Diagnostic Hysteroscopy is performed to diagnose or exclude endometrial pathology – abnormalities of the womb lining. A small telescope camera is passed through the neck of the womb and an image of the inside of the womb is seen on a monitor. The procedure takes less than 10 minutes and allows Olivia to check for polyps, fibroids growing inside the womb, pre-cancerous or cancerous abnormalities. The camera is then removed and a biopsy sample of the womb lining is taken. If no abnormality is seen you may choose to have an IUS (hormone coil) fitted at the end of the procedure to help with problematic periods, as part of HRT or contraception if this is appropriate for you. If polyps or fibroids are found inside the womb, you will be offered a therapeutic hysteroscopy procedure to remove them. This is usually offered as a “see and treat” procedure where Olivia goes ahead with treatment if polyps or fibroids are found inside the womb cavity.
Daycase Hysteroscopic Procedures are ideal for women who have abnormal bleeding problems but don’t wish to have the inconvenience of needing to take too much time off work. Olivia has performed thousands of these since 2015 when they were introduced in the NHS and at Spire. You can choose to have your procedure under local anaesthetic; with or without sedation or under general anaesthetic.
Hysteroscopic Morcellation with Myosure is a safe, effective and fast way of removing polyps, fibroids or even directed biopsies under vision from inside the womb with only minimal discomfort. Polyps or submucous fibroids (where they bulge into the womb cavity) may contribute to or cause heavy painful periods, bleeding in between the periods or after the menopause. Removing them is likely to treat these problems. Removing the lesions also allows for analysis of the tissue fragments to check for pre-cancer and cancer within the lesions.
Olivia and her Ambulatory team at LGH
Endometrial Ablation is a highly effective way of managing heavy periods, particularly over the age of 40. It works by cauterising (burning) the womb lining thereby significantly reducing the heaviness of the periods or stopping them altogether. Success rates are over 90%. You must have completed your family as pregnancy following endometrial ablation is potentially very dangerous.
Ablation is not an appropriate choice for you if you have any risk factors for endometrial cancer or hyperplasia (for example past polyps or hyperplasia, obesity, genetic mutations which increase the risk of womb cancer (BRCA, Lynch Syndrome) as it may not be possible to access the womb cavity after the procedure. If you have fibroids that are larger than 3cm, endometriosis or you are suspected to have adenomyosis, ablation is not a good idea as it is likely that period pains will increase even if you have a good result in terms of the bleeding. 1 in 5 women experience new cyclical cramps. 1 in 10 women may need a hysterectomy after an ablation.
For these reasons, it is best to consider all alternative treatment options for heavy periods before undergoing an ablation. After an ablation – treatments are limited to hormone tablets, NSAIDs and tranexamic acid or Hysterectomy.