Hysteroscopy for Removal of Uterine Septum

What is a hysteroscopy?

A hysteroscopy is a procedure for looking at the inside of the uterus with a thin, flexible, lighted tube. The lighted tube is called a hysteroscope. The uterus is the muscular organ at the top of the vagina. Babies develop in the uterus, and menstrual blood comes from the uterus.

If you have a septum in your uterus, your provider can use the scope to guide a tool into the uterus to remove the septum. A septum is a thin wall of tissue inside the uterus that separates the uterus into 2 parts. Some women are born with a uterine septum but do not know that it is there.

When is it used?

This procedure is performed to find and remove a septum in your uterus. The septum may make it hard to carry a pregnancy successfully.

Examples of possible alternatives to this procedure are:

• an ultrasound scan, which is a way to get pictures of the uterus with sound waves (the test may be done with or without putting fluid into the uterus)
• CT scan or MRI to get pictures of the uterus to confirm the diagnosis
• having abdominal surgery to remove the septum
• choosing not to have treatment, recognizing the risks of your condition

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 pelvic infection.
• You have cancer of the uterus or cervix.
• You have had recent surgery on the uterus.

How do I prepare for a therapeutic hysteroscopy?

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?

Hysteroscopy may be done in your healthcare provider's office, at a surgical center, or at the 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.

Your 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 special scissors, a laser, or an electrical current to remove the septum.

You may have a laparoscopy at the same time. For a laparoscopy, your provider will make a small cut in your abdomen and put another scope through that cut to see the outside of the uterus. This will help your provider avoid putting a hole through the uterus as he or she removes the septum.

What happens after the procedure?

You may stay at the provider's office or the hospital about 1 or 2 hours. In rare cases you may stay at the hospital overnight.

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.

Your provider may insert a small balloon catheter in your uterus after the procedure. It may need to stay in the uterus for a while to help prevent scar tissue from forming inside your uterus. Your provider may also recommend antibiotics to prevent infection or estrogen (hormone) therapy, which can help the uterus to heal normally.

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?

Removing the septum improves your ability to carry a pregnancy. A hysteroscopy is short with a quick and easy recovery. Hysteroscopy avoids the discomfort, hospitalization, expense, and longer recovery of abdominal surgery.

What are the risks associated with this procedure?

A hysteroscopy is considered to be a very safe procedure. It 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 may 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.

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 the provider during office hours if:

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