Hysteroscopy

What Is a Hysteroscopy?

A hysteroscopy procedure is a minimally invasive method that allows your Midtown Manhattan gynecologist to examine the inside of your uterus without major surgery. A hysteroscopy procedure is done to diagnose and/or treat problems with the female reproductive system by using a lighted, narrow tube called a hysteroscope. Thanks to ongoing innovation in medical technology, a hysteroscopy has become an essential tool for diagnosing gynecological problems.

If you’re looking for a hysteroscopy specialist in New York City, look no further than Hysteroscopy Center of New York. Felix Cohen, M.D., FACOG is the experienced gynecologist who founded the Center and who specializes in hysteroscopy, which involves:

• Office hysteroscopyWhen done for diagnostic purposes, Dr. Cohen performs a hysteroscopy as an outpatient procedure. This simplifies treatment, reduces costs and avoids unnecessary exposure to anesthesia.
• No dilation/awake hysteroscopyThis approach avoids vaginal instruments and is quicker and less uncomfortable than the traditional approach. When appropriate, this option makes uterine evaluation quicker and less invasive.
• Hysteroscopy for IVF and fertilityYour gynecologist can use a hysteroscopy as a diagnostic tool if you’re experiencing infertility. This test can confirm whether your uterus is suitable for IVF implantation.
• Endometrial ablationThis is an outpatient treatment that’s usually done to destroy the lining of your uterus, which stops heavy bleeding. It’s an option for women who aren’t planning to get pregnant in the future.
• NovaSure ablationThis is one of the best-known forms of endometrial ablation. Its patented technology uses radiofrequency energy to permanently remove the endometrium. It’s a fast, minimally invasive treatment for heavy bleeding in women who don’t wish to have future pregnancies.
• Hysteroscopy technology and equipmentThe doctors at Hysteroscopy Center of New York use the most up-to-date technology and equipment, enhancing your safety and diagnostic accuracy.
• Anesthesia and pain managementThe use of anesthesia typically depends on whether your procedure is a diagnostic or operative hysteroscopy. For pain management, your doctor may recommend taking oral pain medications before your procedure. You may only need local anesthesia in an office procedure, while for a hospital-based hysteroscopy, you need general anesthesia.
• Hysteroscopy recoveryDr. Cohen and his team provide support throughout your recovery from a hysteroscopy procedure. An office hysteroscopy has a short recovery time of one or two days in most cases. An operative hysteroscopy involves a longer recovery that depends on the extent of your procedure.
• Hysteroscopy costYour hysteroscopy cost varies widely, based on factors that include whether it’s a diagnostic or operative hysteroscopy and how much is involved in the procedure. An in-office procedure typically costs less than a hospital-based hysteroscopy.

What Are the Most Common Reasons for a Hysteroscopy Procedure?

A hysteroscopy is a valuable diagnostic tool that’s usually needed to investigate symptoms like extremely heavy uterine bleeding, bleeding after menopause or irregular spotting between periods. This diagnostic test can confirm the results of other tests, such as an ultrasound, and it often identifies conditions that weren’t clearly visible from other types of imaging tests. Examples of possible findings during a hysteroscopy include:

• Structural abnormalities. This procedure can uncover and sometimes remove abnormalities, such as fibroids, which are growths under the uterine lining that may protrude into the uterine cavity. Endometrial polyps, another uterine abnormality, are growths that develop from the lining of your uterus. They’re often benign, but they can contribute to symptoms like infertility and heavy bleeding.
• Uterine malformation. A hysteroscopy can determine if you have a congenital malformation known as a uterine septum. In this condition, a wall of tissue partially or completely divides your uterine cavity, which can increase the risk of miscarriage or infertility.
• Fallopian tube blockage. With this diagnostic procedure, Dr. Cohen can actually see if your fallopian tubes are blocked.
• Endometrial abnormalities. This procedure allows Dr. Cohen to closely examine the lining of your uterus to identify areas that may require additional evaluation.
• Abnormal adhesions. Bands of scar tissue may form in your uterus that can cause infertility or changes in your menstrual flow. During the same procedure, Dr. Cohen can remove these adhesions. Adhesions may be caused by a previous surgery or infection.
• Tissue sample collection. For women whose Pap smear or ultrasound is abnormal, a hysteroscopy allows your gynecologist to collect a tissue sample for further testing.

Dr. Cohen adds: “I can use a hysteroscopy to remove a lost or embedded intrauterine device. And if you haven’t been able to get pregnant after a year of trying, I can perform a hysteroscopy to diagnose the cause of any uterine abnormalities affecting your fertility, especially if you’ve suffered more than two miscarriages in a row. This procedure can also remove retained tissue after a pregnancy.”

What Can I Expect Before a Hysteroscopy?

Before scheduling your hysteroscopy, you and Dr. Cohen discuss what medications you’re taking — including any vitamins, supplements or herbs — and whether you have any health conditions, such as diabetes or heart disease. Dr. Cohen provides instructions about medications to discontinue one or two weeks before the procedure. If you’re a smoker, stopping before the procedure for a couple weeks improves your recovery, since smoking makes healing move more slowly.

“At Hysteroscopy Center of New York,” explains Dr. Cohen, “we let you know what time to arrive the day of your procedure and whether you need to arrange for a ride home. We may instruct you to avoid eating or drinking for six to 12 hours before your procedure. If you get sick with a fever, cold or flu, let us know before you arrive; we may postpone your procedure.”

How Is a Hysteroscopy Performed?

A hysteroscopy is usually a straightforward procedure, but there are some variations between an operative hysteroscopy and a diagnostic hysteroscopy. For either procedure, you may need to coordinate its timing with your menstrual cycle. The normal steps of the procedure include:

• Emptying your bladder
• Taking a sedative to block pain and help you relax
• Positioning your torso similarly to having a Pap smear
• Dilating your cervix before inserting the hysteroscope through your cervical canal
• Enlarging your uterus with a saline solution or gas
• Using the hysteroscope to send real-time images to a screen for review

If the hysteroscopy is being done for treatment purposes, Dr. Cohen can insert small surgical instruments through the hysteroscope to take tissue samples or to remove uterine polyps or fibroids. The procedure usually takes 15 minutes to an hour.

An operative hysteroscopy treats any abnormalities identified during a diagnostic hysteroscopy. In some cases, a diagnostic and operative hysteroscopy is done at the same time with the see-and-treat approach Dr. Cohen prefers. This prevents the need for a second procedure. You can’t get a hysteroscopy if you’re pregnant or have a pelvic infection.

What Are the Benefits of a Hysteroscopy?

A hysteroscopy procedure has become one of the most effective tools in modern gynecology for diagnosing and treating gynecological conditions. Because of improvements in scope design and operative technique, this procedure now plays a central role in office gynecology, fertility care and minimally invasive surgery. With this procedure, Dr. Cohen can locate and remove uterine abnormalities without damaging nearby tissues.

Many women prefer to have minimally invasive care whenever possible. An office hysteroscopy has moved diagnosis and treatment out of the operating room and into an outpatient setting. This is possible because of better optics and smaller instruments. “An outpatient procedure allows me to reach a diagnosis and perform treatment quickly,” says Dr. Cohen. “And because it’s so minimally invasive, you can return to normal activity within a day afterward.”

When Do I Need Hospital-Based Hysteroscopy?

If you have more complex challenges, you may require a hospital-based hysteroscopy. An operative hysteroscopy allows your NYC physician to insert specialized instruments through the hysteroscope to remove or repair abnormalities. Examples of conditions that may require an operative hysteroscopy include:

• Submucosal fibroids
• Intrauterine adhesions
• Endometrial polyps
• Retained pregnancy tissue

An operative hysteroscopy offers an alternative to more invasive surgical procedures while still providing effective treatment. Since it’s minimally invasive, there are no external surgical incisions. There’s less pain, a faster recovery time and a lower risk of complications.

Having a hysteroscopy in a hospital setting provide access to specialized equipment and multidisciplinary care teams. Your gynecologist may recommend a hospital-based hysteroscopy when you need general anesthesia for procedures that are complex, such as removing large fibroids or extensive adhesions. You may also need a hospital-based hysteroscopy if you have certain medical conditions.

What Can I Expect During My Hysteroscopy Recovery?

The amount of time it takes you to recover depends on how complex your procedure was. If you had anesthesia for your hysteroscopy, you can expect to be observed for a few hours after the procedure. Cramping and bloody discharge are normal for the first few days. You may continue to have a watery discharge for a couple of weeks. In most cases, non-steroidal anti-inflammatory drugs like ibuprofen or naproxen are sufficient to control your pain.

To prevent infection, you may be advised to refrain from sex or using tampons for one to two weeks. Dr. Cohen tells you how soon you can return to normal activities at home or work, which in many cases is within a day or two. You may be advised to avoid hot tubs and swimming for a couple of weeks.

Complications after a hysteroscopy are very rare, especially when your procedure is done by an experienced hysteroscopy specialist like Dr. Cohen. Let the team at Hysteroscopy Center of New York know right away if you experience heavy bleeding, fever, chills, foul-smelling vaginal discharge or severe abdominal pain during your recovery.

How Is Innovation Transforming Hysteroscopy Treatments?

The rapid pace of innovation in hysteroscopy technology continues to improve patient experiences. There are ongoing advancements in imaging systems, instrumentation and procedural techniques. High-definition images allow physicians to identify abnormalities with much greater precision than was possible in the past.

“Advancements in surgical instruments make it possible for gynecologists like me to efficiently remove abnormalities while reducing trauma to the surrounding tissues,” Dr. Cohen states. “Smaller and thinner hysteroscopes usually require less cervical dilation, which makes it more comfortable for you.”

Frequently Asked Questions (FAQs) about Hysteroscopy