Hysteroscopy in Ahmedabad: Seeing and Treating Inside the Uterus

Hysteroscopy Test vs Ultrasound: Why I Sometimes Look Further

A transvaginal ultrasound is always my starting test, and very often it is all that is needed. It has limits, though. It cannot always tell a polyp from a thick lining, may miss thin adhesions, and cannot fully judge how deep a fibroid goes into the wall. A saline infusion sonogram or a 3D ultrasound can narrow things down, but hysteroscopy gives the definitive answer.

During the procedure the cavity is gently opened with sterile saline and the picture appears on a screen. I check, in a set order, both openings of the fallopian tubes, the lining, and the overall shape of the cavity.

Diagnostic Hysteroscopy and Operative Hysteroscopy Compared

Diagnostic (outpatient) hysteroscopy uses a slim scope and often needs no stretching of the cervix. It can frequently be done in a procedure room after a pain-relief tablet and a local anaesthetic, and many women are back at work the next day. Small polyps can sometimes be removed in the same sitting with fine scissors or a grasper.

Operative hysteroscopy uses a wider scope with electrosurgical or mechanical instruments and is done in the operation theatre under anaesthesia. I use it for larger fibroids, a septum or dense adhesions.

Which of the two suits you is something we decide together in clinic, based on your scan, your symptoms and how comfortable you would feel being awake.

Symptoms and Scan Findings That Lead Me to Suggest Hysteroscopy

• Periods that are heavy, irregular or prolonged; bleeding between periods or after intercourse.
• Bleeding after menopause, particularly when the scan shows the lining thicker than 4 mm.
• Infertility or repeated IVF failure when a scan or HSG hints at a problem in the cavity.
• Recurrent miscarriage, to look for a septum or adhesions.
• A scan showing a polyp, a submucosal fibroid or a thickened lining.
• Very scanty or absent periods after a D&C or an infection related to pregnancy, which can point to adhesions.
• A Copper-T or other device whose threads cannot be found, or that has become embedded in the wall.

Hysteroscopy for Polyp Removal and the Other Problems I Treat

Most problems inside the cavity can be dealt with without opening the abdomen.

Hysteroscopy for Copper T Removal When the Threads Are Lost

A Copper-T is normally removed in the OPD by gently pulling on its threads. Hysteroscopy is needed when the threads cannot be seen or felt, when they have broken off, or when the device has partly grown into the wall of the uterus.

Before planning it, I first confirm where the device is - usually with an ultrasound, and an X-ray if the scan cannot find it. If it is inside the cavity, I locate it through the hysteroscope and lift it out with grasping forceps under direct vision. This avoids repeated blind attempts with a hook. If the scan shows the device has moved outside the uterus, which is uncommon, it has to be removed by laparoscopy instead.

Missing threads do not always mean the Copper-T has moved, but until its position is confirmed, use another method of contraception. If you want a new device, it can often be placed at the same sitting - my page on contraception and the Copper-T explains the options.

Hysteroscopy Procedure Time, Cycle Timing and Anaesthesia

A hysteroscopy usually takes 10–45 minutes. A diagnostic look is at the shorter end, and a resection or septum division at the longer end. You then rest for one to two hours before going home.

I usually schedule hysteroscopy in the week after your period finishes and before ovulation. At that point the lining is thin, the view is clearest and an early pregnancy is not a concern. If your cycles are irregular, a urine pregnancy test is done on the day. Bleeding after menopause can be investigated at any time.

• Anaesthesia: a short diagnostic look needs simple pain relief, with or without a local anaesthetic to the cervix. An operative procedure is done under a short general or spinal anaesthetic, which means fasting for about six hours.
• Softening the cervix: I may give a tablet a few hours beforehand, especially if you have never had a vaginal birth or are past menopause.
• Bring your latest ultrasound report and notes from any earlier operations.
• Take a pain-relief tablet about an hour before, if I have advised it.
• Diabetes medicines and blood thinners are adjusted in advance.
• If you are having an anaesthetic, bring an adult who can travel back with you.

Hysteroscopy Risks and How I Keep Them Low

Hysteroscopy is a common, well-established procedure, and complications are uncommon - less so for a diagnostic look than for operative work. The figures below are general published figures:

• Perforation (a small hole in the uterine wall): fewer than 1 in 100 operative procedures. It usually heals by itself; occasionally a laparoscopy is needed to make sure nothing else has been injured.
• Infection: roughly 1 in 100 to 1 in 400 women. Sterile technique, and antibiotics when indicated, keep this down.
• Bleeding: usually light, and it settles on its own
• Fluid absorption during long resections: prevented by measuring the fluid going in and coming out.
• Not being able to enter the cavity because the cervix is tight: made less likely by softening the cervix beforehand.
• Fresh adhesions after septum or adhesion surgery: I sometimes plan a follow-up look.

Hysteroscopy Recovery Time: The Days After the Procedure

Recovery is usually quick. You are likely to leave on the day of the procedure and be back to your routine within one to two days.

• You rest for one to two hours and go home once you have eaten and passed urine.
• Mild cramps, light bleeding or a watery discharge for a few days are expected; simple pain relief is usually enough.
• Avoid intercourse, tampons and swimming until the bleeding has stopped - usually about a week.
• Any tissue removed goes for histopathology, and I discuss the report with you at a follow-up visit about one to two weeks later.

Hysteroscopy for Infertility: When It Helps You Conceive

When there is a genuine problem in the cavity, correcting it can make a measurable difference:

• Removing a septum can lower the risk of miscarriage.
• Removing polyps and submucosal fibroids can improve the chance of implantation, in natural cycles and in IVF.
• Adhesions are the hardest to treat; the result depends on how much healthy lining remains.
• When the scan is normal, a routine hysteroscopy has not been shown to improve IVF success, so I advise it when there is a specific reason.

After a diagnostic look or polyp removal you can usually try to conceive in the next cycle. After septum or adhesion surgery I commonly suggest waiting one to two cycles, sometimes with a check of the cavity beforehand. In short, I do not add hysteroscopy to fertility treatment as a matter of routine.

How I Arrange Your Hysteroscopy at Divine Women's Hospital

• I go through your scan and symptoms in clinic, then book the procedure for a suitable day of your cycle.
• I perform the procedure myself, as day care, at the NABH-certified hospital in Gota. Anaesthesia and recovery are on site, and once you are home the hospital's emergency team can be reached at any hour.
• If a laparoscopy is also needed - for example a tubal check during an infertility work-up - I plan both under one anaesthetic.

Hysteroscopy Cost in Ahmedabad: What Changes the Charge

The charge for a hysteroscopy depends mainly on whether it is a diagnostic look or an operative procedure.

• Diagnostic (office) hysteroscopy - a short procedure, often with only pain relief and a local anaesthetic, and a brief day-care stay.
• Operative hysteroscopy - done in the operation theatre under a short general or spinal anaesthetic, so theatre and anaesthesia charges are added. A fibroid resection or septum division takes longer than a small polyp removal.
• Biopsy and histopathology - any tissue removed is sent for testing.
• Combined procedures - if a laparoscopy is planned under the same anaesthetic, the estimate covers both.
• Tests beforehand - a scan, and blood tests if you are having anaesthesia.

Current charges are given by Divine Women's Hospital on request, once we know which kind of hysteroscopy you need.

Is Hysteroscopy Covered by Insurance in India?

It depends on your policy. Many health insurance policies list day-care procedures, but the terms differ, so ask the hospital desk to check your policy before the date is booked.

Hysteroscopy with Me in Five Steps

1. Consultation and scanwe look at your symptoms and ultrasound to decide whether hysteroscopy will add anything.
2. Schedulingtimed for the early part of your cycle, with the type of anaesthesia agreed in advance.
3. The day-care proceduretypically 10–45 minutes, followed by one to two hours of rest.
4. ExplanationI explain what I found before you leave, often showing you images from the procedure.
5. Results and planat follow-up we go through the biopsy report and agree on fertility plans or any further treatment.

When I Suggest a Hysteroscopy Assessment

• Bleeding between periods, after intercourse or after menopause.
• A scan showing a polyp, a thickened lining or a fibroid in the cavity.
• Two or more miscarriages, or a scan suggesting a septate uterus.
• Very scanty periods following a D&C or a pregnancy.
• Preparing for IVF, or IVF that has failed without explanation.
• Copper-T threads that you or your doctor cannot feel or see.

Hysteroscopy Misconceptions I Often Clear Up

Fact: It is done through the vagina and cervix; an abdominal cut is made solely when a separate laparoscopy is planned.

Fact: Small polyps, thin adhesions and a mild septum can be missed on a scan, so I may suggest hysteroscopy if symptoms continue.

Fact: Large studies have shown no benefit when the scan is normal; I recommend it when there is a specific reason.

Fact: Done for the right reason, it usually improves the cavity. The lining generally heals within one or two cycles, and removing tissue under direct vision is gentler than blind scraping.

Questions Patients Often Ask Me About Hysteroscopy