women and can include:²

• Too much fluid absorbed in the blood (fluid overload).
• Low blood levels of sodium (hyponatremia).
• Fluid collection in the brain (cerebral edema) or the lungs (pulmonary edema).
• Injury to the lining of the uterus.
• Puncture of the uterus (uterine perforation) and bleeding (hemorrhage).

The safe and effective use of a hysteroscope requires specialized training by the doctor.

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Author:	Kathe Gallagher, MSW	Last Updated: August 16, 2007
Medical Review:	Kathleen Romito, MD - Family Medicine Kirtly Jones, MD - Obstetrics and Gynecology
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