Hysteroscopy for Endometrial Ablation

What is a hysteroscopy?

A hysteroscopy is a procedure for looking at the inside of your uterus with a thin, flexible, lighted tube. The tube is called a hysteroscope. Your healthcare provider may be able to use the scope to guide a tool into the uterus to destroy a thin layer of the uterine lining that is causing abnormal bleeding symptoms.

The uterus is the muscular organ at the top of the vagina. Babies develop in the uterus, and menstrual blood comes from the uterus.

When is it used?

This procedure may be done when you have bleeding from the uterus that is very heavy or has lasted for a long time and other treatments have not helped. It is generally not used if you are planning future pregnancies. Removing the lining of the uterus will reduce or stop the bleeding. It does not change your hormone levels.

Examples of possible alternatives to this procedure are:

• hormone therapy to stop menstrual bleeding
• D&C (dilation and curettage), which is a procedure for opening the cervix and then scraping or suctioning tissue from the uterus
• thermal balloon ablation, which is removal of the uterine lining by inserting a balloon filled with warm saltwater into the uterus
• an ultrasound scan, which is a way to get pictures of the uterus with sound waves (to help with diagnosis, but not treatment)
• CT scan or MRI to get pictures of the uterus (to help with diagnosis, but not treatment)
• removal of the uterus (hysterectomy)
• choosing not to have treatment

Ask your provider about these choices and which might be best for you.

You should not have this procedure if:

• You are or have just recently been pregnant.
• You have a uterine or pelvic infection.
• You have cancer of the uterus or cervix.
• You have had recent surgery on the uterus.
• You have a disorder of the endometrium, including an endometrial lining that is too thin or abnormal precancerous cells.

How do I prepare for a hysteroscopy?

Before you have the procedure, you may take progesterone-based hormones or other medicine that blocks the ability of your body to produce estrogen for a while. This will shrink the lining of the uterus.

Plan for your care and recovery after the procedure. Find someone to give you a ride home after the procedure. Allow for time to rest and try to find other people to help you with your day-to-day tasks.

Follow your healthcare provider's instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery. For these reasons, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6 to 8 weeks before surgery.

If you need a minor pain reliever in the week before the procedure, choose acetaminophen rather than aspirin, ibuprofen, or naproxen. This helps avoid extra bleeding during surgery. If you are taking daily aspirin for a medical condition, ask your provider if you need to stop taking it before the procedure.

Follow any other instructions your provider gives you. If you are to have general anesthesia, eat a light meal, such as soup or salad, the night before the procedure. Do not eat or drink anything after midnight or the morning before the procedure. Do not even drink coffee, tea, or water.

Your provider may put a laminaria (a small rod made of seaweed that absorbs moisture) into the cervix the day before the hysteroscopy to help soften and dilate the cervix. This can make the procedure easier and safer to perform.

What happens during the procedure?

The procedure will be done at a hospital.

You are given a local, regional, or general anesthetic. A local or regional anesthetic numbs part of your body while you remain awake. It should keep you from feeling pain during the procedure. You may be given a sedative with the local or regional anesthetic to relax you. A general anesthetic relaxes your muscles, puts you to sleep, and prevents you from feeling pain.

The healthcare provider may stretch open (dilate) your cervix using tools called cervical dilators. The cervix is the opening to your uterus. Your provider will guide the hysteroscope into your vagina, through the cervix, and into your uterus. Gas or fluid may be released through the scope to inflate your uterus. This helps your provider see inside the uterus better. Your provider will use a small laser or other tool to remove or destroy the lining of the uterus.

What happens after the procedure?

You may stay in the hospital several hours or overnight if necessary.

After the procedure you may:

• feel sleepy or groggy from the anesthetic
• have some cramps
• have trouble urinating the first few hours after the procedure
• have a watery or bloody discharge for 3 or 4 weeks

Many women who have this procedure will no longer have any menstrual bleeding. Some will keep having periods but they will be reduced to normal or light bleeding. You will probably not be able to get pregnant after this procedure. If you do get pregnant, the risk of miscarriage and other problems is much higher. If you have concerns about this, discuss them with your healthcare provider. Your provider may advise you to use birth control until after menopause.

Ask your provider how to care for yourself after the procedure and when you should come back for a checkup.

What are the benefits of this procedure?

Bleeding from the uterus should stop because the lining of the uterus has been removed. Hysteroscopy is a short procedure and has a quick and easy recovery. This procedure can help you avoid the discomfort, hospitalization, expense, and longer recovery of a hysterectomy.

What are the risks associated with this procedure?

A hysteroscopy is a very safe procedure and rarely has complications. Possible complications may include:

• A local or regional anesthetic may not numb the area quite enough and you may feel some minor discomfort. Also, in rare cases, you may have an allergic reaction to the drug used in this type of anesthesia. In most cases, local or regional anesthesia is considered safer than general anesthesia. There are some risks when you have general anesthesia. Discuss these risks with your provider.
• You may have infection or bleeding.
• Rarely, the uterus could be punctured and need surgery to repair it.
• Rarely, the bowel or bladder may be injured.
• You may have an allergic reaction to the fluid used during the procedure.
• It may not control the abnormal bleeding. More treatment or surgery may be needed.
• If you become pregnant, the placenta may attach to the uterus in a way that makes it difficult to remove after a delivery.

Ask your healthcare provider how these risks apply to you.

When should I call my healthcare provider?

Call your provider right away if:

• You start to bleed a lot (like a menstrual period).
• You develop a fever over 100°F (37.8°C).
• You have a lot of pain in your lower abdomen.
• You have a vaginal discharge with a bad odor.

Call during office hours if:

• You have questions about the procedure or its result.
• You want to make another appointment.