Generality
Hysteroscopy is a gynecological exam that allows to evaluate the state of health of the uterine cavity (ie the inside of the uterus) and the cervical canal (ie the canal formed by the uterine cervix). To do this, during the examination, the doctor uses a special endoscopic instrument, called a hysteroscope .
Hysteroscopy can have diagnostic (diagnostic hysteroscopy ) or therapeutic (therapeutic or operative hysteroscopy ) purposes.
Diagnostic hysteroscopy allows the identification of various pathologies of the uterus (eg, uterine fibroids or polyps), finding the causes of certain symptoms (eg abnormal blood loss from the uterus etc.) and taking a sample of endometrial tissue to be subjected to biopsy.
Operative hysteroscopy, on the other hand, is a useful resource for the treatment of various pathologies of the uterus (eg the uterine fibroids or polyps mentioned above) and the implementation of so-called tubal sterilization.
In preparation for any hysteroscopy, the patient must undergo: a careful gynecological examination, a careful medical history, a cervico-vaginal swab and a transvaginal ultrasound; furthermore, he must report to the gynecologist, who will carry out the procedure, if he suffers from allergies or if he is taking special medications.
From a procedural point of view, hysteroscopy involves inserting the hysteroscope into the uterus, through the vaginal opening, and using this instrument as an exploratory probe.
The duration of this gynecological exam varies from a minimum of 10 minutes to a maximum of 60 minutes.
Hysteroscopy presents some risks; however, it almost always ends without problems.
Brief review of the anatomy of the uterus
Uneven and hollow, the uterus is the female genital organ that serves to receive the fertilized egg cell (that is, the future fetus) and to guarantee its correct development during the 9 months of pregnancy.
It resides in the small pelvis, precisely between bladder (anteriorly), rectum (posteriorly), intestinal loops (superiorly) and vagina (inferiorly).
During the lifetime, the uterus changes its shape. If up to the prepubertal age it has an elongated appearance similar to a glove finger, in adulthood it looks a lot like an inverted (or upside down) pear, while in the post-menopausal phase it gradually reduces its volume and is crushed.
Regarding the macroscopic aspect, the anatomists recognize in the uterus 2 distinct main regions:
- The body of the uterus or uterine body . Of enlarged form, it is the upper region of the organ in question and the most voluminous. With its walls it delimits the so-called uterine cavity . Its apical part is known as the bottom of the uterus .
- The cervix or cervix . The region below it is narrower than the uterine body. Its walls enclose the so-called cervical canal .
As far as the microscopic aspect is concerned, the anatomists identify in the uterus 3 main cellular layers, which, proceeding from the outside towards the inside, take the name of: perimetric, myometrium and endometrium .
| Measurements and weight of the uterus in an adult woman | |
| Medium length | 7-8 centimeters |
Transverse diameter | 4-5 centimeters |
Antero-posterior diameter | 4 centimeters |
Weight | 60-70 grams |
What is hysteroscopy?
Hysteroscopy is an endoscopic gynecological exam, which allows to evaluate from the inside the state of health of the uterine cavity, the cervical canal and the endometrium .
Realized through the use of the so-called hysteroscope, a tubular instrument, hysteroscopy can have diagnostic or therapeutic purposes: in the first case it is more properly called diagnostic hysteroscopy, while in the second case it is better known as operative hysteroscopy or therapeutic hysteroscopy .
Regardless of whether it is diagnostic or operational, hysteroscopy is a procedure generally performed in an outpatient or day surgery setting; therefore, except in special cases, the patient is never admitted to hospital.
Curiosity: what is the endometrium?
The endometrium is the mucous membrane of the uterus.
Thanks to the influence of the hormones estrogen and the hormone progesterone, it covers the important task of guaranteeing an ideal environment for implantation of the embryo at the uterine level.
Hysteroscope: what it is in short
During the examination, the hysteroscope acts as an exploratory probe of the uterus, after its insertion into the uterine cavity, through the vaginal opening.
Further information on the characteristics of the hysteroscope will be provided when discussing "performing hysteroscopy".
Is hysteroscopy and curettage the same thing?
Hysteroscopy and curettage (or curettage ) are two gynecological exams that are very similar in indications, but extremely different in the executive modalities.
In fact, while in hysteroscopy the gynecologist uses an instrument equipped with a video camera (the hysteroscope) to observe the inside of the uterus and possibly make targeted tissue samples or specific treatments (NB: every aspect will be clarified in the rest of the article), in scraping the gynecologist uses a sort of sharp spoon (the so-called curette ) to scrape parts of suspicious uterine tissue or to be subjected to subsequent laboratory analysis.
In essence, therefore, in the scraping there is no exploration from inside the uterine cavity, the cervical canal and the endometrium, an exploration that is instead present in hysteroscopy and which makes the latter a more specific examination and with more advantages.
Moreover, as it is easy to understand from the brief descriptions given above regarding executive methods, there is also a certain degree of invasiveness between hysteroscopy and curettage, greater in the second procedure than in the first.
The advantages of hysteroscopy in a nutshell:
- Short hospital stay (hospitalization is generally not foreseen);
- Fast recovery times;
- Minimally invasive and not very painful;
- It is a valid alternative to hysterectomy, laparoscopic surgery and laparotomy.
Indications
Clearly, diagnostic hysteroscopy has totally different indications from operative hysteroscopy.
Diagnostic hysteroscopy
What are the uses of diagnostic hysteroscopy?
Diagnostic hysteroscopy is useful for:
- Ascertain the presence of uterine fibroids or polyps .
The fibroma or uterine myoma is a benign tumor of the uterus that originates from one of the smooth muscle cells of the myometrium, the intermediate cellular layer of the uterine wall.
The uterine polyp or endometrial polyp, on the other hand, is a benign tumor of the uterus that originates from one of the epithelial cells of the endometrium, the innermost cellular layer of the uterine wall.
- To ascertain the presence of benign tumors of the uterus other than fibroids and uterine polyps;
- Ascertain the presence of intrauterine adhesions . Intrauterine adhesions are bands of fibrous-cicatricial tissue that abnormally join parts of the normally separated uterus. In medicine, the presence of intrauterine adhesions is known as " Asherman's syndrome ";
- Understanding the reasons for infertility ;
- Evaluate the general state of health of the endometrium during menopause;
- Evaluate the phenomenon of endometrial hyperplasia .
In medicine, the term "endometrial hyperplasia" indicates the abnormal increase in endometrial volume due to excessive cell proliferation. Endometrial hyperplasia may represent a pre-neoplastic condition, thus acting as a prelude to an endometrial tumor ;
- Go back to the causes of an irregularity in the menstrual cycle ;
- Go back to the causes of abnormal blood loss from the uterus ;
- Research the causes of menstruation in women who have passed menopause ;
- Plan in detail for uterine surgery;
- Understanding the reasons that lead a woman to have recurrent spontaneous abortions ;
- Verify the abnormal presence of endometrial tissue in the myometrium. In medicine, the unusual presence of endometrium in the myometrium is a condition known as adenomyosis .
- To ascertain the presence of a congenital anomaly of the uterus. Particularly known congenital abnormalities of the uterus are the so-called Müllerian duct anomalies ; among the latter deserve a special mention: the bicorne uterus, the didelfus uterus, the uterus septum, and the uterine agenesis;
- Take a sample of endometrium to be subsequently subjected to appropriate laboratory analysis ( biopsy ). This practice makes it possible to ascertain the presence of an endometrial carcinoma (a malignant tumor of the endometrium) and to establish its progress.
Operative hysteroscopy
What are the uses of operative hysteroscopy?
Operative hysteroscopy is indicated at:
- Removal of uterine polyps;
- Removal of uterine fibroids ( hysteroscopy myomectomy );
- Removal of benign tumors of the uterus other than polyps and uterine fibroids;
- The removal of intrauterine adhesions;
- Removal from the uterus of post-abortion placental residues (ie post- abortion) or post-partum (ie following a birth);
- The extraction of the so-called intrauterine system (or IUS), a particular device that, inserted in the uterus, acts as a temporary contraceptive;
- The realization of the so-called tubal sterilization, a form of permanent contraception. Tubal sterilization is also called tubal closure .
Contraindications
They represent a contraindication to hysteroscopy, both diagnostic and operative:
- Cervical cancer ;
- Endometrial carcinoma ;
- Pregnancy
- Pelvic inflammation . Examples of pelvic inflammation are: endometritis, pelvic peritonitis, acute vaginitis, acute cervicitis and metritis.
Furthermore, doctors advise against performing hysteroscopy in the event of: nulliparity, intact hymen and cervical stenosis .
Continue: Hysteroscopy: Preparation, Execution and Complications »
