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Diagnostic hysteroscopy
Medical expert of the article
Last reviewed: 04.07.2025
Hysteroscopy can be used to diagnose intrauterine pathology, as well as for surgical interventions in the uterine cavity.
Diagnostic hysteroscopy is the method of choice for diagnosing intrauterine pathology. Conventional separate diagnostic curettage of the mucous membrane of the uterine walls without visual control is ineffective and uninformative in 30-90% of cases.
Preparation of patients for hysteroscopy. Hysteroscopy is a surgical intervention performed depending on the indications on an emergency or planned basis. Planned hysteroscopy is performed after a clinical examination, including blood, urine, vaginal smear tests for purity, chest X-ray, and ECG. It is advisable to determine the blood sugar level in elderly patients, especially those suffering from obesity. The data of a bimanual examination of the pelvic organs, blood test results, and vaginal smear tests should not indicate the presence of an inflammatory process. A clinical examination allows one to form a certain idea of the presence of pathological changes in the uterus, identify concomitant diseases, and determine the type of upcoming anesthesia. If the patient has extragenital pathology (heart disease, lung disease, hypertension, etc.), it is necessary to consult an appropriate specialist and conduct pathogenetic therapy until the identified disorders are fully compensated. III-IV degree of vaginal purity is an indication for its sanitation.
The above studies can be performed on an outpatient basis before admission to the hospital. During a planned hysteroscopy, the doctor has enough time to psychologically prepare the patient, as well as to correct the identified pathological changes.
Before a planned hysteroscopy, the following procedures are carried out:
- Preparation of the gastrointestinal tract (a cleansing enema is given the day before the procedure, the examination is carried out on an empty stomach).
- Shaving the external genitalia.
- Emptying the bladder before the examination.
According to most foreign researchers, diagnostic hysteroscopy can be performed on an outpatient basis without anesthesia or under local anesthesia. According to some doctors, hysteroscopy can be performed on an outpatient basis if there is a one-day hospital and the possibility of emergency transfer of the patient to the hospital if necessary. When performing outpatient diagnostic hysteroscopy, a fibrohysteroscope can be used for examination, and gas can be used to expand the uterine cavity (Lin et al., 1990). The possibilities of performing outpatient hysteroscopy have expanded after the invention of microhysteroscopes with a diameter of 2.4 mm (outer body diameter of 3 mm).
Outpatient hysteroscopy is not performed on nulliparous, postmenopausal, or neurasthenic women. Some authors recommend that postmenopausal patients undergo a short course of estrogen therapy to prepare the cervix for hysteroscopy.
Estrogens are rarely prescribed for this purpose, since these drugs enhance proliferative processes in the reproductive organs, although it is unlikely that a short course of estrogens can cause endometrial hyperplasia.
The question of when to perform a planned diagnostic hysteroscopy remains debatable. Most surgeons prefer to perform a planned hysteroscopy, if possible, in the early proliferative phase (5-7th day of the menstrual cycle), when the endometrium is thin and its bleeding is minimal. It is undesirable to perform hysteroscopy in the second phase of the menstrual cycle, since inadequate contraception can disrupt the process of transporting the fertilized egg through the fallopian tube, which can lead to an ectopic pregnancy. Also, in the second phase, the thickened endometrium interferes with a full examination: pathological formations located in the myometrium can be missed. But there are situations when it is necessary to assess the condition of the endometrium during the secretory phase, in these cases, hysteroscopy is performed 3-5 days before the onset of menstruation. The condition of the uterine walls can be assessed during a control hysteroscopy after removal of the uterine mucosa.
The timing of hysteroscopy is not of fundamental importance during the peri- or postmenopausal period, as well as in emergency situations (for example, during bleeding).
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