What happens after hysteroscopy: pain, menstruation,what can and can not, complications

Update: December 2018

One of the modern diagnostic and therapeutic procedures in
gynecology is hysteroscopy. This operation allows
examine the uterus, identify and, if necessary, promptly remove
pathology, and in many cases, determine the reasons
infertility Whether a hysteroscopy is done, the doctor decides based on
indications and contraindications for this manipulation, but
The last word, of course, remains for the patient.

Briefly about hysteroscopy

Hysteroscopy is called such a diagnostic and treatment
manipulation that allows you to visually assess the uterus from the inside,
identify pathological formations or anomalies of its structure and
need to remove them promptly, that is, without penetrating into
abdominal cavity. This method refers to endoscopic and
carried out using a special optical instrument –
hysteroscope trained specialist.

AT переводе с греческого гистероскопия означает «осматривать
the uterus. Manipulation is diagnostic and therapeutic.
Diagnostic hysteroscopy is carried out not only for inspection
internal uterine surface, but also for material intake
(endometrium) for histological examination (biopsy). ATо время
therapeutic hysteroscopy performed surgery
for example, removal of tumors or foreign bodies.

Preparation for the procedure

Since hysteroscopy refers to invasive procedures and is akin to
surgery before the patient
prescribe a survey (excluding emergency cases):

  • после гистероскопииblood and urine tests (general
    analyzes);
  • vaginal and cervical smears for microflora clarification;
  • blood for syphilis and hepatitis;
  • кровь на ATИЧ-инфекцию;
  • blood biochemistry (especially blood glucose in patients with excessive
    weight);
  • blood per group and Rh factor.

From instrumental methods are assigned:

  • Pelvic ultrasound;
  • Abdominal ultrasound (if indicated);
  • fluorography;
  • blood clotting analysis;
  • ECG (if indicated).

If the patient has chronic extragenital
diseases, consultation of the corresponding profile with
conducting corrective therapy. When detecting colpitis
Vaginal reorganization is appointed (up to 1–2 degrees of purity).

The examination is carried out on an outpatient basis. After entering
the hospital to the patient before the procedure is assigned a cleansing
enema (preparation of the intestine), and immediately before
Hysteroscopy needs to empty the bladder. Take food
on the day of manipulation is prohibited due to intravenous
anesthesia during hysteroscopy. Conducting hysteroscopy plan
on the 5th – 7th day of the cycle, that is, in the first (proliferative) phase, when
A new functional layer of the endometrium has just begun to grow, and
the inner surface of the uterus is available for inspection.

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

ATиды гистероскопии

Hysteroscopy, depending on the destination may be:

  • diagnostic – when you need to identify the causes of “problems”
    on the female line (diagnose endometrial polyposis, submucosal
    myoma node or other pathology);
  • therapeutic – after inspection of the inner surface of the uterus
    surgery is performed (excision of polyps, resection
    myoma node, dissection of adhesions or septum in the uterus);
  • control – is carried out after a certain time (usually after
    six months) after intrauterine intervention with
    hysteroscopy.

For successful surgery it is necessary to straighten the uterine
walls, uterus stretch and expand. To do this in the uterine cavity
Environments are introduced. AT зависимости от используемой среды гистероскопия
divided by:

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

Office hysteroscopy

Office hysteroscopy эндометрия является одним из вариантов
diagnostic hysteroscopy and performed on an outpatient basis. This
The name of the procedure came from Europe, where hysteroscopy with
diagnostic purposes can be performed not only by the 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,
minihysteroscopy, diagnostic video hysteroscopy. Last
the term implies a demonstration to the patient during
manipulating the picture of the inner surface of the uterus. Benefits
minihysteroscopy:

  • low invasiveness of the procedure (using a hysteroscope with
    the smallest diameter, without dilation of the cervical canal);
  • no need for general anesthesia, which reduces the cost
    hysteroscopy and the risk of anesthesiology
    complications;
  • possibility of outpatient treatment, does not require hospitalization
    and does not affect the ability to work;
  • short period of the procedure (no more than half an hour);
  • good handling tolerance;
  • possible holding endometrial biopsy.

Indications

The decision on the need for hysteroscopy is made
doctor on the basis of the following indications:

  • various disruptions in the menstrual cycle in girls, women
    childbearing and premenopausal age;
  • postmenopausal bleeding and bleeding;
  • suspicion and to confirm:
    • submucous myoma node;
    • adenomyosis;
    • endometrial cancer;
    • uterine malformations;
    • intrauterine synechia;
    • perforation of the uterus;
    • residues of the ovum and membranes;
    • cervical cancer;
    • endometrial polyposis and hyperplasia;
    • foreign body in the uterine cavity;
  • clarification of the location of the intrauterine device or its
    parts;
  • infertility;
  • as a preparatory stage before IVF;
  • miscarriage;
  • evaluate the effect and control the result of hormonal
    treatment;
  • complicated postpartum period.

As it becomes clear, hysteroscopy is the most
effective and effective method of diagnosis and treatment
gynecological pathology, therefore, refuse the procedure
impractical.

Contraindications

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

  • acute infectious diseases (catarrhal, sore throat,
    тромбофлебит или пиелонефрит и other);
  • exacerbation of chronic diseases;
  • acute inflammation of the genital organs (colpitis, endometritis,
    adnexitis);
  • uterine pregnancy (desired);
  • ectopic pregnancy or suspicion of it;
  • common cervical cancer;
  • extragenital diseases in decompensation stage
    (cardiovascular pathology, diseases of the liver, kidneys);
  • profuse bleeding from the uterus;
  • atresia of the cervical canal.

ATосстановительный период

ATосстановительный период после перенесенной манипуляции условно
divided into 2 stages. The first stage is the primary
restoration and normalization of the structure and functioning
damaged uterus tissue (mucous membrane and muscle layer). On
The first stage is completely healing microdamages and surgical
cuts, and the cervical
channel. This stage lasts about 2 – 3 weeks and ends.
full regeneration of operational damages and formation
scarless tissue.

ATторой этап восстановления направлен на формирование новой,
newly formed tissue, that is, a new endometrium after
hysteroscopy. A new uterine lining should have normal
structure and all its intrinsic functional properties (growth and
endometrial rejection according to the phases of the menstrual cycle). ATторой
the recovery phase takes more time and lasts up to 6
months.

ATыделения после процедуры

Blood and moderate bleeding will occur in
the first 2 – 3 days after the manipulation. This is due to traumatic
damage to the uterine lining tools. AT дальнейшем выделения
become succinic or yellow that can last until
two weeks. The duration of blood discharge due to
expansion of the uterine cavity during hysteroscopy,
fluid penetrates the vessels, damaging their walls, which leads to
the allocation of “blood”. But in case of abundant blood
discharge and blood clots should immediately consult a doctor.

Menstruation after hysteroscopy

Когда приходят месячные после hysteroscopy? ATсе зависит от
the purpose for which the procedure was carried out. AT случае
diagnostic, especially office hysteroscopy, menstruation
come according to the schedule of the usual cycle, but small
delays (2 – 3 days). This is because with diagnostic
the procedure practically does not injure the endometrium, therefore
a long time to restore it is not required. But in
case of therapeutic hysteroscopy, especially after the completion of the procedure
scraping the uterus, a longer delay is possible
menstruation. AT данной ситуации первым днем менструального цикла
should be considered the day of surgery and expect monthly after about
month. ATажно проследить за характером первой менструации после
procedures. At change of color and a consistence, and also increase
the amount of bleeding should consult with
gynecologist.

Pain after the procedure

Pain after hysteroscopy is considered absolutely normal.
phenomenon, if it is insignificant or moderate, is localized in
lower abdomen or lower back / sacrum and lasts a couple
days The painful sensations are explained, firstly, by stretching
uterine cavity during the procedure gas or liquid, and secondly,
traumatization of cervical and uterine tissues with instruments. Women low
pain threshold complain of severe pain, in such cases, the doctor
может порекомендовать прием НПATС с хорошим обезболивающим эффектом
(ketorol, indomethacin, niz). But if the stomach hurts unbearably,
the nature of pain is cramping, dagger or shooting,
the temperature rises significantly and symptoms increase
intoxication, pain give to the crotch or leg, it is necessary
seek medical attention immediately to exclude
possible complications.

General recommendations

AT раннем восстановительном периоде необходимо четко следовать
to all recommendations of the gynecologist:

  • give up sex life by about 3 to 4 weeks (ideally,
    until the first menstruation);
  • It is forbidden to take a bath, visit the bath and sauna, as well as
    swim in the pool or open water at least 3
    weeks;
  • observe personal hygiene (shower daily, wash
    twice a day using detergents with pH neutral
    reaction (intimate gels, baby soap);
  • as a rule, the doctor prescribes with anti-inflammatory purpose
    treatment after hysteroscopy (prophylactically) with antibiotics
    (ciprofloxacin) and metronidazole course for 5 – 7 days;
  • daily monitoring of body temperature (in the morning and before bedtime);
  • refuse to take aspirin as an anesthetic
    (the drug thins the blood, which will increase bleeding and may
    provoke bleeding);
  • postpone intense physical exertion, heavy physical
    labor and weight lifting more than 3 kg for 1 – 1.5 months
    (wellness sports exercises are allowed after 2 – 3
    weeks);
  • avoiding tampons for the period of bleeding is better
    apply gaskets;
  • prohibition of intravaginal administration of tablets, suppositories, gels and
    creams, as well as douching;
  • after hysteroscopy, do not use spermicides for
    months;
  • stick to a balanced diet, so as not to provoke
    constipation (rejection of spicy, salty, pickled foods, fried and
    fatty foods).
  • timely empty the bladder.

Pregnancy after hysteroscopy

Most women who go through the procedure
hysteroscopy, concerned about the issue of pregnancy
after her. If the procedure was performed for diagnostic purposes, and
no operative procedures were performed in the uterus
interventions such as excision of a polyp, then conception is possible
in the next cycle. This is due to a quick recovery.
mucous uterus and hormonal background. But doctors warn
that the patient should not be rushed, 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
    appendages, cervical background processes, external endometriosis and
    other);
  • the presence of extragenital pathology (it is necessary to adjust
    condition and undergo treatment);
  • preparation for pregnancy (healthy lifestyle, taking folic
    acids, moderate exercise for at least 3 months);
  • testing for genital infections and treatment of both partners
    their detection (chlamydia, cytomegalovirus, papillomavirus
    person and others).

Under favorable conditions, pregnancy is allowed.
not earlier than 3 months after the procedure.

IVF after hysteroscopy

When a patient is preparing for IVF, she should go through enough
complex examination, which includes hysteroscopy.
But not in all IVF clinics this procedure is
mandatory. IVF after hysteroscopy может закончиться неудачно
(miscarriage) in case of undetected and untreated intrauterine
pathology, so most fertility specialists consider mandatory
the procedure. What can detect and remove (when
necessary) a doctor on hysteroscopy before IVF:

  • excise polyps;
  • remove hyperplastic endometrium;
  • dissect intrauterine adhesions;
  • excise the intrauterine septum;
  • remove foci of endometriosis;
  • correct the shape of the uterus in case of its abnormal
    development;
  • remove submucous myoma node;
  • check the patency of the tubes (insertion of a catheter into the tubes).

After operating hysteroscopy plan pregnancy
allowed no earlier than six months. In case of successful
fertilization and implantation of the egg woman put on
dispensary registration since the establishment of pregnancy and
are watching. The course of pregnancy depends not only on
intrauterine surgery, but also from others
factors:

  • hormones before pregnancy;
  • age;
  • the number of births and abortions;
  • condition of the cervix (ICN);
  • extragenital pathology.

Cost of hysteroscopy

Cost of hysteroscopy зависит от того, с какой целью она
held. Diagnostic or office hysteroscopy,
accordingly, it is cheaper because its implementation does not include
surgical intervention. Operating hysteroscopy prices
vary according to the level of complexity of the operation, qualifications and
physician experience and quality equipment. Increases the cost
procedures and the need (in some cases) of staying in
hospital But, of course, the price of the service depends on the region and level
clinics.

For example, in Moscow, diagnostic hysteroscopy will cost 15,000
– 35000 rubles, and the price for an operating system reaches 60000 – 65000
rubles. In the provinces, the price of office hysteroscopy ranges from
2500 – 9000 rubles, and the procedure with surgical treatment
внутриматочной патологии стоит от 3500 до 25000 rubles. Average
цена на пребывание в стационаре составляет 1500 – 4000 rubles.

Possible complications

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

Early complications

From early postoperative complications should Mark:

  • inflammation of the uterus and peritoneum of the pelvis (endometritis,
    pelvioperitonit) – makes up 90% of all complications;
  • intravascular hemolysis due to the duration of the operation
    and using distilled water or non-electrolyte media
    either an increase in 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:

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

Question answer

ATопрос: У меня обнаружили полип эндометрия через
six months after hysteroscopy. What is the reason and how to treat it?

Ответ: Рецидив полипа эндометрия, скорее всего,
associated with incomplete removal of education during the previous
procedures (left leg). The treatment will be repeated
performing hysteroscopy, with excision of the polyp and coagulation of it
bed (electric current or freezing) with possible
the appointment of hormonal drugs.

ATопрос: Какая должна быть температура тела после
hysteroscopy?

Ответ: AT идеале, температура тела утром и
in the evening should not exceed the mark of 37 degrees. But while there
bloody or serous discharge (7 – 10 days), evening
temperature may rise slightly (up to 37.2 degrees). AT
case of higher temperature, as well as its increase in the morning
should consult a doctor to exclude
inflammation of the internal genital organs.

ATопрос: Можно ли после гистероскопии принимать
hemostatic drugs and what?

Ответ: Usually, кровянистые выделения после
deferred procedures are minor and short and not
require admission hemostatic. AT качестве кровоостанавливающих
drugs can take vitamin C, calcium gluconate and vikasol.
If there is anemia, the doctor will recommend taking medications.
gland.

ATопрос: Почему после гистероскопии назначаются
hormonal pills or injections?

Ответ: Так как процедура в большинстве случаев
is performed to remove intrauterine neoplasms,
caused by hormonal imbalance (polyps, fibroids,
endometrial hyperplastic processes), doctor for normalization
hormones recommends hormone therapy. Usually,
oral contraceptives are prescribed for a period of 3 to 6 months.

ATопрос: Нужно ли наблюдаться у гинеколога после
hysteroscopy?

Ответ: Да, обязательно. First visit to the doctor
after the procedure should be 10 – 14 days. Control ultrasound
held after 3, and then after 6 months. AT случае благоприятных
results of the survey and the absence of complaints a woman in the future
must visit a gynecologist every year.

ATопрос: On какой день выписывают из стационара
после hysteroscopy?

Ответ: Если процедура запланирована как
stationary, then on average the patient is allowed to go home already on
the next day. But in some cases it is possible to leave the hospital.
after a few hours (satisfactory condition, smearing
bloody issues). Leave a woman for a few days (2 – 3)
in hospital may after significant surgery
(removal of myoma node or multiple endometrial polyps)
либо при возникновении complications.

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