Hysteroscopy involves looking into the cavity of the uterus with a small "scope". Hysteroscopy can be performed as either an office procedure or an outpatient hospital procedure. In the office it is mainly used as a diagnostic tool to help evaluate patients that have infertility, recurrent miscarriage, or abnormal bleeding.
How is hysteroscopy done in the office?
Office hysteroscopy is a relatively painless procedure. Usually an appointment will be made in advance for this procedure. Upon arrival you will be given a mild pain medicine (Motrin or Anaprox) to help with cramping during the procedure. You will be placed in a special chair that tilts back. The doctor will then wash the vagina and cervix off with a "prep" solution. Next a local anesthetic, like the dentists use (lidocaine), will be placed in the cervix. This usually provides excellent relief of any discomfort during the procedure. The doctor will then carefully dilate the cervix to allow the "scope" to be placed into the uterus. Usually carbon dioxide gas or water is attached to the scope to allow the walls of the uterus to expand. A bright light is also attached to the scope to illuminate the cavity of the uterus. The doctor will then carefully look at the inside of the uterus and make sure it is normal. The places where the fallopian tubes enter into the uterus can usually be seen. Any abnormalities are usually discussed afterward. In most cases a small sample of the lining of the uterus is removed for examination. This is especially true if there is any abnormal bleeding.
D&C
Curettage of the uterus (womb) is the scraping of the lining of the uterus (the endometrium). The procedure is commonly known as dilation and curettage or D&C.
There are two main reasons for performing a D&C:
- an evacuation D&C is performed in a recently pregnant woman to remove tissue remaining in the womb.
- a gynecological D&C is part of the investigation of a woman who is experiencing heavy or irregular periods or vaginal bleeding after the menopause.
Why are gynecological curettages performed?
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 or may be due to a disease of the cervix or uterus.
Older women, especially those who experience postmenopausal bleeding, receive a gynecological D&C. A gynecologist will scrape (curette) the lining of the womb to make a diagnosis and find out which treatment is best.
Few women under the age of 40 require this procedure because disease in the uterus is rarely seen in young women.