A B C D E F G H I J K L M N O P R S T U V W

HYSTEROSCOPY - DILATATION AND CURETTAGE

What is a Hysteroscopy ?

An operation to curette, or sample the lining of the womb. A hysteroscopy is an examination of the inside of the womb using a very fine telescope, or hysteroscope, introduced through the neck of the womb.

Why is a Hysteroscopy performed ?

This operation is performed for two reasons. The first is to try to make a diagnosis, usually to explain why the womb is bleeding in an abnormal way. The second is to treat something that is wrong. A hysteroscopy is usually done at the same time as a D&C. It allows the doctor to see the inside of the womb. A hysteroscopy can be done in the clinic or in the operating theatre under an anaesthetic. DIAGNOSIS When a woman has a normal period, she loses blood and the tissue cells lining the womb (endometrium). In the first half of the monthly cycle the ovaries make a hormone called oestrogen. This makes the endometrium grow thicker. After ovulation, the ovaries make a second hormone, progesterone. If the egg which is released from the ovary each month is not fertilized, the endometrium is shed, together with blood. The whole cycle then starts all over again. If a woman bleeds too often, too much or too little, she may have a hormone problem or an abnormality inside the womb itself. A sample of some of the endometrium obtained by a D&C can be examined in the laboratory. The laboratory can tell us about the hormones and if there are any polyps or abnormal build-up of cells (hyperplasia) inside the womb. Rarely we may find cancer changes in the tissues. This applies especially to women who start to bleed after the change of life. A hysteroscopy with a D & C will usually be recommended if this happens. Examining the endometrium in the second half of the cycle can also tell us if you have ovulated, and is sometimes done in infertility tests. Infections such as tuberculosis may also be diagnosed. TREATMENT A woman who has a polyp in the womb may bleed between periods or may have heavier periods. Removing the polyps with a D & C will cure her. Usually, however, a D&C is done to make a diagnosis and just doing a D&C will not produce any long-term improvement in troublesome periods. A similar procedure is used in treating women who have had a miscarriage and still have some of the pregnancy tissues inside the womb. This is known as evacuation of retained products of conception (ERPOC). If a contraceptive device ( coil ) gets stuck, a D & C may also be done to remove it.

Preparations needed for a Hysteroscopy

A D & C is usually done as a day case. If fit and healthy in every other way, and if home circumstances are suitable, this is much easier. If the doctor anticipates any possible difficulty with the anaesthetic he will suggest that you have an overnight stay. The same would apply if living alone. At the most, patients are asked to spend the nights before and after the operation in hospital. You will not need more than 3 or 4 days off work altogether. The doctor must be told if you are on any regular drugs, and needs to know of any allergies and any problems with anaesthetics in the past. In some hospitals hysteroscopy and taking a sample from inside the womb are done in the clinic without the need to be starved or stay in hospital. This option may not be suitable for all women.

What Happens during a a Hysteroscopy

The operation is done through the vagina and there will be no scar. When a D&C is done the cervix, or neck of the womb, is stretched up, or dilated. The cervix will be dilated enough to allow the surgeon to pass a hysteroscope and a small curette (scraping instrument) into the womb. The curettings obtained will be collected and sent to the laboratory. A general anaesthetic is preferred, as stretching the cervix is painful. A local anaesthetic can be used. It is not always necessary to dilate the cervix to do a hysteroscopy when this is done in the clinic. The operation only lasts about 5 minutes.

Possible Complications during a a Hysteroscopy

This is a very safe operation, but every operation and anaesthetic carries a small risk. Unexpected problems and reactions can arise with anaesthetics. Hysteroscopy done as an outpatient avoids the risks of general anaesthetic but a small number of women will find this uncomfortable or feel faint during the examination. A D & C is such a short operation that major complications are very rare indeed. It is possible to push the dilator through the wall of the womb into the abdominal cavity. This sounds very alarming but all that is usually done is to extend the hospital stay another day or two. An infection of the womb and tubes can follow a D & C. All these complications are also very rare indeed.

After a Hysteroscopy

There are very few problems after a D & C because it is such a short operation. A period-like pain may continue for a day or two. Some bleeding and discharge occurs up to a week or so later. It is sensible not to use a tampon or have intercourse until this discharge stops. A tampon may be worn at the next proper period. Return to normal work is possible usually after 24 to 48 hours.

If a Hysteroscopy is not performed

If a hysteroscopy or D & C is not done, it would be difficult to make the diagnosis that would explain some symptoms. There are of course other ways to check hormone abnormalities and ovulation. What is so useful about a D & C is that it makes sure there is nothing abnormal in the womb. In particular this means cancer, especially when a woman bleeds after the menopause. There is a risk of continued bleeding and infection if a D&C is not done in cases of incomplete miscarriage.