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Hysteroscopy, Dilatation and Curettage (D&C),
Removal of cervical / endometrial polyps and fibroids
The purpose of this leaflet is to help women who are scheduled to have a Hysteroscopy and D&C understand the nature of the planned surgery. It also explains about the removal of both cervical and endometrial polyps. It is intended as a general guide and an individual's treatment will be tailored to their specific requirements. If you have any further questions, do not hesitate to ask myself or one of the nursing staff.
What is hysteroscopy?
This is a procedure in which a fine telescope is passed through the neck of the womb (cervix) in order to see the inside of the womb (uterus) The walls of the womb are then separated with fluid in order to obtain a good view. It takes about 10 minutes to perform.
What is a D&C?
D&C stands for Dilatation and Curettage. It is a procedure that is used to obtain a sample of the lining of the womb for examination by a pathologist. The cervix is opened up (dilated) and the lining of the womb is scraped with a fine spoon-like instrument known as a "Curette".
What is a polypectomy?
This means the removal of a polyp. A polyp is a glandular growth which is usually attached to the cervix ("cervical") or the inside of the womb ("endometrial") by a stalk. Polyps are usually benign ie. NOT cancer. They can be removed either by twisting them off, or by using a hot wire loop ("Resection").
What types of fibroids can be removed?
Fibroids that protrude into the cavity of the womb can often be removed using hysteroscopy, unless they are very large. Small fibroids can be removed without a significant effect on fertility but the removal of larger fibroids can reduce future fertility.
Why is hysteroscopy performed?
Hysteroscopy is performed to look for abnormalities of the lining of the womb. It is therefore usually performed to investigate heavy, prolonged or irregular periods, bleeding between periods or bleeding after the menopause.
What anaesthetic will I have?
Hysteroscopy can be performed under local or general anaesthesia. Depending on your circumstances, I will often recommend one or the other.
What are the risks of hysteroscopy?
A small hole is made in the womb (perforation) in about 1% of cases but observation in hospital overnight is all that is usually required. Occasionally a telescope (laparoscopy) may need to be inserted through the belly button to check for signs of internal injury.
Pelvic infection occurs after hysteroscopy in less than 1% of procedures. Significant bleeding is rare, the exception being when a large fibroid is removed. In 1-2% of cases it is not possible to insert the hysteroscope into the cavity of the uterus, usually because of previous surgery to the cervix or when a woman has not had vaginal births in the past. Serious complications of hysteroscopy are very rare.
What can I expect after surgery?
I will see you after the operation and explain my findings to you. All the procedures described above have similar after-effects. You will usually be able to go home on the same day. Minor lower abdominal discomfort should be expected and Paracetamol, Co-codamol or Ibuprofen are usually sufficient for pain relief. It is usual to have some bleeding which will be bright red at first but will change to brown after a few days. The bleeding can continue for up to 2 weeks and you should avoid tampons and sexual intercourse during this time. Your next period may be heavier or lighter than usual. Do not drive for 48 hours.
Diagnostic hysteroscopy under general anaesthesia. RCOG Consent Advice October 2004