What is a hysteroscopy?
A hysteroscopy is a test that allows your doctor to look inside your womb using a narrow tube-like telescope called a hysteroscope. This instrument is very slim (about 3-5 millimeters in diameter). It is carefully passed through the vagina and cervix and into your womb.
What is a D & C?
A dilation and curettage (D & C) is the scraping of the lining of the uterus (the endometrium).
Why is it needed?
A hysteroscopy operation is performed for two reasons. The first is to try to make a diagnosis, usually to explain why the womb is bleeding in an abnormal way. The second is to treat something that is wrong.
When a woman has a normal period, she loses blood and tissue cells that line the womb (endometrium). In the first half of the monthly cycle the ovaries make a hormone called oestrogen. This makes the lining of the womb grow thicker. After ovulation, the ovaries make a second hormone known as progesterone. If the egg which is released from the ovary each month is not fertilized the lining of the womb (endometrium) is shed, together with blood. The whole cycle will then start over again.
Sometimes the character or amount of a woman’s period can change, or there may be breakthrough bleeding or spotting in between periods or during sexual intercourse. Such changes can be caused by hormonal disturbances. A D&C means a sample from the lining of the womb is scraped away and examined in the laboratory. The lab can give information about the hormones or if there are any polyps (build-up of cells). A woman who has a polyp in the womb may bleed between periods or may have heavier periods. Removing the polyp with a D&C will cure the symptoms.
A D&C enables the doctor to see directly into the womb to make sure there is nothing abnormal. In particular this means cancer, especially when a woman bleeds after the menopause.
The laboratory may also find cancer changes in the tissues. This applies especially to those women who start to bleed after the menopause (change of life). A D&C will always be recommended if this happens.
Performing a D&C helps make a diagnosis and deciding which treatment is best.
What does it involve?
The operation is done through the vagina so there will be no scar. The cervix (neck of the womb) is dilated or stretched enough to allow the surgeon to pass a small curette (scraping instrument) into the womb. The sample obtained will be collected and sent to the laboratory.
The procedure can be performed under local anaesthetic. You will need to take some medication in preparation for the procedure. This will include two 200mg Misoprostol tablets. These are to be inserted into the vagina, as high as possible, the night before the procedure. You can take 1 gram of oral Paracetamol with this medication as it might give you cramping period pain. You will also need to come to the hospital one hour before your appointment time to take 1 gram of Paracetamol, 50mg of Voltarol and 50mg of cyclizine by mouth.
The procedure takes about 20 minutes and will not involve an overnight stay.
What are the alternatives?
An endometrial pipelle biopsy can be done in an outpatient setting. This is the removal of tissue using a small plastic tube. This can be done instead of a D&C or to determine if a D&C is necessary.
Depending on your symptoms and circumstances it may be possible to examine the womb using ultrasound (an imaging technique using sound waves). However, a hysteroscopy may be the best option to help diagnose or treat the problem.
If a D&C is not done it might be more difficult to make a diagnosis that would explain some symptoms.
There are added ways to check hormone abnormalities and ovulation through blood sampling
A light meal can be eaten up to two hours before the procedure.
If you are diabetic, further instructions will be given on medication.
You will need to prepare and have sanitary towels and pain killers (such as paracetamol) at home for when you are discharged.
How will I feel afterwards?
You may have some period type pain, but painkillers will be offered if you need them. You need to be comfortable before you can be discharged.
You can expect some vaginal bleeding.
What happens after the procedure?
You will be able to go home about half an hour to an hour after the procedure.
What are the risks?
This is a very safe operation, but every operation and anaesthetic carries a small risk. Unexpected problems and reactions can arise even with local anaesthetics. A hysteroscopy and D&C is such a short operation that major complications are very rare indeed.
It is possible to push the dilator through the wall of the womb into the abdominal cavity. This sounds very alarming but all that is usually needed is a day or two stay in hospital.
Infection of the womb can follow a D&C.
All of these complications are very rare indeed.
If you have any discomfort, paracetamol or a similar painkiller can be taken.
Any vaginal bleeding will gradually darken and stop over the next week or so.
It is important to use sanitary towels not tampons until any bleeding has stopped to avoid the risk of infection.
You may resume sexual intercourse when any bleeding has stopped.
You may bath or shower as normal the following day.
If you have increased pain, an offensive discharge, a raised temperature, prolonged or heavy bleeding, you should contact your GP for advice.
You may be given a follow-up appointment to see the gynaecologist approximately two to six weeks following the procedure. However, the consultant may write to you with the results.
For further information about this procedure, please contact Petter Day Treatment Unit on 01271 322722.