You may need a hysteroscopy or laparoscopy to further investigate the possible causes of your problem. A ‘diagnostic’ hysteroscopy (hystero = uterus or womb, oscopy = to look) is used to investigate problem bleeding. An ‘operative’ hysteroscopy is used to treat problems afecting the endometrium e.g. endometrial growths or polyps, fibroids that grow in the middle of the womb (submucous are subendometrial)
In this procedure, a small, fibre-optic ‘telescope’ is used to see the internal organs. The small fibreoptic telecope passes through the cervix, so your abdomen (tummy) does not have to be opened. The lining of the uterus (the endometrium), which is the likely cause of your bleeding, can be examined and a biopsy (small piece of tissue) sent to the laboratory for further investigation under the microcope. A larger scope with operating attachments can be used to remove polyps or fibroids.
A hysteroscopy is usually performed under local or general anaesthetic as a day-case procedure and takes 15-20 minutes. No incision is made. Patients usually recover from hysteroscopy rapidly.
In addition to diagnostic hysteroscopy we can use a hysteroscope to remove fibroids (link) that are in the middle of the womb (transcervical resection of fibroids), as well as removing or ablating the endometrium (transcervical resection or ablation of the endometrium). This can be combined with the insertion of a Mirena IUS and is a minimal access solution to problem bleeding that often helps a woman avoid a hysterectomy.
Complications include bleeding and occasionally infection, which can be treated. If after the operation you have more pain and bleeding than you would expect, or if you have a fever, contact your doctor. Serious complications, e.g. perforation of the womb are uncommon and if dealt with at the time do not usually have any long term problems.