A hysteroscopy is a procedure that allows a gynaecologist to look inside the uterus. It involves passing a hysteroscope which is a thin telescopic instrument with a light attached to the end, through the vagina and cervix and into the uterus. The tiny hysteroscope conveys an image to a video monitor to assist in diagnosis and/or treatment of gynaecological problems.
A diagnostic hysteroscopy may used to investigate any of the following conditions:
Once a diagnosis has been made, a gynaecologist can use the hysteroscope to treat certain conditions. This is known as an operative hysteroscopy. Fine instruments can be inserted through channels in the hysteroscope and used to:
HOW DO I CHOOSE A SPECIALIST?
Your GP, or the doctor you first consulted, will be able to recommend and refer you to a Gynaecological surgeon who can perform the procedure.
You may be happy to accept the advice of your GP with regard to a specialist, or you may like to investigate your choices; either option is safe and valid. In Australia each medical speciality has a governing body to which the consultants belong. These are often good organisations to turn to for information about what you can expect from your medical specialist. You can access the Royal Australian College of Surgeons via their website at http://www.surgeons.org/
The list of questions below may help you to better understand your treatment, and if necessary decide on a particular doctor. Practical issues you may also like to consider are what hospital(s) does a particular doctor operate from, and what are their fees. (If you need more information about fee setting and gap arrangements, please refer to our brochure “what you should know before going into hospital”, which is also available on the HCF website).
To access a list of Gynaecological surgeons who participate in HCF’s Medicover no gap arrangement:
Please note: Participation in HCF’s no gap initiatives is at the doctor’s discretion. HCF does not guarantee that every medical service provided by these doctors will be a no gap service. Some doctors who participate in the HCF Medicover No Gap arrangement have chosen not to be listed on the HCF website. Patients are encouraged to confirm with their doctor whether they will support HCF’s no gap initiatives for their treatment.
WHAT SHOULD I ASK MY SPECIALIST?
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Make sure you fully understand the procedure that is planned; do not be afraid to ask. It is your right to know all the relevant information, as this is part of informed clinical consent. Your doctor will ask you to sign a consent form.
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In addition to what the procedure entails, you should also ask about:
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Any alternative treatments worth considering
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Preparation necessary for the procedure
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Expected benefits
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Any risks associated with the procedure
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Further treatment and follow up appointments - jot down any questions or concerns so that you can ask your doctor at your next appointment
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Most medication should be continued as usual, but some may interfere with the operation. Your doctor will inform you of the medication you should stop. As a guide, the following medication may require special instruction:
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Aspirin (or any related products)
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Blood thinners (Warfarin, heparin)
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Arthritis medication
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Insulin
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Arthritis medication
Don’t forget to mention any homeopathic or herbal remedies you are taking, as these can have interactions and side effects too.
WHERE IS IT DONE?
Occasionally a doctor might perform a simple diagnostic hysteroscopy in his rooms or the outpatients department but it is more commonly performed in a hospital, stand alone day surgery or the day surgery unit of an overnight hospital. Any type of operative hysteroscopy is done under a general anaesthetic so this would always be done in hospital.
HOW LONG IS THE PROCEDURE?
It usually takes between 10-60 minutes to perform a hysteroscopy.
WHO IS INVOLVED?
The people involved in the procedure are:
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The Gynaecologist, your Specialist doctor
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Anaesthetist: they administer the anaesthetic, and look after you whilst the procedure is being carried out
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Nurses for the procedure and recovery
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Pathologist if any blood tests are necessary
HOW DO I PREPARE FOR A HYSTEROSCOPY?
A hysteroscopy needs to be done at a time when you are not menstruating. It is very rarely performed on a pregnant woman.
If you are a smoker and you cannot give up completely, try to avoid smoking in the weeks leading up to the operation. This may help to avoid post-operative complications such as chest infection.
You will normally be required to fast for 8 hours prior to the procedure but your doctor will have his/her own specific preparation requirements. These instructions should be strictly followed.
WHAT DO I TAKE WITH ME TO THE DAY SURGERY/HOSPITAL?
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Bring any recent, relevant x-rays or scans
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Do not bring any valuables with you
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Leave all jewellery at home (sometimes a plain band on your finger is acceptable)
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Wear comfortable clothing
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Bring any medication that you would usually take during the day, under most circumstances you may still be able to take these
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Remove all nail polish and do not wear any make-up
2. Costs and Charges
WHAT IS IT GOING TO COST?
Ask your doctor whether he will participate in HCF’s no gap arrangement for your surgery so that you do not incur any out of pocket expense. If your doctor does not wish to participate, it is your doctor’s responsibility to fully inform you of your financial liability and any out of pocket expense prior to you consenting to the surgery.
For your information, the average charges for claims paid for Hysteroscopic Procedure admissions for the financial year 06/07 are provided below:
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On Average
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Charge
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Medicare Pays
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HCF Pays
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3
If your doctor DOES NOT use HCF’s No Gap Arrangement YOU PAY
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% of all admissions where your doctor DOES NOT use HCF’s No Gap Arrangement
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4
If your doctor USES HCF’s No Gap Arrangement YOU PAY
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% of all admissions where your doctor USES HCF’s No Gap Arrangement
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Total Average Hospital Component (accommodation, theatre and hospital related services)
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$881
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$880
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1
Medical Services Component
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Anaesthetic Services
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$320
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$115
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$38
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$215
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54.5%
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$0
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45.5%
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Gynaecological Surgical Services
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$384
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$143
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$48
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$309
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47.6%
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$0
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52.4%
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Pathology Services
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$137
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$88
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$29
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$37
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7.0%
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$0
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93.0%
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2
Total Average Medical Services
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$791
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$320
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$107
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$398
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64.7%
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$0
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35.3%
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Hospital and Medical Services Average for
Hysteroscopic Procedure Admissions
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$1,672
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$320
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$987
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$398
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64.7%
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$0
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5
35.3%
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Points to Note:
- Charges are based on HCF claims for a sample size of 1,652 same day admissions in participating day surgeries or private participating hospitals (day surgeries/private hospitals that have an agreement with HCF for accommodation, theatre and hospital related services) – covered under Medicare items 35630 and 35633.
- As a private patient in a non-participating hospital you may incur an out of pocket expense for the hospital component (accommodation, theatre and hospital related services).
- There is no excess payable for same day admissions.
1 These medical services are in-patient services only.
2 The medical charges are based on averages and each episode of care is different, i.e. you may not have all of these medical services, and/or you may also have other medical services not indicated here e.g. specialist consultations. Therefore, the total average medical service charge ($791) differs from the sum of the individual average charges as shown.
3 Doctors who do not use the HCF no-gap arrangement have a higher average out of pocket charge, as their charges are higher than those doctors who use the no-gap arrangement and incur nil out of pocket charges to the patient. Therefore, the sum of the average benefits plus the average out of pocket charge you pay will not equate to the charge as shown in the table.
4 Doctors’ charges vary so always ask your doctor whether he/she will participate in HCF’s No Gap Arrangements.
HCF Medicover Schedule of Benefits lists all services for extra benefit in excess of the Commonwealth Medicare Benefits Schedule (CMBS) fee, which providers, registered under the HCF Medicover No Gap arrangement will receive as full payment for services provided. This also applies to unregistered providers should they charge within the schedule of benefit listed. This arrangement ensures that our members incur no out of pocket expense.
5 This percentage indicates the total coverage of hospital and medical services for all hysteroscopic procedure admissions. The percentages shown for each type of medical service are much higher as they are calculated for those services only and not the entire admission, which includes all medical services and the hospital services. In an admission you may have one medical service with an out of pocket expense, which then excludes the whole admission from being fully covered. Hence the significant difference in percentage for individual types of medical services as compared to the total admission fully covered.
2. Day of procedure
WHAT HAPPENS TO ME AT THE DAY SURGERY/HOSPITAL?
When you arrive at the day surgery or hospital, the admissions clerk will attend to the associated paperwork.
On admission a nurse will perform some basic observations and tests, request your medical history, and check your current medication (including herbal and homeopathic medicines) and any known allergies.
Your gynaecologist should have fully explained the procedure, including the associated risks and benefits, prior to your admission to hospital. Generally at this time he or she would have asked you to sign a consent form giving your permission for the procedure to be carried out. However, if the consent form has not already been done, your surgeon should attend to this before you enter the operating theatre.
An anaesthetist will visit you prior to your operation to discuss your anaesthetic.
WHAT CAN I EXPECT DURING A HYSTEROSCOPY?
Once in the anaesthetic bay of the operating theatre, a small plastic tube called a cannula will be placed into a vein in your arm or hand. The cannula is used to administer intravenous sedation, which is the first stage of your general anaesthetic. Once the anaesthetic has taken effect, you will be moved into the operating theatre.
You will be placed on the operating table on your back with your legs spread apart and your feet and knees supported in stirrups.
Before the procedure begins, your vulva will be cleansed using an antiseptic solution. A speculum, which is a metal instrument used to keep the vaginal walls apart, is inserted so that there is a clear view of the cervix. The canal of the cervix is gently stretched open allowing the hysteroscope to be inserted. Saline or carbon dioxide gas may be injected via the hysteroscope to expand the inside of the uterus as the walls of the uterus normally sit together.
A video monitor is used so that the surgeon can examine the uterus to see if there are any abnormalities.
If abnormalities are found or already known to be present, your surgeon may do an operative hysteroscopy. This is done by passing surgical instruments through the fine channels inside the hysteroscope and using either very small scissors or diathermy (electrical current) to remove any abnormal growths. If needed, a biopsy of the uterus lining can be taken and sent to a pathologist for examination.
3. Aftercare
WHAT HAPPENS AFTER A HYSTEROSCOPY?
In the recovery room, nursing staff will monitor your vital signs such as blood pressure, pulse and temperature until you have recovered fully from the anaesthetic. When you first wake you will be receiving supplemental oxygen via a face mask or nasal prongs (small plastic tubes inserted into your nostrils). You may still have a drip attached although this will be removed very quickly.
Once fully awake you will be able to eat and drink normally. You should be able to go home the same day if there are no complications, although the nursing staff will encourage you to have something to eat and drink, walk around and pass urine before you are discharged. You won’t be able to drive yourself home so you need to arrange for someone to pick you up and accompany you home. If this is difficult, please advise your doctor or hospital prior to admission.
It is quite normal to experience mild abdominal discomfort for 24 hours following the hysteroscopy. You may also have light vaginal bleeding which can last up to five days. Sometimes people experience shoulder tip pain which is referred pain caused by the gas used to inflate the uterus.
Before discharge, you should be given specific instructions from either your specialist or the nurses looking after you about what to expect over the next couple of days, and when and how to seek additional help if needed. Generally you should seek medical attention if you experience the following symptoms: