Diagnostic Hysteroscopy
FAQ
Frequently Asked Questions
In my experience it is very painful and therefore cannot be performed in an outpatient setting without anaesthesia in 2% of cases at most. In the other 98% the examination should actually take 1 or 2 minutes, is painless or at most produces discomfort such as suprapubic cramps similar to those of a menstruation that disappear quickly without any treatment.
The success of the examination and the acceptability to the patient depend on the use of correct technique, adequate and efficient instrumentation, the skill of the operator resulting from appropriate training, and the number of hysteroscopies performed
Sand abnormal uterine bleeding (A.U.B. metrorrhagia, menorrhagia, menonetrorrhagia, haemorrhagic oozing) occur during fertile age, a gynaecological examination with ultrasound is necessary, and if a thickened endometrium is found, the presence of endouterine neoformations is suspected (polyp, myoma, abortion or placental remnant, etc.), a diagnostic hysteroscopy is necessary
If, on the other hand, they occur during menopause or post-menopause, it is essential to perform a diagnostic hysteroscopy as soon as age and thickness increase. Here too, a distinction must be made between dysfunctional premenopausal bleeding and endouterine pathologies such as polyps, myomas, typical or atypical endometrial hyperplasia, and endometrial cancer.
Diagnostic hysteroscopy makes a definitive diagnosis because it allows the uterine cavity to be explored directly and a targeted biopsy to be performed if necessary.
If the woman is young, of childbearing age or scheduled for assisted fertilisation (IVF), it is possible to first perform medical treatment and then hysteroscopic resection of the malignant lesion, achieve pregnancy and remove the uterus only after giving birth
We recommend a diagnostic hysteroscopy at the beginning of medical therapy (so-called time 0) in order to be able to accurately assess any endometrial thickening that may appear later
The subsequent protocol involves an oncological visit with a TV ultrasound every year. If the thickness of the endometrium remains unchanged we do nothing. If, however, it tends to grow then we repeat the hysteroscopy as well as if abnormal uterine bleeding appears.
The control criteria for undergoing a diagnostic hysteroscopy are:
- endometrial thickness: greater than 6-8 mm
- pathological TV echoes
- U.B. (abnormal uterine bleeding)
- in the case of AUB the presence of pathologies reaches 67% and of these 19% are E.I.N.(atypical hyperplasia) or endometrial cancer
- a) A control ultrasound scan must be performed to rule out even the suspicion of uterine malformations, septum uteri, polyps, myomas. With a 3D ultrasound scan, performed by a particularly experienced gynaecologist, one can make a differential diagnosis between septum and bicornuate uterus, measure the length of the septum, the distance between the base of the septum and the external surface of the uterus, the shape of the uterine fundus (convex, flat or concave). This information is essential to allow the surgeon to perform an effective, complete septal resection (metroplasty) aimed at recovering as large a cavity as possible.
- b) if the ultrasound scan suspects abnormalities within the uterine cavity (septum uterus, polyps, myomas) a diagnostic hysteroscopy must be performed as soon as possible before seeking a new pregnancy. If the pathology is confirmed an operative hysteroscopy is scheduled to eliminate it
- c) if abdominal pain or bleeding persists for a long time, an ultrasound scan should be carried out to rule out the presence of abortion residues and then as soon as possible undergo diagnostic and then operative hysteroscopy to remove the residues and not risk Asherman's syndrome (endouterine adhesions that can lead to sterility)
d) in the case of an internal abortion, in the past, a curettage or aspiration was performed. Today, it is preferred to perform an operative hysteroscopy to remove only the abortion, thus avoiding unnecessary traumatisation of the uterine walls but worse with the risk of causing adhesions, amenorrhoea and sterility.
Until a while ago, if a woman wished to close her tubes, she could request the outpatient application of a device called ESSURE
For about two years now, however, it has been taken off the market both for market reasons and because of the appearance of side effects in only a few cases out of about one million applications.
Currently, the only way to perform tubal sterilisation is to perform a salpingectomy or partial tubal resection laparoscopically and under general anaesthesia
The operation is recommended in the first phase of the menstrual cycle. Patients who do not use a contraceptive means must abstain from sexual intercourse in the cycle during which the procedure is performed.
From the first interview, it is a good idea to allow a period of time for reflection, which can vary from about one week to three months, to allow for possible reconsideration.
We do not recommend it at a young age and to nulliparous women. The only condition is the patient's signature of consent and that of the partner if the patient so wishes
Yes it is true. Since I have been performing hysteroscopies, which is about 30 years, I no longer do scrapings. It is a blind examination, which in many cases fails to make a diagnosis due to failure to take material, but which above all causes unnecessary trauma to the uterine walls, risking the formation of adhesions that prevent future visualisation of the uterine cavity or loss of fertility. Hysteroscopy allows a targeted biopsy to be performed without doing any damage and can also be performed in the presence of even heavy bleeding.
In the menopause it is preferable to always remove it, especially if it bleeds and is large. In fact, in a percentage of cases it can have atypical or frankly cancerous cells inside, a percentage that increases with age until it reaches over 60 % probability after the age of 70. In the fertile period, however, I recommend removing them because they can bleed, grow and, for women who wish to become pregnant, can jeopardise their success since they secrete a substance that is toxic both for the implantation of the embryo and for the continuation of the pregnancy. Moreover, since, if they are small, they can be removed in the outpatient clinic during a diagnostic hysteroscopy, there is no point in keeping them only under control
Once it has been ruled out that the problem stems from the male partner, almost all infertility centres nowadays require a hysteroscopy as one of their diagnostic tests.
The scarce invasiveness and safety of outpatient hysteroscopy, associated with the infertile couple's desire to quickly achieve diagnostic objectives that are often a source of anxiety and uncertainty, make this method recommendable in the diagnostic evaluation of the uterine cavity, as part of a correct reproductive diagnostic pathway. S.E.G.I. GUIDELINES)
In fact, in a significant percentage of cases, pathologies that cause or contribute to infertility are found at hysteroscopy. Diagnostic hysteroscopy is then imperative when one or more failures have occurred in a P.M.A. (medically assisted procreation) pathway
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