Irregular Menstrual Bleeding? A Hysteroscopic Polypectomy May Be the Solution
By: Dr Jeff Livingston
Tags: Womens Health, Women, Health, Surgery, Menstruation

Irregular Menstrual Bleeding? A Hysteroscopic Polypectomy May Be the Solution

Endometrial polyps are a common cause of abnormal uterine bleeding

Getting prepared for surgery can be scary. Learning about an upcoming procedure alleviates fear and anxiety. Let’s talk about endometrial polyps and how to fix them with a hysteroscopic polypectomy. We will answer questions about how long the procedure will last, what’s involved, what to expect, and even advice on packing your bag.

While your surgeon preps, we’ll make sure you’re ready.

What are endometrial polyps?

Everyone has heard of colon polyps. Your father probably showed you pictures after his recent colonoscopy. #TMI. Polyps are small finger-like tissue growths that appear on any mucosal surface in our bodies. The colon is one common spot, but polyps can grow anywhere, like the nasal cavity, cervix, and inside the uterus in the endometrial cavity.

Endometrial polyps are small overgrowths of tissue hanging inside the cavity of the uterus. The vast majority are benign, but in rare, cases polyps can be cancerous.

Polyps are most common in women age 20–40 but also contribute to postmenopausal bleeding. Fortunately, most polyps are noncancerous, but they can cause frustrating bleeding between periods, during exercise, and after sex.

Endometrial polyps can be found on a transvaginal sonogram, a hysteroscopy, or a specialized sonogram called a saline-infused sonogram.

Many women have endometrial polyps without having symptoms (asymptomatic). Others suffer from irregular menstrual bleeding and spotting.

What is a hysteroscopic polypectomy?

Hysteroscopy is a simple procedure where a doctor uses a small camera called a hysteroscope to evaluate the inside of the uterine cavity. During a hysteroscopy, a surgeon can remove uterine fibroids ( myomectomy) and polyps (polypectomy) without cutting or removing any part of the uterus.

A hysteroscopic polypectomy combines the visualization of hysteroscopy with a cutting device to remove the polyps without making any incisions on your body.

Your cervix will be slightly dilated to allow the introduction of the camera into the uterus. The gynecologist confirms proper placement and evaluates the polyp to identify its attachment to the uterus. A resection instrument is chosen and placed down the operative channel to allow surgical removal.

How long will I be in the hospital?

Hysteroscopic polypectomies are outpatient procedures. You may go home as soon as the procedure is complete if performed in the office setting. If the procedure is done under general anesthesia, you may go home when you have completed the postoperative recovery.

Can my family visit me?

Some hysteroscopic procedures can be performed in a medical office setting. Other hysteroscopic procedures are done in a hospital or Ambulatory Surgery Center. A trusted family member should drive you to and from the appointment. Your family is welcome to stay with you before and after this outpatient procedure

Does my procedure require an anesthetic?

Anesthesia is required for a hysteroscopic polypectomy procedure. The anesthesia type will vary depending on the surgical setting, the surgeon’s experience, and office equipment availability.

Oral sedation, paracervical block, IV sedation, and general anesthesia are all potential anesthetic options.

What’s the procedure when I check-in?

Most surgeries will involve a preoperative visit with your surgeon to go over the procedure’s risks and benefits in detail. Your surgeon answers questions regarding your upcoming surgery. The surgical consent form is reviewed, signed, or updated with any changes.

In most settings, patients will receive a preoperative phone call by a nurse or medical assistant one to two days before surgery. If any blood work or preoperative testing is required, it will be scheduled and confirmed.

If the hysteroscopic procedure is being performed in an office setting, the process may feel like a normal office visit.

For hospital or ambulatory surgery center based procedures, the staff will guide you to the preoperative holding area to change into a surgical gown and store your valuables. You will meet the nursing team who will provide care during your stay. An IV will be placed at this time. The anesthesia team will come to interview you and answer questions. Typically your surgeon will also come and review any last-minute question.

What happens in the operating room?

After the preoperative evaluation, the team will guide you to the operating or procedure room. You will move from the mobile bed to the operating table. Once you are positioned comfortably and safely, the anesthesiologist will give you medication through your IV.

The OR nursing team will cover your body with sterile drapes and prep the vagina for surgical sterility. The team then performs a “surgical time-out.” A surgical safety checklist is read out loud, requiring all surgical team members to be present and attentive.

The surgeon then performs the surgical procedure.

Once the procedure is complete. A post-procedure review is done together as a surgical team. All instruments and equipment are counted and verified. When finished, the anesthesiologist will begin to assist the patient in waking up for transfer to the recovery room.

How long will I be in the operating room?

Multiple medical device technologies can be used to perform a hysteroscopic polypectomy. Gynecologic surgeons typically have a personal preference or comfort level with one or more of the various options. Each medical device works by combining the visualization of hysteroscopy with a cutting device to remove the fibroids.

The most common technologies include hysteroscopic scissors, lasso, grapes, or an electrosurgical resecting device such as Myosure™, Symphion™, or True Clear™. While each system functions differently, each subscribes to the same basic concept: polyp resection under visual surveillance.

Your cervix will be slightly dilated to allow the introduction of the camera into the uterus. The gynecologist confirms proper placement and evaluates the polyp to identify its attachment to the uterus. A resection instrument is chosen and placed down the operative channel. A small cutting instrument slides down next to the camera for surgical removal.

The polyp is cut into small pieces and removed. The procedure is complete once we have restored a normal-appearing uterine cavity.

When the treatment is finished, the devices are safely removed.

How long will I be in surgery?

Once the patient enters the operating room, a series of safety steps must occur. This process takes about 20 minutes.

The operative time for a hysteroscopic polypectomy varies. Small, soft polyps may take only a few minutes. Large, dense, or hard to reach polyps may take longer.

In general, 30 minutes of operative time should be expected.

When can I go home?

Postoperative recovery time will vary from person to person. Each patient must meet certain discharge criteria. The patient’s vital signs must be stable. The patient must be alert, oriented, and able to walk with assistance. Postoperative nausea, vomiting, and pain must be controlled as well as confirmation of no postoperative bleeding.

The nursing team will go over discharge instructions, and the plan for postoperative pain management options will be confirmed.

Hysteroscopic polypectomy procedures require a minimal amount of postoperative recovery. Patients are often discharged as early as 30–60 minutes after the procedure.

What is the usual recovery time

Most women should be able to return to normal daily activities the next day. You should speak with your physician about the resumption of sexual activity. You should not use tampons for up to seven days after the procedure to reduce the potential risk of infection.

The short term effects on menstrual bleeding vary. Most will see immediate improvement. Others will experience spotting as the polyp fragments and endometrial tissue are expelled.

You should be able to resume all work and household activities the day after your procedure. You should expect to feel a little vaginal soreness for 2–3 days. Mild uterine cramping is also common.

Some patients will require mild pain medication like NSAIDs or even low dose narcotics for a brief period of time.

It is wise to wear a sanitary pad for a few days as you may experience vaginal spotting or dark vaginal discharge.

You will be instructed to abide by pelvic rest for approximately one week. This includes no douching, no sex, and no tampons.

You should call your doctor if you experience heavy vaginal bleeding, fevers, or worsening abdominal pain.

Light bleeding, spotting, and brown or black discharge is common and expected. Sanitary napkins are advised.

Your doctor will schedule a postoperative examination 1–2 weeks after the procedure. The fibroid specimen pathology report will be reviewed during this visit.

Danger Signals to look out for after the procedure

After a hysteroscopic polypectomy procedure, we expect light spotting and vaginal discharge.

If you experience heavy bleeding, abdominal or pelvic pain, a fever, or pain that increases over time beyond 24 hours, call your physician. After any surgery, contact your physician if you meet any of the following criteria:

DANGER SIGNALS TO BE AWARE OF POST PROCEDURE

Pain not controlled with prescribed medication

Fever > 101

Nausea and vomiting

Calf or leg pain

Shortness of breath

Heavy vaginal bleeding

Foul-smelling vaginal discharge

Abdominal pain not controlled by pain medication

Inability to pass gas

What preparations should I make for aftercare at home??

Hysteroscopic procedures require very little postoperative care. Vaginal discharge and spotting are expected. One should have a supply of sanitary pads available. Sexual activity should be avoided until cleared by your doctor. One may resume a normal diet and exercise the day after the procedure.

What information should I provide to my doctors and nurses?

It is imperative to provide your doctor with an updated list of all medications, vitamins, and dietary supplements prior to surgery. All medication and food allergies should be reviewed. Share any lab work, radiologic procedures, or other medical tests done by other healthcare providers with your surgeon prior to your procedure.

Previous version published on Medika Life July 2020