PATIENT RESOURCES
HYSTEROSCOPY
Hysteroscopy is performed as a short day procedure, under a general anaesthetic.
Diagnostic Hysteroscopy
A small (4mm) telescope, inserted gently via the cervical canal allows direct visualisation of the cavity of your womb.
Sterile saline is used to subtly inflate the uterus so that your doctor may understand its shape. Images are saved to help explain findings to you post-operatively.
The final stage of the procedure is a dilatation and curettage (D&C). Your cervix is gently dilated (typically to 8 or 9mm) and a sample of the endometrial lining is removed for assessment. Treatment of some minor abnormalities (for example removal of an endometrial polyp) may be performed at this time.
The ideal time to perform a hysteroscopy is soon after your menstrual period has ended, and prior your next ovulation. This timing corresponds to between days 5 and 10 of your menstrual cycle. Performing a hysteroscopy at this time maximises visual clarity and minimises the risk of affecting a pregnancy.
Operative Hysteroscopy
Operative hysteroscopy may be needed as a second stage procedure to correct more serious uterine abnormalities. Examples include very large endometrial polyps, a uterine septum, uterine adhesions, or sub-mucosal uterine fibroids.
Your cervix needs to be dilated to a greater degree (approximately 12mm) in order to accommodate a larger telescope. The type of fluid used is different (glycine). This is important because the operative hysteroscope instrument uses electrical energy to perform your procedure. Glycine is used because it does not conduct electricity. It is not safe to use more than a prescribed amount of glycine at a single procedure. If your operation is complex (i.e. very large fibroid) it may need to be completed in several stages.
Potential Risks of Hysteroscopy
The risk of a serious adverse outcome occurring during a hysteroscopy is very rare (<1% of treatments )
Hypothetical complications include:
Anaesthetic complications
Bleeding
Infection
Injury or perforation of the cervix or of the uterus. If this occurs, you may need to remain in hospital for observation or undergo surgical repair.
Adhesion formation within the uterine cavity following curettage (Asherman syndrome)
Glycine overdose (water intoxication)
Inability to remove an entire polyp/fibroid in one operation.
Pre operative instructions
Fasting: Our anaesthetist insists that you consume NO food OR drink, in the 6-hours prior to your procedure.
Pre-medication: For operative hysteroscopy, 400mg of misoprostol is prescribed to be inserted vaginally 2-4 hours before your procedure. This allows a more natural and gentle dilation of your cervix
Post operative care
Hysteroscopy is a relatively quick procedure to perform. You will be able to go home on the same day after review. When you have woken from your anaesthetic, you will be able to eat and drink normally.
We suggest in the first 48-hours after your procedure that you take Paracetamol (two 500mg tablets up to every 6 hours) and Ibuprofen (two 200mg tablets up to every 8 hours) to treat mild uterine cramping. It is normal to experience some cramping and a small amount of vaginal bleeding following a hysteroscopy. This is likely to resolve reasonably quickly.
To reduce the risk of infection, you should avoid intercourse and deep water baths until you have attended you review appointment. Review will usually be approximately 1-2 weeks from the date of your procedure.
A significant amount of post-operative pain, bleeding or suspicion of infection should prompt you to immediately contact Women’s Health Melbourne for further advice. If you require urgent advice or assistance after hours, contact the Royal Women’s Hospital (03 9835 2000).
LAPAROSCOPY
A Laparoscopy is a form of minimally invasive, small-incision gynaecological surgery, performed under a general anaesthetic. It involves two surgeons, your primary surgeon and an assistant. In many practices, the role of surgical assistant is performed by a junior doctor.
At Women’s Health Melbourne, your laparoscopy will be performed by two experienced gynaecologists, ensuring you receive the premium level of care. You will be introduced to the doctor who will be the assistant surgeon for your procedure.
Two small (5mm) incisions are made into the abdominal wall through which laparoscopic ports are inserted to reach the inner abdomen. The site of the first incision is usually at the umbilicus (belly button). The second incision is in the midline, cosmetically placed at the level of the pubic hair. The laparoscope and a secondary instrument access the abdomen and pelvis via these ports. Gas is used to inflate the abdomen – allowing surgeons to move instruments around the abdomen/pelvis with care and finesse. Under laparoscopic vision, your abdomen/pelvis is systematically examined. If pathology is found (e.g. endometriosis) 2 further incisions are usually required.
What is found will determine the action and the operating time required. In cases where unexpected pathology and extremely severe endometriosis (e.g. with bowel involvement) is diagnosed at laparoscopy, it may be necessary to plan treatment as a second stage procedure. Occasionally multi-disciplinary surgical collaboration is necessary (e.g. Advanced Laparoscopic Specialist Team and Bowel Surgeon or Urologist)
Operative Risks of Laparoscopy
Serious complications of laparoscopy are uncommon (<1% of cases)
Possible complications include:
Anaesthetic complications
Bleeding
Infection
Blood clots forming in the legs/lungs
Accidental injury to bladder, ureter (tube connecting kidneys and bladder), bowel or blood vessels
Conversion to open (large incision) surgery in the case of a significant complication occurring.
Inability to remove all of the pathology (e.g. fibroid or endometriosis) in one operation
Pre-operative instructions
Bowel Prep:
Where severe endometriosis is anticipated, a bowel preparation regimen is recommended. Picoprep can be purchased over-the-counter from your pharmacy.
On the day prior to surgery:
Clear fluids only (e.g. water, tea without milk, and soup broths)
Picoprep (1 sachet) at 1pm and
Picoprep (1 sachet) at 4pm
This regimen will cleanse the bowel prior to surgery. It is important to maintain hydration with clear fluids.
Fasting: Our anaesthetist insists that you consume NO food OR drink, in the 6-hours prior to your procedure.
Post operative care
Many women will be able to undergo laparoscopy as a day-stay surgical procedure and go home on the same day or the following morning after review.
After your procedure, shoulder-tip discomfort is common. This pain is referred and due to diaphragm irritation from the gas used to inflate the abdomen. General abdominal tenderness for 3 to 7 days post-operatively is common (especially at the incision sites).
We suggest in the first 72-hours after your procedure that you take Paracetamol (two 500mg tablets up to every 6 hours) and Ibuprofen (two 200mg tablets up to every 8 hours). A prescription for stronger pain relief tablets will be given – take these as required.
A fibre supplement (e.g. Metamucil) should be used whilst taking pain relief medication as constipation is a common side effect.
To reduce the risk of infection, you should avoid intercourse and deep water baths until you have attended you review appointment. Review will usually be approximately 1-2 weeks from the date of your procedure.
In most cases sutures will dissolve and do not need to be removed.
Return to work
You will be provided with a medical certificate for 2 weeks. Some women feel ready to return to work after 1 week. How ready you feel will depend on factors including your work role and the extent of your surgery.
It is normal to experience some cramping and a small amount of vaginal bleeding following a laparoscopy. This is likely to resolve reasonably quickly.
A significant amount of post-operative pain, bleeding or suspicion of infection should prompt you to immediately contact Women’s Health Melbourne for further advice. If you require urgent advice or assistance after hours, contact the Royal Women’s Hospital (03 9835 2000).
EMERGENCY CONTRACEPTION
Unprotected intercourse can result in unplanned pregnancy. The risk of pregnancy is highest close to the time of your ovulation.
Emergency contraception is a backup method for preventing pregnancy after unprotected intercourse. It is designed to be a one-time emergency treatment.
Important questions:
When was the first day of your last menstrual period?
When was the exact date and time of unprotected intercourse?
Emergency Contraception Treatment Options
The morning after pill:
Can be used up to 72 hours after unprotected intercourse
Contains the progestagen Levonorgestrel (1.5mg)
Can be taken as a single dose
Available over the counter from Australian pharmacies (prescription not needed)
Ulipristal acetate (an alternative to Levonorgestrel) is not yet available in Australia.
Copper IUD (Intra-Uterine Device)
Can be used within 5 days (120 hours) of unprotected intercourse.
When emergency contraception should be used
You have had unprotected intercourse and do not use any regular contraception
You forgot to use your regular contraception (condom, pill, vaginal ring)
Your partner’s condom was used incorrectly or broke while you were having intercourse.
How emergency contraception works
The morning after pill works by giving a strong short burst of hormones to prevent ovulation (the time in your cycle you are most likely to become pregnant).
The copper IUD works by preventing fertilization/ implantation. If left in the uterus, it will continue to protect against pregnancy for 10 years or until removed.
You should have your next period within 2 to 4 weeks of using emergency contraception. If you skip your period, contact Dr Raelia Lew or your GP.
Safety
Emergency contraception is safe and does not cause birth defects or affect the health of future pregnancies
Side effects
Usually well tolerated
Can cause nausea and irregular bleeding
Regular Contraception
If you have become sexually active and are not planning a pregnancy, you should consult either Dr Raelia Lew or your GP to discuss a reliable form of regular contraception.