A hysteroscopy looks inside your womb using a narrow telescope with a light and camera at the end, called a hysteroscope. It’s passed through your vagina and cervix into your womb so you won’t have any incisions.
A hysteroscopy investigates many gynaecological symptoms including: heavy periods, bleeding - unusual or postmenopausal, pelvic pain, recurrent miscarriages or if you’re having difficulty conceiving.
Fibroids and polyps can be diagnosed using a hysteroscope. It can also be used to treat gynaecological conditions such as removing fibroids, polyps, displaced intrauterine devices (IUDs) and scar tissue that can cause absent periods and reduced fertility.
Laparoscopy is keyhole or minimally invasive surgery. It has a number of advantages over open surgery and therefore is used whenever appropriate. These include: a faster recovery time and shorter hospital stay, less side effects such as pain, bleeding and scarring.
Diagnostic laparoscopy is used to see inside your abdomen and pelvis and to take biopsies. It can diagnose endometriosis and investigate cancer. A small tube with a camera and light source, called a laparoscope, is inserted through small incisions in your skin. Images are sent to a television monitor for your surgeon to see.
A laparoscopy can also be used to treat problems in this area including: endometriosis, remove scar tissue, ectopic pregnancy, female sterilisation, remove an ovarian cyst, treat fibroids, remove lymph nodes in cancer treatment and remove the womb or ovaries. It’s usually performed under general anaesthetic.
Anterior vaginal wall repair
Anterior vaginal wall repair is a surgical operation to restore a sinking vaginal wall, known as a prolapse. It’s performed under general or spinal anaesthetic and usually takes around half an hour.
Symptoms of a vaginal wall prolapse include: unable to empty your bladder fully, full feeling bladder all the time, vaginal pressure, bulging at the opening of your vagina, urine leakage when coughing, sneezing or lifting, pain when having sex, and bladder infections.
During the procedure your surgeon moves your vagina back into its correct position, tightens bladder supporting and removes any bulge in your vagina.
Endometriosis is a common condition where cells of the uterine lining are found outside the womb, often on organs in the abdomen and pelvis.
Common symptoms include: pelvic pain, pain during sexual intercourse, painful periods, heavy irregular periods and infertility.
The definitive way to diagnose endometriosis is by a laparoscopy. This allows your surgeon to see any endometriosis tissue. A biopsy sample may be taken for laboratory testing. Endometriosis can be excised or ablated (with diathermy or laser). If you’ve very severe endometriosis a laparotomy (a larger incision on the abdomen) may be advised.
A hysterectomy surgically removes a woman’s womb. This means that following a hysterectomy a woman cannot become pregnant so it’s normally the last treatment option if others are unsuccessful.
A hysterectomy treats: heavy periods, chronic pelvic pain, non-cancerous tumours called fibroids, prolapse of the uterus or cancer of the womb, ovaries or cervix.
There are many types of hysterectomy including: radical hysterectomy (the womb, cervix and ovaries are removed), total hysterectomy (most commonly performed - the womb and cervix are removed) and subtotal or partial hysterectomy (the upper part of the womb is removed and the cervix and ovaries are left in place).
There are several ways a hysterectomy can be performed:
vaginal hysterectomy – performed entirely through an incision made in the vagina under general, spinal or local anaesthetic. There are no visible scars.
laparoscopic hysterectomy – tiny incisions usually in the abdomen and vagina allow laparoscope and instruments to be inserted. Uses minimally invasive surgery under general anaesthetic. It’s often the preferred choice.
abdominal hysterectomy – an incision is made in the lower abdomen under general anaesthetic
Your consultant gynaecologist will discuss the options with you.
Ovarian cyst removal
Ovarian cysts are fluid-filled sacs that develop in or on the surface of a woman’s ovary. They are very common before the menopause. Many don’t cause any symptoms so you may only find out you have one if you’re having other tests. If an ovarian cyst is small and not causing any symptoms they are normally left and often they disappear on their own within a few months. If an ovarian cyst is large and causing symptoms your gynaecologist will normally recommend its surgical removal.
Ovarian cyst removal is carried out either by laparoscopy or laparotomy. Most cysts are removed using laparoscopy. A large or potentially cancerous cyst may be removed using laparotomy. This involves making a single larger incision in the abdomen and allows better access to the cyst so that the whole cyst and ovary may be removed and sent to a laboratory to check if it’s cancerous.
Removal of ovaries
The ovaries are almond shaped organs found above the uterus and house your eggs. An oophorectomy, or the removal of ovaries, is carried out if the ovaries are damaged or to treat ovarian cancer or endometriosis.
The ovaries can be removed simply either laparoscopically or using open surgery under general anaesthetic. An oophorectomy can be performed on its own or as part of a hysterectomy.
One or both ovaries can be removed. If just one ovary is removed menstruation may continue and you can have children but if both ovaries are taken away, then menstruation stops and you can no longer have children.
Laparoscopic sterilisation is a permanent method of female contraception. It blocks or seals the fallopian tubes that connect the ovaries to the womb. The eggs therefore cannot reach the sperm to become fertilised. They are still released from the ovaries but they’re naturally absorbed into the woman's body.
Laparoscopic sterilisation is the most common method of female sterilisation. Clips, rings or tying and cutting the fallopian tubes are methods to block them.
Sometimes hysteroscopic sterilisation is performed. This involves inserting a tiny piece of titanium into the fallopian tubes using a hysteroscope. This then causes scar tissue to form around the fallopian tube which blocks the tube.
Hormone replacement therapy (HRT) replaces hormones that are at a lower level as you approach the menopause. The menopause is described as when a woman permanently stops having periods and she can no longer get pregnant.
HRT can relieve symptoms of the menopause such as: hot flushes, mood swings, night sweats, vaginal dryness and a reduced sex drive.
Treatment for miscarriage
A miscarriage is defined as the loss of a pregnancy in the first 23 weeks. Many miscarriages are brought about because of abnormal chromosomes in the baby that mean the baby won't develop properly. Miscarriage can be very distressing but most women do go on to have a successful pregnancy in the future.
After a miscarriage, pregnancy tissue can be left in the womb. It will naturally pass out of the womb over time or it can be removed earlier by taking medication that will cause the tissue to pass or by surgery.
Stress incontinence treatment
Stress incontinence is when your bladder leaks urine during physical activity, when you sneeze, cough, change position or lift something heavy. It’s caused when the pelvic floor or sphincter muscles become weakened.
Behavioural changes, pelvic floor muscle exercises and medicines are normally the first line of treatment. Surgery is recommended if these have no success.
Surgical options for stress incontinence include: tape procedures (women only - tape holds up the urethra in the correct position), sling procedures (a sling is used to support the bladder neck and urethra), colposuspension (women only – laparoscopic or open surgery to lift the tissues between your bladder and urethra) and artificial urinary sphincter (replacement urinary sphincter).