The development of office hysteroscopy started in 1980 with the invention of the first special device used to visualise the uterine cavity by an optical telescope, called a hysteroscope.
In 1997, the method was enhanced with the invention of a new device, which could be used not only for inspection but for surgical treatment too. The first specialist who combined the two kinds of procedures into the single ‘See and Treat’ one was Prof. Stefano Bettocchi in Italy.
The procedure started to gain popularity even 20 years ago, mainly for small surgical interventions, such as removing polyps, small myomas, or septums.
In the last decade, many new instruments and devices for office hysteroscopy became available, including medical laser, which allowed the performing of a vast array of procedures.
Office hysteroscopy can now solve virtually every uterine pathology with the existing modern instruments.
About the procedure
As the name suggests, this procedure is performed in the doctor’s office, without anaesthesia, without the need for pre-operative patient preparation, and without a hospital stay. It is usually done in the first clean days of the menstrual cycle when the uterine lining has not grown too much yet. Depending on whether it is a diagnostic or an operative one, office hysteroscopy lasts between 10 and 20 minutes. By means of a very thin optic device, only 3–4 mm in diameter, which is inserted through the vagina, a full inspection of the female genital tract is performed.
This minimally invasive technique allows for a quick and precise diagnosis of conditions in which ultrasound or gynaecological examination are not informative enough. By office hysteroscopy, we can find and treat small polyps, fine adhesions, uterine cavity defects, retained products of conception after abortion, endometriosis lesions, or we can make a biopsy when cancer or other pathology is suspected.
Office hysteroscopy does not require anaesthesia because the instruments’ diameter is only about 3–4 mm, the same as the tool used to place an intrauterine device. The operator technique is of utmost importance for reducing the pain in this procedure.
Most patients describe their sensations during the procedure as similar to menstrual pain, quickly fading after the manipulation.
On very rare occasions, local anaesthesia can be applied to the cervix.
Sometimes, when fallopian tubes are patent, the distention medium used during hysteroscopy can pass through and spill into the abdominal cavity, which can cause nausea.
Office hysteroscopy is a minimally invasive surgical procedure, which is indicated in specific conditions and symptoms, such as:
- Suspected uterine adhesions, or the so-called Asherman’s syndrome;
- Irregular menstrual bleeding, especially in menopausal women;
- Failed IVF cycles;
- Menstrual cycle irregularities following an abortion;
- A lost intrauterine device;
- Dull pain during periods (dysmenorrhoea).
- Presence of inflammation;
- Confirmed malignant neoplasms.
It is recommended that you are well-rested, calm, and fed.
If your pain threshold is low, you can take pain medication before the procedure.
During office hysteroscopy, you can follow the process together with your doctor. You are in control, and in case you feel pain or discomfort, the manipulation can be stopped.
After the procedure, you may have spotting or light bleeding, which should resolve in 2-3 days. You can return to sexual activity right after the bleeding stops.
A follow-up visit can be recommended at your consultant’s discretion in 10 to 15 days.