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Menopause (Expert Forum)
Thorough Hysteroscopy Procedure Information
Answered by
Machelle Seibel, MD - Women's Health, menopause, ReproductiveMedicine
University of Massachusetts Medical School
MA
Questions in the Menopause forum are answered by Dr. Machelle Seibel. Topics covered include menopause issues, depression, hormone replacement therapy, hot flashes, joint or muscle problems, memory problems, mood swings, osteoporosis, sexual problems, skin changes, sleeping problems, vaginal problems, and weight problems.
Thorough Hysteroscopy Procedure Information
by CrohnieToo, Aug 26, 2006 12:00AM
64 years old, 14 years post-menopause. Cervical stenosis preventing office hysteroscopy. Surgical hysteroscopy suggested due to mild, rare, but intermittent pale pink spotting (5-6 times over past 18 months-2 years), minimal amount of fluid in the endometrial cavity, recent (5-6 months) intermittent sharp twinges or pangs in left abdomen 1/2 way below top of hip bone ridge.
July 2002 uterus 6.1 x 2.2 x 3.4 cm, 4mm endrometrial stripe, 5.1 x 4.14 x 4.3 cm simple left ovarian cyst patient has opted to wait and watch. 0.3 x 0.5 cm calcified uterine fibroid.
September 2005 uterus is 7 cm x 1.8 cm x 4.5 cm, endometrial stripe is 3 mm, small amount of intrauterine fluid still identified. Simple cyst now 7 cm x 6 cm.
25 Aug 2006 pelvic & transvaginal ultrasound report not yet available, however endometrial fluid did appear to be about 3 ?? in volume.
Patient avoids sedation/anesthesia due to not knowing what is going on and having no say or control during surgery/procedure & nightmares for several days after having either.
HOW is the cervix dilated for this procedure? Can this procedure be done w/epidural AND no sedation so patient is awake, alert and aware? Does the hysteroscope allow for visuals on a monitor that can be turned so patient can watch and see (as for a colonoscopy)? How much risk is there to bladder, urethra, ureters and intestine w/cervical dilation and surgical hysteroscopy? How long does bleeding usually occur after this procedure? How long is script pain control usually needed after surgical hysteroscopy w/cervical dilation due to stenosis?
July 2002 uterus 6.1 x 2.2 x 3.4 cm, 4mm endrometrial stripe, 5.1 x 4.14 x 4.3 cm simple left ovarian cyst patient has opted to wait and watch. 0.3 x 0.5 cm calcified uterine fibroid.
September 2005 uterus is 7 cm x 1.8 cm x 4.5 cm, endometrial stripe is 3 mm, small amount of intrauterine fluid still identified. Simple cyst now 7 cm x 6 cm.
25 Aug 2006 pelvic & transvaginal ultrasound report not yet available, however endometrial fluid did appear to be about 3 ?? in volume.
Patient avoids sedation/anesthesia due to not knowing what is going on and having no say or control during surgery/procedure & nightmares for several days after having either.
HOW is the cervix dilated for this procedure? Can this procedure be done w/epidural AND no sedation so patient is awake, alert and aware? Does the hysteroscope allow for visuals on a monitor that can be turned so patient can watch and see (as for a colonoscopy)? How much risk is there to bladder, urethra, ureters and intestine w/cervical dilation and surgical hysteroscopy? How long does bleeding usually occur after this procedure? How long is script pain control usually needed after surgical hysteroscopy w/cervical dilation due to stenosis?
Doctor's Answer
by Machelle Seibel, MD, Aug 30, 2006 12:00AM
, Aug 30, 2006 12:00AM
You are asking good questions and you should discuss them with your doctor before having the procedure. Doctors have different opinions on how they might answer these questions.
It is possible to do a hysteroscopy under epidural. Usually there is some light anesthesia also given to make the person more comfortable, but still awake or sometimes, drift off to sleep. A monitor can be used and often is, but patients aren't usually allowed to look. It is your surgeon's decision.
A thin long curved piece of metal goes into the uterus to open it a little. Then a bigger piece, etc. It usually takes only a few minutes.
No surgery is without some risk. So there are risks to the nearby organs such as the bladder, intestines, and ureters but the risk is typically small. Your doctor can tell you his or her risk level.
Bleeding typically stops in a few days after the prodedure and pain usually stops or is fairly mild in a day or two. Pain medication usually isn't needed for more than a few days.
It is possible to do a hysteroscopy under epidural. Usually there is some light anesthesia also given to make the person more comfortable, but still awake or sometimes, drift off to sleep. A monitor can be used and often is, but patients aren't usually allowed to look. It is your surgeon's decision.
A thin long curved piece of metal goes into the uterus to open it a little. Then a bigger piece, etc. It usually takes only a few minutes.
No surgery is without some risk. So there are risks to the nearby organs such as the bladder, intestines, and ureters but the risk is typically small. Your doctor can tell you his or her risk level.
Bleeding typically stops in a few days after the prodedure and pain usually stops or is fairly mild in a day or two. Pain medication usually isn't needed for more than a few days.
Now, I can't find those earlier sites and information. Am I to assume they no longer do the graduated cones to dilate the cervix or the seaweed stuff to dilate the cervix?
10 years or more ago we used luteinizing hormone to open the cervix on a female dog w/a closed pyometra. It made them vomit and have diarrhea but it sure got that uterus/cervix open and draining! They don't utilize something like that in humans to open the closed cervix, do they?