By Dr Patricia Muthaura
Abnormal bleeding or not bleeding at all is a major concern that most women suffer from be it in their reproductive ages, or beyond. It is estimated that one in five women, will at some point suffer from some sort of abnormal bleeding, affecting their quality of life, causing anaemia, or even limiting their ability to conceive especially those in their reproductive ages.
Abnormal bleeding should always prompt one to visit a doctor for evaluation. In order for the doctor to establish the underlying cause, a pelvic exam and an ultrasound are usually the first line of evaluation. Sometimes, ultrasound scans may not give adequate results to enable doctors arrive at a conclusive diagnosis and a hysteroscopy may be recommended for such patients.
Hysteroscopy is an advanced technology procedure that is done in women in, or beyond their reproductive ages under anesthesia. This practice is somehow similar to a pap-smear test and involves a hysteroscope – a thin, lighted tube fitted with a camera that is inserted into the birth canal to examine the cervix and inside of the uterus, or womb for the diagnosis, or treatment of several conditions that could be causing the abnormal bleeding.
The doctor first inserts gas, or a liquid-like saline through the hysteroscope into the uterus to expand it. This gives a clear view of its lining and the opening of the fallopian tubes through the hysteroscope. Hysteroscopy examines the interior (lining) of the uterus, and is not appropriate for examination, or diagnosis of problems, or conditions that occur within the muscular wall, or on the outside of the uterus.
The beauty of this procedure is that it has the capability to identify and treat serious conditions which that could be the cause of the abnormal bleeding. Such include fibroids, polyps, or tumors inside the uterus. Causes for the absence, or significant reduction in bleeding such as scarring following previous surgical procedures or infections like tuberculosis may be identified as well as causes of some fertility problems.
The procedure can also be carried out to visually confirm results of an ultrasound test. Any woman in menopause, who experiences vaginal bleeding should urgently seek medical attention. A hysteroscopy is critical for early diagnosis of endometrial cancer, a type of cancer that is usually curable if detected early.
The greatest advantage of hysteroscopy is that the cause of abnormal bleeding may be treated at the same time of the procedure. Polyps, or fibroids in the uterine cavity can be removed. If no cause of heavy bleeding is identified, an endometrial ablation can be done. Endometrial ablation removes the endometrium which is the lining of the uterus. In most cases, this stops you from having periods. If it doesn’t stop your periods, your flow should at least return to normal, or be very light.
During hysteroscopy, causes of no bleeding, or infertility can also be treated. Scar tissue from previous uterine surgeries can be removed, polyps blocking the fallopian tubes can also be removed. Some infertility patients may have an abnormal uterus, with a wall dividing the uterine cavity into two. This wall can also be removed during a hysteroscopy procedure.
Depending on the purpose of the procedure and patients health status, thorough physical examinations including pelvic checks are carried out as hysteroscopy is not suitable for someone with an active pelvic infection.
After the procedure, patients might experience some cramping, or light bleeding but in most cases, a woman may resume normal activities between two to three days. However, if the patient experiences symptoms such as fever, heavy bleeding, or discharge and severe abdominal pain, she should notify the doctor immediately.
Complications of hysteroscopy are rare and can include perforation of the uterus, bleeding, infection, damage to the urinary, or digestive tract, and medical complications resulting from reactions to drugs, or anaesthetic agents.
This procedure is highly specialised and requires the expertise of a fully trained and experienced gynecologist in a well-equipped theatre facility.
Dr Patricia Muthaura is the Section Head, Gynaecology and Consultant Obstetrician Gynaecologist at Aga Khan University Hospital, Nairobi