Hysteroscopy

A hysteroscope is a fine telescope that is introduced through the cervix and is used to view the uterine cavity. The uterine cavity is distended with either fluid or carbon dioxide to gain a good view. The procedure of hysteroscopy is a commonly performed operation that is used to investigate abnormal uterine bleeding. It may also be an important investigation in fertility treatment.

The hysteroscope is used to view the lining of the uterus (endometrium) and can detect abnormalities such as polyps, fibroids and uterine septae. Biopsies from the uterine lining can be easliy taken through the hysteroscope.

Hysteroscopy is usually carried out with a short, daycase general anaesthetic. A "curette" or D&C is sometimes carried out at the time of hysteroscopy.

Hysteroscopic surgery

A slightly larger instrument than a hysteroscope called a resectoscope can also be introduced through the cervix. This instrument contains a cutting blade and can be used to cut away large polyps and fibroids. This approach is also the method of choice if you have a uterine septum that needs correction.

Endometrial ablation

Annother instrument called a "rollerball" can also be introduced through the resectoscope and used to cauterize the lining of the uterus with electricity. This is an effective treatment for heavy periods. A number of methods can be used to ablate the lining of the uterus including thermal balloons, freezing and microwaves. The rollerball method is a very safe and effective method that I recommend. Following endometrial ablation, about 80-90% of patients have much lighter periods than before. It is a minimally invasive procedure, only requiring a day case stay in hospital and usually one day off work.

Not everyone is suitable for endometrial ablation. The uterus must be fairly normal and not greatly enlarged or distorted by such things as fibroids. You must also have completed your family, as endometrial ablation renders you effectively infertile.

If you are suitable, endometrial ablation may be an effective option for the treatment of heavy periods that may avoid a hysterectomy.