A diagnostic hysteroscopy is a procedure that will allow the doctor to look inside your uterus(womb) using a hysteroscope, an instrument with a small video camera attached. This is inserted via the vagina, through the cervix(neck of the womb). This will allow the doctor to help find the cause of your symptoms. Therapeutic hysteroscopy uses the hysteroscope as well as other surgical instruments to remove part of the endometrium(lining of the womb) for evaluation, polyps(small growths of the lining of the womb), tissues such as fibroids etc. Dilation and curettage is a procedure that first uses instruments to dilate the cervix, followed by a curette to obtain endometrium to be sent for biopsy. Some reasons why these procedures may be performed are to exclude malignancy in abnormal uterine bleeding, treatment of menstrual abnormalities and investigation of subfertility. A speculum is first inserted into the vagina to part the vaginal walls. A hysteroscope is then introduced into the vagina, through the cervix and into the uterus. Fluid or gas is then used to distend the womb for visualization of the cavity. Therapeutic hysteroscopy and/or dilation and curettage is then performed as indicated. Although a hysteroscopy is considered a minor procedure and is usually of a short duration(less than half an hour), as with all surgeries, complications can sometimes occur even with the best effort of the surgical and nursing teams. Some of these are inherent in any operative procedure. If complications do occur, recovery may take a longer period of time and further procedures may be necessary. Some common complications include bleeding and infection. Other complications include the inability to gain entry into the uterine cavity, inadequate tissue for diagnosis, damage to the cervix, menstrual abnormalities and scarring of the uterine cavity(Ashermann’s syndrome). Uterine perforation which is the perforation of the wall of the womb may occur in up to 5 in 1000 women. Most of the these heal by themselves. If this complication is suspected, a diagnostic laparoscopy may be performed in the same setting to evaluate further. Sometimes, a perforation is not obvious at the time of surgery and may present later. On rare occasions, surrounding organs like the bladder and bowel may be injured and additional surgical procedures required. Potential complications may be higher in women who are postmenopausal, obese, have significant abnormality to the uterus, have had previous surgeries, or those with pre-existing medical conditions.
