Towards the middle of the menstrual cycle an egg is released from one of the ovaries. Hormones from the ovaries will have made the endometrium thicken, ready for a fertilised egg. If the egg is fertilised, it will stick firmly to the endometrium and develop into a baby in the uterus.
If the egg is not fertilised, the hormones change. This change makes the endometrium come away with some bleeding; this is a period. After a few days a new layer of thin endometrium forms. This starts to thicken, ready for the next possible fertilised egg.
After the menopause, the ovaries stop producing the hormones that control the menstrual cycle. The endometrium remains thin and the periods stop.
What has gone wrong?
Miscarriages and infertility can be caused when a fertilised egg cannot attach itself to the endometrium. Endometrial problems can prevent the egg from lodging in the uterus, where it would normally develop.
Before the menopause, heavy and painful periods often happen with a perfectly normal endometrium. We can treat this bleeding with an operation to destroy the endometrium without removing the uterus. Rarely, there is a disease of the endometrium, which needs a different treatment. We do a hysteroscopy before most gynaecology operations, to check that the endometrium is normal.
After the menopause, any bleeding or thickening of the endometrium is investigated, in case the endometrium has become malignant. Sometimes the ovaries start producing hormones for one or two cycles after the menopause. This can produce some period like bleeding.
The aim of the procedure is to check the state of your endometrium and to take small samples, called biopsies, for examination under the microscope.
We use a special narrow telescope called a hysteroscope to do the hysteroscopy. The hysteroscope is passed through the vagina and cervix, into the body of the uterus. There are no incisions. A biopsy will be taken from the endometrium if any abnormality is found. The procedure is often done in a hysteroscopy outpatient clinic; there is a separate leaflet covering hysteroscopy - outpatient. It is also possible to do a biopsy with you awake, but on occasions going to sleep with a general anaesthetic is used instead. This is usually carried out as a day case, although there is a chance you will need to stay in overnight, especially if any treatment is carried out at the same time.
The examination and tissue sampling should show us the exact condition of the endometrium. We can then plan the most appropriate and effective treatment.
Are there any alternatives?
There are several other tests that can be used to give us information about the state of the endometrium. These include:
Smear tests from the cervix.
A variety of scans, such as ultrasound, CT and MRI scans.
However, a hysteroscopy will give a direct view of the endometrium and the ability to take biopsies for further examination.
What if you do nothing?
If you do nothing we will probably not know the cause of your problems. The correct treatment may not be possible. Serious disease may be missed and any problems are likely to continue. You may miss out on important treatment.
Author: Dr David Hutchon F.R.C.O.G. Consultant Gynaecologist.
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