An important component in the evaluation of a woman’s reproductive function includes an evaluation of the uterus. Information about the uterus can be obtained by physical examination, hormonal manipulation, biopsies, ultrasound, x-rays, MRI’s or CT scans. The most direct and accurate way to assess the inside of the uterine cavity is with a surgical procedure called hysteroscopy.
Hysteroscopy offers a direct view of the inside of the uterus and any abnormalities that may be present, thus providing a definitive diagnosis in most cases. Hysteroscopy allows for the precise localization of lesions and their surgical treatment with special instruments designed to be used through a hysteroscope.
Hysteroscopy can be used to evaluate the uterine cavity as part of an evaluation of infertility, recurrent pregnancy loss or abnormal uterine bleeding. Abnormalities that can be found include polyps (outgrowths of the lining), fibroids (benign muscular tumors of the uterus), scar tissue, and congenital defects of the uterus.
Hysteroscopies are ideally done when the lining of the uterus is thin. This can be while on birth control pills, on the GnRH agonist Lupron, or in the first several days after a period has stopped.
Endometrial Polyps: Polyps are outgrowths of the lining of the uterus (the endometrium). They are the most common reason for doing hysteroscopy. They are soft and fleshy to touch, come in a wide range of sizes, and often have more than one present. We believe that they can prevent implantation of an embryo. Their cause is unknown. Polyps are almost always benign when found in women in the reproductive age group; however, they are always sent to the pathologist to confirm this. They can be easily removed by grasping them with a special instrument and pulling them out. If numerous polyps are present, a D&C (dilation and curettage, a scraping of the lining) can be helpful in getting the polyps out quickly.
Fibroids: Fibroids are benign muscular tumors of the uterus. They are very common, occurring in up to 40% of all women. For many women, fibroids will not cause a problem. However, depending on the size and location, fibroids can cause heavy bleeding, painful, or irregular periods, pelvic pain, infertility, or early pregnancy loss. Some women will have bowel or bladder problems due to the pressure from the fibroids. When a patient is symptomatic from fibroids, there are three ways of removing them: through the hysteroscope, through the laparoscope or via laparotomy (open operation). The hysteroscopic approach is used if they are protruding into the uterine cavity and not too deeply embedded into the wall of the uterus.
Scar Tissue (Asherman’s Syndrome): Scar tissue is the result of inflammation. For the inside of the uterus to have scar tissue, there usually has been an infection and/or an operative procedure (usually both). The scar tissue can be cut with scissors thru the hysteroscope.
Uterine Anomalies: There are several types of uterine birth defects. However, only the uterine septum is treated with the hysteroscope. The septate uterus is a problem because of the high miscarriage rate (around 60-70%) associated with them. Fortunately, the septate uterus is well suited for treatment through the hysteroscope. During the procedure, the septum is divided (by scissors, resectoscope, versapoint) and the walls retract to form a normal shaped cavity. This treatment is usually very effective in reducing the miscarriage rate back to the baseline rate (8-30% depending on age).