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<p><span style="color: #00826a;"><strong>Hysteroscopy</strong></span> is a medical procedure using a scope inserted through the cervix to directly view pathological conditions at the cervix and inside the uterine cavity, or to observe the openings of the fallopian tubes into the uterine cavity.</p>
<p>&nbsp;</p>
<p>This method has advantages over uterine curettage because the doctor can directly see the pathology inside the uterine cavity, which is beneficial for patients with focal lesions. This procedure can be used as a diagnostic tool and can also provide treatment simultaneously, such as removing polyps inside the uterine cavity, excising uterine fibroids, or removing an intrauterine device (IUD) stuck inside the uterine cavity. However, the limitation of hysteroscopy is that it cannot diagnose diseases located in the uterine muscle layer or the fallopian tubes. Doctors recommend hysteroscopy for patients with the following symptoms:</p>
<ol>
<li style="list-style-type: none;">
<ol>
<li>Women of reproductive age with abnormal menstrual bleeding in terms of amount and/or duration</li>
<li>Women suspected of having fibroids or polyps inside the uterine cavity based on ultrasound examination</li>
<li>Postmenopausal women with uterine bleeding (vaginal bleeding) who continue to bleed after endometrial biopsy or curettage</li>
<li>Women with uterine abnormalities, such as a septate uterus</li>
<li>Women with heavy menstrual bleeding without pathology found from external uterine examination; the doctor can perform hysteroscopy to destroy or remove the endometrial lining to stop menstruation</li>
<li>Women with infertility and a history of very light or absent menstruation after curettage, suspected to have intrauterine adhesions (Asherman’s syndrome)</li>
<li>Women who have had an IUD for a long time and cannot remove the IUD string normally, possibly due to tissue covering the IUD or partial perforation of the uterine wall; the doctor will use hysteroscopy to remove the IUD</li>
<li>Women with recurrent miscarriage and ultrasound findings of fibroids or polyps inside the uterine cavity</li>
</ol>
</li>
</ol>
<h2></h2>
<h2 style="color: #00826a;"><span style="color: #00826a;">Preparation Before Hysteroscopy</span></h2>
<p>Hysteroscopy for diagnostic purposes or to find the cause of disease can be performed in an outpatient gynecology clinic. There is no need to fast or avoid drinking because the diagnostic equipment has a smaller diameter than surgical instruments.</p>
<p>&nbsp;</p>
<p>However, if the doctor needs to perform surgery inside the uterine cavity, the patient must fast for 6 hours before the procedure. The duration of hysteroscopy depends on the procedure performed. Diagnostic hysteroscopy usually takes about 10-30 minutes. Surgical procedures depend on the complexity and size of the fibroid; larger fibroids require longer surgery. Typically, the surgical procedure itself (excluding preparation and cervical dilation) takes no longer than 1 hour.</p>
<p>&nbsp;</p>
<p>Sometimes, a second surgery may be scheduled after the initial hysteroscopy. If the procedure is diagnostic and no general anesthesia is used, the patient may not need to take time off work and can resume normal activities. However, if surgery involves significant blood loss and general anesthesia, the doctor may advise the patient to rest at home for about one week. The attending physician will provide specific recommendations on a case-by-case basis.</p>
<h2></h2>
<h2 style="color: #008080;"><span style="color: #00826a;">Restrictions After Hysteroscopy</span></h2>
<p>After hysteroscopy, avoid activities that may affect the uterine cavity for about 2 weeks or until there is no pain in the vagina or lower abdomen, no abnormal discharge, and/or no vaginal bleeding. Activities to avoid include:</p>
<ul>
<li style="list-style-type: none;">
<ul>
<li>Vaginal douching</li>
<li>Sexual intercourse</li>
<li>Bathing in a bathtub</li>
<li>Swimming</li>
<li>Using tampons</li>
</ul>
</li>
</ul>
<h2></h2>
<h2 style="color: #00826a;"><span style="color: #00826a;">Contraindications for Hysteroscopy</span></h2>
<p>However, hysteroscopy is not performed in the following cases:</p>
<ul>
<li style="list-style-type: none;">
<ul>
<li>Pregnant women</li>
<li>Severe pelvic inflammatory disease or pelvic infection</li>
<li>Presence of cervical cancer infection</li>
</ul>
</li>
</ul>
<h2></h2>
<h2 style="color: #00826a;"><span style="color: #00826a;">Self-Care After Hysteroscopy</span></h2>
<p>After hysteroscopy, observe and take care of yourself as follows:</p>
<ul>
<li style="list-style-type: none;">
<ul>
<li>Minor vaginal bleeding after surgery/hysteroscopy is normal. Sometimes, tissue fragments from the surgery may be expelled from the uterine cavity, which can cause bleeding for about 5-7 days after the procedure.</li>
<li>You may experience dull pain in the uterus area, which can be relieved with painkillers such as paracetamol.</li>
<li>Do not perform vaginal douching.</li>
</ul>
</li>
</ul>
<h2></h2>
<h2 style="color: #00826a;"><span style="color: #00826a;">What Are the Complications of Hysteroscopy?</span></h2>
<p>Generally, complications or side effects from hysteroscopy are very rare. Possible complications include:</p>
<ul>
<li style="list-style-type: none;">
<ul>
<li>Cervical tear due to cervical dilation</li>
<li>Uterine perforation when inserting instruments into the uterine cavity or during fibroid surgery</li>
<li>Fluid and electrolyte imbalance, ranging from mild (no symptoms) to severe symptoms such as seizures, abnormal heart rhythm, unconsciousness, and possibly death</li>
<li>Heavy bleeding from the uterus or vaginal bleeding</li>
<li>Infection inside the uterine cavity (endometritis)</li>
</ul>
</li>
</ul>
<p>&nbsp;</p>
<p>Finally, the doctor advises that you must return to see a doctor or go to the hospital before the scheduled appointment if you experience heavy or prolonged vaginal bleeding, severe lower abdominal pain, purulent vaginal discharge with foul odor, high fever, chills, etc. Do not ignore or delay treatment, or endure pain until it progresses to endometrial cancer. If unsure or have questions, you should contact the hospital immediately for more information.</p>
<p>&nbsp;</p>
<p style="text-align: right;"><span style="color: #00826a;"><strong>Captain (Navy) Dr. Sosakul Boonyawiroj</strong></span><br />
Gynecologic Oncology Specialist<br />
Women’s Health Center, Phyathai 1 Hospital</p>


Hysteroscopy for diagnostic purposes to find the cause of the disease can be performed in the gynecology outpatient examination room. There is no need to fast or abstain from drinking. It is suitable for women with recurrent miscarriage or women who are in a condition of

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