Update: December 2018

One of the modern diagnostic and therapeutic procedures in gynecology is hysteroscopy. This operation allows you to examine the uterus, identify and, if necessary, promptly remove pathology, and in many cases, decide on the problem. The doctor decides whether to perform hysteroscopy, based on the indications and contraindications for this procedure, but the last word, of course, remains with the patient.

Briefly about hysteroscopy

Hysteroscopy is a therapeutic and diagnostic manipulation that allows you to visually evaluate the uterus from the inside, identify pathological formations or anomalies in its structure and, if necessary, remove them promptly, that is, without penetrating the abdominal cavity. This method is endoscopic and is performed using a special optical device - a hysteroscope - by a trained specialist.

Translated from Greek, hysteroscopy means “to examine the uterus.” Manipulation can be diagnostic or therapeutic. Diagnostic hysteroscopy is performed not only to examine the internal uterine surface, but also to collect material (endometrium) for histological examination (biopsy). During therapeutic hysteroscopy, surgical interventions are performed, for example, removal of tumors or foreign bodies.

Preparation for the procedure

Since hysteroscopy is an invasive procedure and is akin to surgery, before undergoing it the patient is prescribed an examination (excluding emergency cases):

The following instrumental methods are prescribed:

• Ultrasound of the pelvis;
• (if indicated);
• fluorography;
• blood clotting test;
• (if indicated).

If the patient has chronic extragenital diseases, a consultation with a doctor of the appropriate profile with corrective therapy is indicated. If detected, vaginal sanitation is prescribed (up to 1 - 2 degrees of cleanliness).

The examination is carried out on an outpatient basis. After admission to the hospital, the patient is given a cleansing enema (bowel preparation) before the procedure, and immediately before hysteroscopy it is necessary to empty the bladder. Eating on the day of the procedure is prohibited due to intravenous anesthesia during hysteroscopy. Hysteroscopy is planned for days 5–7 of the cycle, that is, in the first (proliferative) phase, when the new functional layer of the endometrium has just begun to grow and the inner surface of the uterus is accessible for inspection.

It is also necessary to abstain from sexual intercourse 3 days before the procedure, and stop douching a week before. The use of spermicides and vaginal suppositories 7 days before hysteroscopy is also not recommended.

Types of hysteroscopy

Hysteroscopy, depending on the purpose, can be:

• diagnostic – when it is necessary to identify the causes of “problems” in the female line (to diagnose endometrial polyposis, submucosal myomatous node or other pathology);
• therapeutic - after examining the inner surface of the uterus, surgical intervention is performed (excision of polyps, resection of a myomatous node, dissection of adhesions or septum in the uterus);
• control - carried out after a certain time (usually six months) after intrauterine interventions using hysteroscopy.

For a successful operation, it is necessary to straighten the uterine walls, stretch and expand the uterus. For this purpose, media are introduced into the uterine cavity. Depending on the medium used, hysteroscopy is divided into:

• liquid (saline solution or 5% glucose is injected);
• gas (carbon dioxide is introduced).

Office hysteroscopy

Office endometrial hysteroscopy is one of the options for diagnostic hysteroscopy and is performed on an outpatient basis. This name for the procedure comes from Europe, where hysteroscopy for diagnostic purposes can be performed not only by a gynecologist, but by a general practitioner, and it is performed on an outpatient basis, in medical offices (by Western definition - in offices).

Office hysteroscopy is called simple hysteroscopy, mini-hysteroscopy, diagnostic video hysteroscopy. The latter term implies showing the patient a picture of the inner surface of the uterus during the manipulation. Advantages of minihysteroscopy:

• low traumatic procedure (a hysteroscope with the smallest diameter is used, without expanding the cervical canal);
• there is no need for general anesthesia, which reduces the cost of hysteroscopy and the risk of anesthetic complications;
• Possibility of outpatient implementation, does not require hospitalization and does not affect the ability to work;
• short period of the procedure (no more than half an hour);
• good tolerance to manipulation;
• It is possible to perform an endometrial biopsy.

Indications

The decision on the need for hysteroscopy is made by the doctor based on the following indications:

• various disruptions in the menstrual cycle in girls, women of childbearing and premenopausal age;
• bleeding and spotting in postmenopause;
• suspicion and for confirmation:
  • submucosal myomatous node;
  • adenomyosis;
  • endometrial cancer;
  • malformations of the uterus;
  • intrauterine synechiae;
  • perforation of the uterus;
  • remnants of the fertilized egg and membranes;
  • polyposis and;
  • foreign body in the uterine cavity;
• clarification of the localization of the intrauterine device or its parts;
• infertility;
• as a preparatory stage before IVF;
• miscarriage;
• evaluate the effect and monitor the result of hormonal treatment;
• complicated postpartum period.

As it becomes clear, hysteroscopy is the most effective and efficient method for diagnosing and treating gynecological pathology, so it is not advisable to refuse the procedure.

Contraindications

Like any other intrauterine procedure, hysteroscopy is not performed in the following situations:

• acute infectious diseases (colds, sore throat, etc.);
• exacerbation of chronic diseases;
• acute inflammation of the genital organs (colpitis, endometritis, adnexitis);
• intrauterine pregnancy (desired);
• or suspicion of it;
• advanced cervical cancer;
• extragenital diseases in the stage of decompensation (cardiovascular pathology, kidney);
• profuse bleeding from the uterus;
• atresia of the cervical canal.

Recovery period

The recovery period after the manipulation is conventionally divided into 2 stages. The first stage consists of the primary restoration and normalization of the structure and functioning of damaged uterine tissue (mucous membrane and muscle layer). At the first stage, microdamages and surgical incisions are completely healed, and the cervical canal is restored and regenerated. This stage lasts about 2–3 weeks and ends with complete regeneration of surgical damage and the formation of scar-free tissue.

The second stage of recovery is aimed at the formation of new, newly formed tissue, that is, a new endometrium after hysteroscopy. The new uterine mucosa must have a normal structure and all its inherent functional properties (proliferation and rejection of the endometrium according to the phases of the menstrual cycle). The second stage of recovery requires more time and lasts up to 6 months.

Discharge after the procedure

Blood and moderate spotting will occur in the first 2 to 3 days after the procedure. This is explained by traumatic damage to the uterine mucosa by instruments. Subsequently, the discharge becomes bloody or yellow, which can last up to two weeks. The duration of ichor discharge is due to the expansion of the uterine cavity with liquid during hysteroscopy; the liquid penetrates into the vessels, damaging their walls, which leads to the release of “ichor”. But if heavy bleeding or blood clots appear, you should immediately consult a doctor.

Menstruation after hysteroscopy

When does your period come after hysteroscopy? It all depends on the purpose of the procedure. In the case of diagnostic, especially office hysteroscopy, menstruation occurs according to the usual cycle schedule, but slight delays are possible (2 - 3 days). This is explained by the fact that during the diagnostic procedure the endometrium is practically not injured, so a long time for its recovery is not required. But in the case of therapeutic hysteroscopy, especially after completion of the procedure by curettage of the uterine cavity, a longer delay in menstruation is possible. In this situation, the first day of the menstrual cycle should be considered the day of the operation and expect menstruation in about a month. It is important to monitor the nature of the first menstruation after the procedure. If there is a change in color or consistency, or an increase in the amount of bleeding, you should consult a gynecologist.

Pain after the procedure

Pain after hysteroscopy is considered absolutely normal if it is minor or moderate, localized in the lower abdomen or lower back/sacrum and lasts a couple of days. Painful sensations are explained, firstly, by the stretching of the uterine cavity during the procedure with gas or liquid, and secondly, by traumatization of the tissues of the cervix and uterus with instruments. Women with a low pain threshold complain of severe pain; in such cases, the doctor may recommend taking NSAIDs with a good analgesic effect (ketorol, indomethacin, Nise). But if the stomach hurts unbearably, the nature of the pain is cramping, dagger-like or shooting, the temperature rises significantly and the symptoms of intoxication increase, the pain radiates to the perineum or leg, then you must immediately seek medical help to eliminate possible complications.

In the early recovery period, it is necessary to strictly follow all the recommendations of the gynecologist:

• abstain from sexual activity for about 3–4 weeks (ideally, before your first period);
• It is prohibited to take a bath, visit a bathhouse and sauna, or swim in a pool or open water for at least 3 weeks;
• maintain personal hygiene (shower daily, wash twice a day using detergents with a pH-neutral reaction (intimate gels, baby soap);
• as a rule, the doctor prescribes anti-inflammatory treatment after hysteroscopy (prophylactically) with antibiotics (ciprofloxacin) and metronidazole for a course of 5–7 days;
• daily monitoring of body temperature (in the morning and before bedtime);
• stop taking aspirin as a pain reliever (the drug thins the blood, which will increase spotting and can cause bleeding);
• postpone intense physical activity, heavy physical labor and lifting weights of more than 3 kg for 1 - 1.5 months (health-improving sports exercises are allowed after 2 - 3 weeks);
• refusal of tampons during the period of bleeding, it is better to use pads;
• a ban on intravaginal administration of tablets, suppositories, gels and creams, as well as douching;
• after hysteroscopy, you should not use spermicides for a month;
• adhere to a balanced diet so as not to provoke constipation (refusal of spicy, salty, pickled foods, fried and fatty foods).
• Empty your bladder in a timely manner.

Pregnancy after hysteroscopy

Most women who undergo a hysteroscopy procedure are concerned about when pregnancy will occur after it. If the procedure was performed for diagnostic purposes, and no surgical interventions were performed in the uterine cavity, for example, excision of a polyp, then conception is possible already in the next cycle. This is due to the rapid restoration of the uterine mucosa and. But doctors warn the patient that there is no need to rush, and when you can get pregnant depends on many other factors:

• the nature of the menstrual cycle (regular or not);
• the presence of other gynecological diseases (inflammation of the appendages, background processes of the cervix, external endometriosis and others);
• the presence of extragenital pathology (it is necessary to correct the condition and undergo treatment);
• preparation for pregnancy (healthy lifestyle, moderate physical activity for at least 3 months);
• examination for sexually transmitted infections and treatment of both partners if they are detected (human papillomavirus and others).

Under favorable conditions, it is allowed to plan a pregnancy no earlier than 3 months after the procedure.

IVF after hysteroscopy

When a patient is preparing for IVF, she must undergo a fairly complex examination, the protocol of which includes hysteroscopy. But not all IVF clinics require this procedure. IVF after hysteroscopy may fail (miscarriage) in the case of undetected and untreated intrauterine pathology, which is why most reproductologists consider the procedure mandatory. What a doctor can identify and remove (if necessary) during hysteroscopy before IVF:

• excise polyps;
• remove hyperplastic endometrium;
• cut intrauterine adhesions;
• excise the intrauterine septum;
• remove foci of endometriosis;
• correct the shape of the uterus in case of its abnormal development;
• remove the submucosal myomatous node;
• check the patency of the pipes (inserting a catheter into the pipes).

After surgical hysteroscopy, planning a pregnancy is allowed no earlier than six months later. In case of successful fertilization and implantation of the egg, the woman is registered at the dispensary from the moment pregnancy is established and is carefully monitored. The course of pregnancy depends not only on the intrauterine surgery performed, but also on other factors:

• hormonal levels before pregnancy;
• age;
• number of births and;
• cervical condition (UC);
• extragenital pathology.

Cost of hysteroscopy

The cost of hysteroscopy depends on the purpose for which it is performed. Diagnostic or office hysteroscopy, respectively, is cheaper since it does not include surgery. Prices for surgical hysteroscopy vary according to the level of complexity of the operation, the qualifications and experience of the doctor and the quality of the equipment. Increases the cost of the procedure and the need (in some cases) for hospital stay. But, of course, the price of the service depends on the region and the level of the clinic.

For example, in Moscow, diagnostic hysteroscopy will cost 15,000 - 35,000 rubles, and the price for an operating room reaches 60,000 - 65,000 rubles. In the provinces, the price of office hysteroscopy ranges from 2,500 to 9,000 rubles, and the procedure with surgical treatment of intrauterine pathology costs from 3,500 to 25,000 rubles. The average price for a hospital stay is 1,500 – 4,000 rubles.

Possible complications

Hysteroscopy, like any invasive procedure, is fraught with complications.

Early complications

Among the early postoperative complications, the following should be noted:

• inflammation of the uterus and peritoneum of the small pelvis (endometritis, pelvioperitonitis) – accounts for 90% of all complications;
• intravascular hemolysis caused by the duration of the operation and the use of distilled water or electrolyte-free media or increased intrauterine pressure;
• bleeding – no more than 5% of all complications (observed after resection of fibroids, resection or ablation of the endometrium).

Late complications

Late complications include:

• formation of pyometra in postmenopausal patients (in case of rough manipulation);
• formation of hydrosalpinxes, especially with chronic adnexitis;
• deformation of the uterine cavity (after resection of the endometrium or removal of large myomatous nodes);
• exacerbation of chronic inflammatory processes;
• incomplete removal of intrauterine formations.

Question answer

Question:
I was diagnosed with an endometrial polyp six months after the hysteroscopy. What is the reason for this and how to treat it?

Answer: Recurrence of an endometrial polyp is most likely associated with incomplete removal of the formation during the previous procedure (a stalk remains). Treatment will consist of repeated hysteroscopy, with excision of the polyp and coagulation of its bed (with electric current or freezing) with the possible prescription of hormonal drugs.

Question:
What should be the body temperature after hysteroscopy?

Answer: Ideally, body temperature in the morning and evening should not exceed 37 degrees. But while there is bloody or bloody discharge (7-10 days), the evening temperature may rise slightly (up to 37.2 degrees). In case of a higher temperature, as well as its increase in the morning, you should consult a doctor to exclude an inflammatory process of the internal genital organs.

Question:
Is it possible to take hemostatic drugs after hysteroscopy and which ones?

Answer: As a rule, bleeding after the procedure is insignificant and short-lived and does not require hemostatic agents. Vitamin C, calcium gluconate and Vicasol can be taken as hemostatic drugs. The doctor will recommend taking iron supplements.

Question:
Why are hormonal pills or injections prescribed after hysteroscopy?

Answer: Since the procedure in most cases is carried out to remove intrauterine tumors resulting from hormonal imbalance (polyps, fibroids, endometrial hyperplastic processes), the doctor recommends hormone therapy to normalize hormonal levels. As a rule, oral contraceptives are prescribed for a period of 3 to 6 months.

Question:
Is it necessary to see a gynecologist after hysteroscopy?

Answer: Yes, definitely. The first visit to the doctor after the procedure should be 10 to 14 days. Control ultrasound is performed after 3 and then after 6 months. If the examination results are favorable and there are no complaints, the woman should subsequently visit a gynecologist every year.

Question:
On what day are you discharged from the hospital after hysteroscopy?

Answer: If the procedure is planned as an inpatient procedure, then on average the patient is sent home the very next day. But in some cases it is possible to leave the hospital after a few hours (satisfactory condition, spotting). A woman may be left in the hospital for several days (2–3) after a significant surgical intervention (removal of a myomatous node or multiple endometrial polyps) or if complications arise.

Recommendations after hysteroscopy help you recover faster and return to your normal lifestyle. Recovery after a diagnostic procedure is conventionally divided into two stages. First, there is a primary restoration of tissues that have been damaged, in addition to this, the tissues of the uterus, mucous membranes, and the entire muscle layer are restored. At the first stage, healing of microdamages and incisions occurs. Treatment after hysteroscopy is prescribed by the doctor.

After the procedure, the cervical canal is restored. The first stage of recovery lasts about 20 days. As a result, the damage becomes less noticeable; Scarless tissue begins to form. The second stage of recovery after hysteroscopy of the uterus lasts longer: a renewed endometrium is formed (the mucous membrane of the uterus must have its own structure and its own biological functions). The second recovery stage lasts up to 5 months.

Causes of discharge after the procedure

After this type of diagnosis, discharge in the form of blood may appear: they are usually observed on the 3rd day. The discharge occurs due to the fact that the mucous membrane of the uterus is damaged as a result of medical manipulations and the uterine solution is used for hysteroscopy. At first, the discharge is bloody, then it becomes yellow in color; Their approximate duration is two weeks. The discharge is due to the fact that during the procedure the uterine cavity expands. The liquid used during manipulation is able to penetrate into the vessels, thus their walls are damaged and the woman observes discharge.

Determination of the menstrual cycle: are delays possible?

If you notice excessive blood clots, be sure to seek help! As for the menstrual cycle, it all depends on the purposes of hysteroscopy. If it was carried out for diagnostic purposes, menstruation will occur without delay. There may be delays of several days: this is normal. If hysteroscopy is performed for diagnostic purposes, the endometrium is not damaged, so it does not require much recovery time. In the case of therapeutic hysteroscopy, everything is different. If curettage of the uterine cavity has occurred, menstruation will most likely be delayed. In this case, the menstrual cycle will begin the day after the operation: this means that menstruation should be expected in a month.

You should pay attention to the nature of the first menstruation after therapeutic hysteroscopy. Pay attention to the color and consistency of your periods. If you notice that your bleeding is increasing, be sure to consult your gynecologist. After hysteroscopy, pain often occurs. This is normal, but if it is intense, you should consult a gynecologist. In a normal state, a woman has pain in the lower abdomen along with the lower back. The duration of such pain is 3 days. They are explained by the fact that during manipulation the uterine cavity is stretched (it is affected by liquid or gas).

The pain is caused not only by this reason: the fact is that the tissue of the cervix is ​​injured by medical instruments. If a woman has a low pain threshold, she will complain of severe pain. In this case, the doctor recommends a medicine with a powerful analgesic effect. If a woman feels unbearable cramping pain, her temperature may rise, and symptoms of intoxication may appear. If a woman feels that the pain is radiating to the perineum or legs, she needs to urgently call an ambulance, otherwise complications will arise. Be sure to follow your doctor's recommendations.

1. You should be away from sexual activity for 3 months.
2. It is forbidden to go to the bathhouse or sauna.
3. You cannot visit swimming pools, swim in rivers or ponds.
4. Compliance with hygiene rules is mandatory: take a shower, wash yourself 2 times a day (it is advisable to use a special gel with neutral PH).

For the purpose of prevention, the doctor may prescribe anti-inflammatory drugs, including antibiotics. The course of treatment will be 7-8 days. Antibiotics are prescribed taking into account the patient's health condition. Body temperature must be monitored. You should not take aspirin: it is a painkiller. The medicine can thin the blood and increase blood discharge. It is important to know that ordinary aspirin can cause bleeding. During the rehabilitation period, you should not overload, both mentally and physically. Try to rest on time and don’t get nervous. If we talk about health-improving sports exercises, they can be done after 3 weeks.

What should you not do after hysteroscopy? You should stop using tampons and it is recommended to replace them with pads. It is prohibited to administer tablets intravaginally. All kinds of suppositories and douching creams are contraindicated. You need to eat rationally, not drink strong drinks, and especially alcohol. It is worth emptying your intestines on time, giving up all harmful foods: these include salty, spicy, pickled, fried, and too fatty foods. You need to take medications with the permission of a gynecologist: uncontrolled use is fraught with consequences.

About pregnancy

Women are interested in: when pregnancy occurs after a diagnostic procedure. If a diagnostic hysteroscopy was performed and the doctor did not perform surgical intervention, for example, removal of polyps, you can begin conception in the next cycle. Some doctors are sure that there is no need to rush into pregnancy. It is necessary to pay attention to the features of the menstrual cycle, as well as to the frequency and regularity. Other gynecological diseases should also be taken into account. For a successful pregnancy, you need to lead a healthy lifestyle.

It is recommended to do moderate exercise for three months. It is necessary to be examined for the presence of sexually transmitted infections. Treatment is mandatory if chlamydia, papillomavirus and other unpleasant infections are detected. Pregnancy can be planned no earlier than 4 months after the medical procedure. If a woman is going to do IVF, she needs to undergo a long and very complex examination. It is important to know that IVF after hysteroscopy can end badly: a woman may have a miscarriage.

2014-01-15 21:54:12

Marina asks:

Good afternoon! I really need some advice. In the summer I had a very bad stomach. after hysteroscopy it turned out that I have superficial gastritis. The doctor prescribed a diet, a course of Omez and Phospholugel. Then she added Chophytol to the therapy. a month and a half ago I took a test for Halicobacter, it turned out to be elevated 26.3 units when the norm is 0-3.5 units. This time the doctor prescribed amoxicillin, clarothromycin and ultop. On the first day of taking these medications, I started having severe pain. I started taking only the first two drugs (7 days) and at the same time took bifidumbacterin. After 5 weeks, I did a repeat Helicobacter test - and it was again elevated, and the hemoglobin decreased, although before that it was normal. Tell me, what should I do now? I don't know if I should trust this doctor again.

2013-07-24 14:30:05

Svetlana asks:

Hello! After a hysteroscopy, I was diagnosed with endometriosis. They prescribed Visane for 6 months, I had five days left to drink, a nagging pain in the lower abdomen began, everything was fine before. What could be the reason?

Answers Medical consultant of the website portal:

2012-08-17 14:34:34

Elena asks:

Good afternoon For a year I had severe pain during menstruation. An ultrasound revealed tissue in the uterus and a hysteroscopy was recommended. Diagnosis after hysteroscopy: uterine body polyp, small uterine leiomyoma, adenomyosis. Histology result: c/c - mucus, blood, scraps of squamous epithelium, p/m - blood, small layers of endometrium in the medium proliferation phase, some with focal stromal fibrosis. The surgeon who performed the hysteroscopy recommends 3 injections of diferelin or decapeptyl depot as treatment. My attending physician recommends taking the drug Vizanne. I don’t know what to choose. help me please

Answers Palyga Igor Evgenievich:

I think that taking Visane will be enough for you. The injections contain a high dose of the hormone, which is released in portions (the so-called depot form). Not all patients tolerate it well. The tablets will act more gently.

2011-10-31 18:15:43

Nadezhda asks:

Hello, I am 45 years old. For 11 years I have been seeing a gynecologist for the presence of small uterine fibroids, and at first there was only one node on the surface of the uterus, now there are four of them. Over the past two years, I have had two hysteroscopies, the indication is suspicion of polyps, intermenstrual bleeding, thickening of the endometrium up to 8 mm on days 6-8 of the cycle. During the first hysteroscopy, the conclusion was that there was a small uterine fibroid in its cavity. At the second, a polyp was removed. Next, treatment with the hormonal drug duphoston was prescribed from the 16th day of the cycle, 2 tablets per day, 10 days. I have been taking it for the 5th cycle already, and in the first three I was pleased with the result. Menstruation was not heavy, it began on the 4th day after the end of treatment, the tension in the breasts, which was observed already by the 15th day of the cycle, disappeared. The ultrasound picture showed normal thickness of the endometrium, the structure of the ovaries improved. On the 4th cycle, menstruation came 5 days earlier and went already on the 8th day of taking the drug. They passed without any problems. The gynecologist told me that Duphoston should be taken for no more than 6 months. She prescribed me to continue taking the drug for another 2 months, and then suggested the Mirena IUD. There was no alternative offer, despite my distrustful attitude towards this method of treatment. I had 2 cesarean sections, in addition, I have cysts on the cervix, a scar from cauterization of cervical erosion, in my youth, when installing an IUD as a contraceptive, I experienced discomfort and pain, after which 6 months later I had it removed. I have heard a lot of negative reviews regarding the Mirena IUD. I would like to get an answer: how long can I take the drug Duphoston with my diagnosis, and what alternative treatment can I get, how effective a treatment can be the installation of the Mirena spiral. Thank you in advance.

Answers Wild Nadezhda Ivanovna:

Mirena is a levonorgestrel system. It just looks like an intrauterine device. It has a therapeutic effect due to the presence of gestogen or, in other words, progesterone, which acts in the uterine cavity for 5 years and does not allow the formation of new polyps and fibromatous nodes. Of course the choice is yours. Duphaston can be taken for a long time, there are no restrictions for it, just against the background of long-term use of duphaston, monitoring of the blood coagulation system, control of a cytological smear from the cervix, control of the mammary glands, and ultrasound monitoring of the condition of the uterus are necessary. If there was endometrial polyposis, then it is necessary to repeat the histological examination of the endometrium after 6 months of treatment. What speaks in his favor is that while taking treatment there is a cycle disruption, i.e. Taking duphaston for 10 days in the menstrual cycle is not enough; you need to take it according to a different regimen, but after a diagnostic curettage followed by a histological examination of the scraping.

2011-10-18 18:48:39

Olga Kranenburg asks:

Hello dear doctor,
I have the following situation: 7 years ago I had a caesarean section, I don’t have any abdominal pain. But recently I turned to a gynecologist, after Hysteroscopy, the doctor saw that the internal suture on the uterus (near the cervix) had come apart a little. They explained to me that if I want a second child, then there must be a planned cesarean section, because during contractions the suture may completely come apart. I was so shocked by what I heard that I didn’t think to ask. Can the suture come apart on its own at 8-9 months of pregnancy, when the baby begins to actively grow?? We want to have a second child, but isn’t it dangerous? Thank you very much in advance for your answer. Olga

Answers Tovstolytkina Natalia Petrovna:

Hello Olga. The danger of uterine rupture along an old scar always exists in all women who have had a caesarean section. It is impossible to predict the course of pregnancy in each individual patient. If the uterine scar fails, the pregnant woman spends the last weeks of pregnancy in a hospital setting, and delivery is carried out by planned cesarean section.

2011-04-09 11:01:31

Elena asks:

Hello! Please answer, is 17-OPK good for the treatment of endometrial hyperplasia? After hysteroscopy, I took 3 injections of 12.5%, 2 ml each, on days 7, 14, 21 of the cycle. On day 21 there was black discharge, pain in the back and lower abdomen. This has been going on for 4 days now. The doctor suggested I start drinking organametril. Is it suitable for treatment for my diagnosis and what is the best way to use it? I'm tired of experimenting on myself... Merena was also placed, but after six months I had to take it out, because... she festered......

Answers Klochko Elvira Dmitrievna:

Good afternoon. All your previous and current prescriptions relate to the standards of treatment for hyperplasia. These are not experiments, as you write. This is traditional therapy. It is better to take Orgametril for 21 days, then a 7-day break. There are at least 6 such cycles.

2011-03-26 19:30:21

Gulnaz asks:

Hello, a week ago I had a hysteroscopy with the removal of endometrial polyps, I felt good for 2 days after the operation, but in the last few days I have been bothered by nagging pain in the lower abdomen and lower back, there is no bleeding, I took antibiotics and metronidazole for 4 days, now I am taking Zhanine. Tell me, can I have any consequences after hysteroscopy, which could cause pain and discomfort, thank you in advance.

2010-02-09 18:47:01

Elena asks:

Hello! I am 43 years old. In December, menstrual irregularities such as metrorrhagia and endometrial polyposis were diagnosed. After hysteroscopy, a diagnosis of complex endometrial hyperplasia was made. After curettage, the bleeding did not stop completely. The doctor prescribed injections of oxyprogesterone capronate, 4 ml three times a week for 4 weeks, and then 4 ml twice a week for 2 weeks. After 10 injections, an allergic reaction appeared and they were canceled. A week later, menstruation began, it is so heavy that it looks like bleeding and slight pain in the lower abdomen. Is this normal or not? Please advise what to do? Thank you very much in advance.

Answers Vengarenko Victoria Anatolevna:

Elena, of course this is not normal, you need to select another drug, there are many drugs for the treatment of hyperplasia: OPK 17, Buserilin, Zolodex, but these drugs should be prescribed only under the supervision of a doctor.

2016-08-16 11:32:36

Alexandra asks:

Good afternoon, I am 31 years old. diagnosis - infertility 1. We have been trying to get pregnant for four years now. According to the results of echohysterosalpingography, synechia was detected in the uterine cavity - both tubes are passable. Then last year they did a hysteroscopy - synechiae in the uterine cavity and a polyp were removed. Afterwards, she underwent a course of drug treatment. Treatment was also prescribed for my husband - he has chronic prostatitis - spermogram: leukospermia, normozoospermia. There were no abortions or pregnancies. Next, I was prescribed G. hydrotubation. During the first procedure, they did an ultrasound after the infusion and discovered a problem with the left tube - namely, a narrowing in the place where it leaves the uterus. During the second procedure, the pain became worse and my blood pressure increased. The doctor referred me to a cardiologist; they gave a conclusion about mitral valve prolapse and said that this is not a contraindication for pregnancy and childbirth. Already this year, he was sent for MSG: the left tube with signs of perisalpingitis is passable, the right tube is passable to the ampullary section - the concentrate did not leak into the abdominal cavity. The doctor prescribed physical procedures - phonophoresis and mud and said that he would conduct some more research with a gel on the patency of the tubes after undergoing physical procedures to look at the effectiveness of the treatment. and if it turns out to be unchanged, it will be sent to the lapara. Tell me how it turned out that initially the pipes were passable, but after a series of manipulations they became “not very good”; we don’t get sick with STDs, we were tested for everything possible and concealed the infection more than once. All is clear. How effective can physical treatment be? I'm afraid to do a lapar, because there is a possibility of an adhesive process (which already exists)? With my diagnosis, can I apply for IVF under the compulsory medical insurance policy?

Hysteroscopy is a modern endoscopic method for identifying pathology of the uterine cavity. It is a minimally invasive diagnostic and therapeutic procedure. Today it is rightly called the “gold standard” for identifying pathological processes in the uterine cavity. Depending on the indications, hysteroscopy can be:

• Diagnostic procedure.
• Therapeutic minimally invasive surgery.

Women of reproductive age are prescribed from days 6 to 12 of the cycle.

Briefly about the method

In gynecological practice, modern endoscopic equipment is used for hysteroscopy, which is a whole system of lenses with different optical characteristics, which allows performing assigned diagnostic and surgical tasks. Gas or aqueous media can be used to expand and increase the volume of the uterus during hysteroscopy. The choice depends on the indications and purposes of the manipulation being performed.

Indications and contraindications

Indications for hysteroscopy are:

• Cyclic hormonal disorders in women of reproductive age.
• Pathological nature of vaginal discharge, especially after menopause.
• Diagnosis and surgical treatment of fibroids and other benign formations, adenomyosis, foreign bodies, for histological confirmation of malignant tumors of the uterine body.
• Uterine bleeding, in order to identify the source, cause and possibility of stopping.
• The need to sanitize the uterus from the remaining areas of the placenta, membranes of the fertilized egg, and perform sterilization.
• Diagnostics to determine the possible cause of infertility.
• Carrying out a planned diagnostic procedure after previous surgical treatment.
• In order to identify anomalies and variations in the structure of the uterus.

Hysteroscopy is a minimally invasive surgical intervention, performed routinely or for emergency reasons, for therapeutic or diagnostic purposes, and has contraindications:

1. Acute inflammatory processes of the uterus requiring therapeutic treatment, inflammatory type of smear during gynecological examination.
2. Pregnancy at any stage.
3. The period of inflammatory infectious diseases (flu, sore throat, etc.), exacerbation of chronic diseases.
4. Menstrual bleeding.

Postoperative period

After the intervention is performed, discharge from the medical institution usually occurs either on the day of the procedure or the next day. Long-term hospital stay and observation are usually not required.

The duration of the recovery period after hysteroscopy of the uterus ranges from five days to three weeks and depends on the extent of the intervention performed.

As a rule, diagnostic hysteroscopy does not affect the patient’s ability to work and after a day or two the woman can start working. After therapeutic hysteroscopy, the period of incapacity for work can last up to five days.

The postoperative period is characterized by signs caused by the healing of the uterine mucosa injured during manipulation, restoration of the previous volume of the uterus after its artificial increase during hysteroscopy. The clinical picture of the postoperative period is due to the following symptoms:

• Painful sensations.
• Vaginal discharge.
• Cycle change.
• Stress factor.

Pain after hysteroscopy

The pain is localized in the suprapubic region. As a rule, the pain is mild, nagging, and is similar in intensity to pain during menstruation. The first hours after the procedure may be cramping, which is caused by contraction of the uterus and restoration of its previous size. More often, pain does not require the use of analgesic drugs, or is easily relieved by taking non-steroidal anti-inflammatory drugs (paracetamol, Nimesil, Ketorol, ketorolac), antispasmodics (No-shpa, papaverine). In duration, moderate or slight, pain in the lower abdomen can be expressed from several hours to three to four days.

Vaginal discharge

Serous-hemorrhagic discharge from the genital tract is caused by damage to the endometrium of the uterus during hysteroscopy. In the first hours after the intervention, they may be more abundant, then they resemble normal menstruation. The first two to three days, the discharge may contain small clots or pieces of tissue. They continue after the diagnostic procedure for up to 4-5 days, and after therapeutic hysteroscopy (removal of a formation from the uterine cavity) they can last up to 10 days.

Menstrual cycle

The next period usually comes on time. The first day of the cycle must be counted from the day of surgery. Sometimes removal of space-occupying lesions can lead to a slight increase in cycle duration.

Prescription of antibacterial drugs in the postoperative period

As a rule, antibiotics are not required in the postoperative period. However, if the pathological process had signs of an inflammatory nature (when removing the remaining fertilized egg, part of the placenta), antibacterial therapy is prescribed to prevent postoperative endometritis. The duration of treatment depends on the specific situation, but on average it ranges from five to seven days.

Body temperature after hysteroscopy

In the postoperative period, there is usually no increase in body temperature. If chills or fever appear, you should immediately consult a gynecologist to exclude the possibility of developing a postoperative inflammatory process in the uterus.

Recovery and rehabilitation period

The period of complete recovery after hysteroscopy is up to 3 weeks. An indispensable condition of this period is compliance with simple but necessary recommendations.

• Maintain sexual rest for at least 3 weeks, since mechanical trauma to the uterus during sexual intercourse can cause bleeding.
• Measurement of body temperature the first 5–7 days after the intervention. This will allow you to timely identify and take the necessary measures to treat postoperative inflammation of the uterus.
• Compliance with hygiene measures: take a hygienic shower twice a day, refrain from taking baths. Visiting baths, saunas, and thermal procedures is contraindicated.
• Follow the recommendations of the attending physician regarding the use of antibiotics and medications taken for pain relief.
• Compliance with the daily routine, nutrition, limitation of physical activity.

If you experience excessive blood clots, bleeding from the genital tract, increased pain, or increased temperature, you should immediately consult a doctor.

Hysteroscopy is a modern procedure that is used for therapeutic and diagnostic purposes in gynecological practice. This endoscopic manipulation is carried out with a special optical device - a hysteroscope. It is performed using sedation in combination with local anesthesia or general anesthesia.

For diagnostic purposes, it is used to examine the inside of the uterus and to collect biological material for research. It can also be used to remove tumors and foreign bodies. This procedure can be performed if there is a suspicion of an oncological process, a perforation of the uterine wall after surgery, or to clarify the position of the spiral inside the uterus.

Despite the fact that hysteroscopy is considered a simple procedure and is well tolerated by patients, certain complications may occur after it is performed. Patients often complain of pain after hysteroscopy.

Causes and nature of pain

Pain after the procedure can be explained as follows:

• During the manipulation, the uterine cavity was stretched with gas or liquid.
• Minor damage that can be caused by instruments in direct contact with the uterine mucosa.
• The patient has a low pain threshold.

If for several days after hysteroscopy the lower abdomen or lower back/sacrum hurts and these sensations are insignificant or moderate, then this phenomenon is quite normal.

For 3 days after the procedure, patients may be recommended painkillers - Nurofen, Ketanov, Dexalgin, Nimid. But they should not be abused, so as not to miss some more serious complications.

There are emergency conditions in which you should definitely seek medical help:

• the lower back hurts very much;
• cramping, stabbing or shooting pains in the lower abdomen that radiate to the perineum;
• body temperature rises sharply;
• symptoms of general intoxication are observed.

If the patient does not experience serious complications, then sick leave is usually not provided. In most cases, 3-4 hours after the procedure or the next day, the woman is allowed to go home. However, each case is individual and health workers usually accommodate patients who are unable to go to work after the manipulation.

If the patient feels well and has no complaints after hysteroscopy, a cycle duration of 50 days can be considered normal

Features of menstruation after hysteroscopy

The diagnostic procedure, as a rule, does not disrupt the patient’s cycle. In this case, the endometrium is practically not injured and does not require a long period of time for its recovery. Menstruation occurs on time or with a slight delay of 2-3 days.

With therapeutic hysteroscopy with curettage of the uterine cavity, everything is different. In this case, the menstrual cycle begins to count from the day of the operation and menstruation should be expected in about a month. But sometimes after this endoscopic manipulation a more serious delay can occur.

After hysteroscopy, the selections deserve special attention, of which there will be quite a lot. You should pay attention to their color, smell and quantity. If some characteristic confuses you, then you should not delay your visit to the gynecologist.

After the procedure, pain in the sacrum and lower abdomen is definitely expected, which will resemble the sensations before the arrival of menstruation. If they go away on their own after some time, then this is considered normal. If, after hysteroscopy, periods become too painful, then this is a serious reason for a visit to the gynecologist, especially if this occurs along with specific discharge.

There is no reason to expect that there will be no pain at all after such an endoscopic procedure. However, as a rule, they are quite tolerable or easily relieved with analgesics, and also go away on their own after a few days.