1. Diagnostic Hysteroscopy
   • Used to diagnose problems inside the uterus such as abnormal bleeding, uterine fibroids, polyps, or congenital abnormalities (e.g., uterine septum).
   • Often done in cases of infertility, recurrent miscarriages, or abnormal uterine bleeding.
   • Usually carried out at an outpatient or physician's office. It may not require general anesthesia, though some may need local or mild sedation.


2. Operative Hysteroscopy
   • Used to treat uterine problems or abnormalities that have been identified during diagnostic hysteroscopy.
   • To remove fibroids, polyps, adhesions (Asherman’s syndrome), or to correct uterine abnormalities.
   • Often combined with diagnostic hysteroscopy. Instruments can be inserted through the hysteroscope to perform procedures like excision of polyps or fibroids.


3. Office-Based Hysteroscopy
   • A minimally invasive version of diagnostic hysteroscopy that can be done in a clinic or office setting without the need for general anesthesia.
   • For simpler diagnostic evaluations like confirming the cause of abnormal uterine bleeding or locating an intrauterine device (IUD).
   • Done with mild sedation or no anesthesia at all, using smaller, more flexible hysteroscope.

Hysteroscopy is minimally invasive, and while it can cause discomfort, it is generally well-tolerated. It’s often performed in cases where more detailed information or treatment is needed than can be provided by imaging alone.

1. Diagnosis of Uterine Problems
   • Abnormal Uterine Bleeding: Unexplained heavy menstrual periods, bleeding between periods, or postmenopausal bleeding.
   • Infertility: To evaluate possible uterine causes of infertility or repeated miscarriages.
   • Pelvic Pain: To identify the cause of chronic pelvic pain or pain during menstruation.


2. Investigation of Uterine Conditions
   • Fibroids or Polyps: To look for or remove uterine fibroids or polyps, which are benign growths in the uterus.
   • Adhesions (Asherman's Syndrome): To detect and treat scar tissue in the uterus, which can affect menstruation and fertility.
   • Congenital Uterine Abnormalities: To investigate the shape and structure of the uterus.


3. Treatment of Uterine Problems:
   • Removal of Polyps or Fibroids: Hysteroscopy can also be used to remove polyps or fibroids found in the uterus.
   • Endometrial Ablation: A procedure to treat heavy menstrual bleeding by removing the lining of the uterus.
   • Treatment of Abnormalities: Correcting structural abnormalities, such as a septate uterus (a congenital malformation of the uterus).

Procedure of Hysteroscopy

Hysteroscopy is commonly performed to diagnose or treat uterine problems, such as abnormal bleeding, fibroids, polyps, or infertility. It's a useful diagnostic and therapeutic tool for gynecological conditions.

1. Pre-procedure consultation: The doctor will review the patient’s medical history and may conduct a physical exam or other tests (like a pelvic ultrasound).


2. Anesthesia: Depending on the reason for the procedure, it can be done with local, regional, or general anesthesia.
   • Local anesthesia numbs only the cervix.
   • General anesthesia may be used for more complicated procedures or if the patient prefers not to be awake.


3. Medication: Sometimes, medications are prescribed before the procedure to soften the cervix and make it easier to insert the hysteroscope.

Procedure Steps

1. Positioning: The patient is placed in a lithotomy position (lying on the back with legs in stirrups).


2. Cervical Dilation: If necessary, the cervix is gently dilated using dilators or medications.


3. Insertion of the Hysteroscope: The hysteroscope (a thin, lighted tube) is inserted through the vagina and cervix into the uterus. Carbon dioxide gas or a liquid solution (saline or glycine) may be used to expand the uterus for better visualization.


4. Inspection: The doctor inspects the lining of the uterus (endometrium) for abnormalities such as polyps, fibroids, adhesions, or malformations.


5. Treatment (if necessary): If a problem is detected, small surgical instruments can be passed through the hysteroscope to treat the condition (e.g., removal of polyps or fibroids).
   Biopsy: A small tissue sample may be taken for further analysis.


6. Completion: The hysteroscope is withdrawn, and the uterus returns to its normal size.

Post-Procedure

1. Recovery: If general anesthesia is used, the patient will be monitored until fully awake. The procedure itself typically lasts 5–30 minutes.


2. Discharge: The patient is usually discharged on the same day.


3. Side Effects: Mild cramping, spotting, or a watery discharge can occur. Usually, they go away in a few days.


4. Follow-Up: Any findings or treatments are discussed with the patient, and follow-up appointments may be scheduled to review results or monitor recovery.



Risks and Complications

Though generally safe, hysteroscopy may carry risks, including

1. Infection
2. Uterine perforation
3. Heavy bleeding
4. Damage to surrounding organs