Hysteroscopy with curettage: technological progress for a better treatment

Hysteroscopy makes curettage much less invasive, thus improving the procedure and reducing subsequent discomfort.

Curettage, a commonly used procedure to remove tissue from inside the uterus, can be a traumatic experience for many women due to its invasiveness and potential physical and emotional side effects. However, hysteroscopy can be presented as a beneficial alternative to this practice. Hysteroscopy is a minimally invasive technique that allows visualization and treatment of uterine problems by inserting a hysteroscope through the cervix.

Taking advantage of the latest technological advances in this field, Instituto Bernabeu stands out for its advanced application of hysteroscopy. The highly trained medical teams and cutting-edge technologies allow for accurate visualization and assessment of the uterine cavity, which makes the diagnosis of various conditions and personalized treatments planning easier. This combination of medical expertise and cutting-edge technology makes Instituto Bernabeu a referent in the use of hysteroscopy, providing patients with a safer and more effective option to address gynaecological problems.

Differences between conventional curettage and with hysteroscopy

Traditional curettage and hysteroscopy are two different procedures used to remove tissue from inside the uterus, but they differ in several important ways:

1. Invasiveness: Conventional curettage is an invasive procedure involving the removal of uterine tissue by dilating the cervix and scraping the uterine cavity with a curette. Hysteroscopy, on the other hand, is less invasive and is performed by inserting a thin hysteroscope through the cervix, allowing visualisation and treatment of problems within the uterine cavity without the need for excessive dilation.
2. Complications: Traditional curettage may carry higher complications risk, such as infection, damage to the uterus or excessive bleeding due to the procedure’s invasive nature. Hysteroscopy, being less invasive, has a lower risk of serious complications.
3. Recovery: Recovery after conventional curettage may take longer as the procedure is more invasive. Patients may experience abdominal pain, bleeding and discomfort for several days. In contrast, hysteroscopy generally has a faster recovery, with less post-procedure pain and discomfort.
4. Diagnosis and treatment: Hysteroscopy allow, not only the removal of uterine tissue, but also direct visualisation of uterine cavity. This makes it a useful tool for both diagnosis and treatment for uterine conditions such as polyps, fibroids, uterine septa or adhesions. Traditional curettage focuses primarily on tissue removal and has a more limited focus on diagnosis.

In summary, while conventional curettage is an invasive procedure to remove uterine tissue, hysteroscopy is a less invasive technique that allows more accurate visualisation and treatments of problems within the uterine cavity. Hysteroscopy offers advantages such as less invasiveness, complications lower risk, faster recovery and the simultaneous diagnosis and treatment possibility.

Hysteroscopy or curettage use cases

Hysteroscopy and curettage are procedures used on different gynaecological conditions. The following are some common situations in which these techniques can be applied:

Hysteroscopy:

1. Diagnosis of uterine abnormalities: Hysteroscopy is used to evaluate and diagnose various abnormalities in the uterine cavity, such as polyps, fibroids, uterine septa, adhesions or uterine malformations.
2. Abnormal uterine bleeding: When a woman has abnormal uterine bleeding, hysteroscopy can help determine the underlying cause, such as polyps, fibroids, endometrial hyperplasia or uterine cancer.
3. Infertility: Hysteroscopy is used in infertility cases to investigate and treat problems within the uterine cavity affecting embryo implantation, such as polyps, adhesions or uterine septa.
4. Removal of polyps or fibroids: Hysteroscopy allows the removal of uterine polyps or small fibroids located inside the uterine cavity.
5. Miscarriage: In case of incomplete miscarriage, where not all gestational tissue is expelled, hysteroscopy can be performed to visualise the tissue and take directed biopsies.

Curettage:

1. Miscarriage: In case of incomplete miscarriage, where not all gestational tissue is expelled, Curettage can be performed to remove all remaining tissues.
2. Retained placenta: If after delivery or abortion, part of the placenta or foetal tissue remains in the uterus, curettage may be necessary to remove it and prevent infection or haemorrhage.
3. Uterine tissue evaluation:  Curettage is performed to obtain a uterine lining (endometrium) tissue sample in case of abnormal bleeding, suspected endometrial hyperplasia or uterine cancer, for histopathological analysis.

Benefits of hysteroscopy over curettage

Hysteroscopy has several benefits over conventional curettage:

1. Less invasive: Hysteroscopy is a less invasive procedure compared to curettage. It is performed by inserting a thin hysteroscope through the cervix, which minimizes the need to dilate it and reduces the amount of removed tissue.
2. Lower complication risk: Hysteroscopy has a lower complication risk compared to conventional curettage. Because it is less invasive, it decreases the risk of infection, damage to the uterus, excessive bleeding, or other complications associated with more invasive procedures.
3. Faster recovery: After hysteroscopy, recovery is usually faster compared to conventional curettage. Hospitalisation times are shorter, and patients experience less post-procedure pain and discomfort.
4. Combined diagnosis and treatment: Hysteroscopy enables direct visualisation of the uterine cavity, which facilitates both diagnosis and treatment of different uterine conditions. In a single procedure, polyps, fibroids, uterine septa, adhesions or other abnormalities can be identified and treated.
5. Uterine tissue preservation: Hysteroscopy preserves most of the uterine tissue, as it focuses on selective removal of specific areas of interest. This is especially important in cases where fertility preservation is desired.

It is very important to keep in mind that each case is unique and that the choice between hysteroscopy and curettage will depend on each patient’s clinical situation, symptoms and individual needs. The physician will carefully assess the situation and recommend the most appropriate approach in each specific case.

Preparation previous treatment

1. Medical assessment: Prior to hysterogram, a complete medical evaluation will be performed, which may include a medical history review, physical examination and additional diagnostic tests.
2. Information and informed consent: The doctor will explain the hystero-curettage in detail, including risks, benefits and alternatives. The patient will be given an informed consent form t oread and sign before undergoing treatment.
3. Medication and allergies: Patient will be asked about any current intake of medication, including anticoagulants or other medications that may affect the procedure. Possible allergies to medications or material used during the hystero-curettage will also be assessed.
4. Cervix preparation: In some cases, it may be necessary to dilate the cervix prior to the procedure. This can be achieved by using cervical dilators or by applying local medication to facilitate access to the uterus during hysteroscopy. 
5. Fasting: Clear instructions about fasting will be given prior to the procedure, which usually includes not eating or drinking anything for several hours before the hystero-curettage to minimise the anaesthesia risks.

What to expect during treatment

During the hystero-curettage treatment, it is important to keep in mind that each case may be unique and experiences may vary.

But it is generally considered a relatively short procedure. After treatment, you will be allowed to rest and recover before receiving instructions on post-operative care and possible side-effects.

What to expect after treatment

After hystero-curettage, you may experience some common side effects and discomfort. Here are some effects you can expect during recovery period:

1. Vaginal bleeding and discharge: It is normal to experience some vaginal bleeding or discharge during the first few days after procedure. It may vary in amount and duration, but should generally decrease gradually. If you experience excessive or persistent bleeding, or if you have concerns, it is important to inform your doctor.
2. Pain and discomfort: You may feel some degree of pain or discomfort in the pelvic area after treatment. This may include mild cramping, bloating, or menstrual-like discomfort. If pain is severe or does not improve, it is important to tell your doctor.
3. Rest and physical activity: Your doctor may recommend you to rest for the first few hours after procedure is done. After that, you can gradually resume your normal daily activities. However, avoid intense physical activity or heavy lifting for a period of time, as directed by your doctor.
4. Cervix care: After hystero-curettage, your doctor may recommend you to avoid sexual intercourse, tampons, or douching for a specific period of time. This helps to allow the cervix’s proper healing and prevent infection.
5. Results and follow-ups: Depending on the intervention’s specific reason, results and follow-ups may vary. Your doctor will provide you with information about the procedure’s results and any further action that may be necessary, such as follow-ups, testing, additional treatment, or further consultations.

Frequently asked questions

Does the hysteroscopy process hurt?

No, generally you will not experience pain during a hysteroscopy with curettage performed under general anaesthesia. During procedure, you will be completely insensitive to pain.

Under general anaesthesia, you will be completely asleep and unaware of what is happening. General anaesthesia is administered through an intravenous line and allows you to be completely unconscious during hysteroscopy with curettage.

This helps to reduce any discomfort or pain during procedure.

Anaesthesia’s aim is to ensure you are comfortable and pain-free during procedure. The medical team will be constantly monitoring your vital signs and making sure you are well throughout the procedure.

It is important to keep in mind that everyone is different and response to anaesthesia may vary. Some women may experience mild discomfort or uncomfortable sensations after anaesthesia wears off. However, this is temporary and can be controlled with painkillers.

How many resting days are necessary after surgical hysteroscopy?

The number of resting days required after a surgical hysteroscopy may vary depending on several factors, including the procedure’s nature, the individual patient’s response, and the physician’s specific recommendations.

In general, a resting period of 1-2 days is recommended after surgical hysteroscopy. During this time, you may be advised to avoid intense physical activity, heavy lifting and sexual intercourse.

What is the estimated sick-leave period for hysteroscopy?

In general, for a diagnostic hysteroscopy or minor surgical procedure, time off work is estimated to be 1-3 days.

However, in the case of more extensive surgical hysteroscopies or procedures that require a longer recovery, a longer time off work period may be required. This can range from few days to a week or two, depending on the procedure’s nature and the physician’s recommendations.

Dr Paolo Cirillo, ginecólogo en Instituto Bernabeu