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Chapter 7 - Indications for Hysteroscopy

Published online by Cambridge University Press:  10 September 2020

By
Dimitrios Mavrelos ,
Ertan Saridogan ,
Mary E. Connor  and
T. Justin Clark
Edited by
Mary E. Connor  and
T. Justin Clark
Mary E. Connor
Affiliation:
Royal Hallamshire Hospital, Sheffield
T. Justin Clark
Affiliation:
Birmingham Women’s Hospital
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Summary

Improved hysteroscopic technology has enabled clinicians not only to perform diagnostic outpatient hysteroscopy but also to treat uterine lesions. Bipolar diathermy electrodes have reduced the risk of fluid overload, allowing the excision of larger fibroids at a single setting and thus reducing the need for abdominal operations. Novel indications for hysteroscopy have become available, such as hysteroscopic tubal occlusion. Concomitant developments in hysteroscopic equipment and ultrasound technology have influenced how these tools are used in the diagnosis and treatment of intrauterine conditions.

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Diagnostic and Operative Hysteroscopy , pp. 83 - 95
Publisher: Cambridge University Press
Print publication year: 2020

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References

Royal College of Obstetricians and Gynaecologists, London School of Hygiene & Tropical Medicine, Ipsos MORI. National Heavy Menstrual Bleeding Audit: First Annual Report. London: RCOG; 2011 www.rcog.org.uk/globalassets/documents/guidelines/research--audit/nationalhmbaudit_1stannualreport_may2011.pdf (accessed October 2019).Google Scholar
Munro, M, Critchley, H, Fraser, I. The FIGO systems for nomenclature and classification of causes of abnormal uterine bleeding in the reproductive years: who needs them? Am J Obstet Gynecol 2012; 207: 259–65.CrossRefGoogle Scholar
Valentin, L. Imaging techniques in the management of abnormal vaginal bleeding in non-pregnant women before and after menopause. Best Pract Res Clin Obstet Gynaecol 2014; 28: 637–54.Google Scholar
Timmerman, D, Verguts, J, Konstantinovic, M, et al. The pedicle artery sign based on sonography with color Doppler imaging can replace second-stage tests in women with abnormal vaginal bleeding. Ultrasound Obstet Gynecol 2003; 22: 166–71.CrossRefGoogle ScholarPubMed
Mavrelos, D, Naftalin, J, Hoo, W, et al. Preoperative assessment of submucous fibroids by three-dimensional saline contrast sonohysterography. Ultrasound Obstet Gynecol 2011; 38: 350–4.CrossRefGoogle ScholarPubMed
Wamsteker, K, Emanuel, MH, de Kruif, JH. Transcervical hysteroscopic resection of submucous fibroids for abnormal uterine bleeding: results regarding the degree of intramural extension. Obstet Gynecol 1993; 82: 736–40.Google Scholar
National Institute for Health and Care Excellence. Heavy Menstrual Bleeding: Assessment and Management. NICE Guideline NG88. London: NICE; 2018. www.nice.org.uk/guidance/ng88 (accessed November 2019).Google Scholar
Lieng, M, Istre, O, Qvigstad, E. Treatment of endometrial polyps: a systematic review. Acta Obstet Gynecol Scand 2010; 89: 992–1002Google Scholar
Van Dongen, H, de Kroon, CD, Jacobi, CE, et al. Diagnostic hysteroscopy in abnormal uterine bleeding: a systematic review and meta-analysis. BJOG 2007; 114: 664–75.Google Scholar
Cooper, NAM, Barton, PM, Breijer, MC, et al. Cost-effectiveness of diagnostic strategies for the management of abnormal uterine bleeding (heavy menstrual bleeding and post-menopausal bleeding): a decision analysis. Health Technol Assess 2014; 18(24): 1–201.CrossRefGoogle ScholarPubMed
Farquhar, C, Ekeroma, A, Furness, S, Arroll, B. A systematic review of transvaginal ultrasonography, sonohysterography and hysteroscopy for the investigation of abnormal uterine bleeding in premenopausal women. Acta Obstet Gynecol Scand 2003; 82: 493–504.Google Scholar
Clark, TJ, Middleton, LJ, Cooper, NA, et al. A randomised controlled trial of outpatient versus inpatient polyp treatment (OPT) for abnormal uterine bleeding. Health Technol Assess 2015; 19(61): 1–194.Google Scholar
Van Hanegem, N, Breijer, MC, Slockers, SA, et al. Diagnostic workup for postmenopausal bleeding: a randomised controlled trial. BJOG 2017; 124: 231–40.Google Scholar
Clark, TJ. Hysteroscopy is needed in the diagnostic workup of postmenopausal bleeding. BJOG 2017; 124: 241.Google Scholar
Emanuel, MH, Wamsteker, K, Hart, AA, Metz, G, Lammes, FB. Long–term results of hysteroscopic myomectomy for abnormal uterine bleeding. Obstet Gynecol 1999; 93: 743–8.Google ScholarPubMed
Hart, R, Molnar, BG, Magos, A. Long term follow up of hysteroscopic myomectomy assessed by survival analysis. BJOG 1999; 106: 700–5.Google Scholar
Vercellini, P, Zaina, B, Yaylayan, L, et al. Hysteroscopic myomectomy: long-term effects on menstrual pattern and fertility. Obstet Gynecol 1999; 94: 341–7.Google ScholarPubMed
Lumsden, MA, Gebbie, A, Holland, C. Managing unscheduled bleeding in non-pregnant premenopausal women. BMJ 2013; 346: f3251.CrossRefGoogle ScholarPubMed
Musonda, P, Burbos, N, Duncan, TJ, et al. Comparing the performance of two clinical models in estimating the risk of endometrial cancer in symptomatic postmenopausal women. Eur J Obstet Gynecol Reprod Biol 2011; 159: 433–8.Google Scholar
Cancer Research UK. Uterine cancer statistics. www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/uterine-cancer (accessed October 2019).Google Scholar
National Institute for Health and Care Excellence. Suspected Cancer: Recognition and Referral. NICE Guideline NG12. London: NICE; 2015. www.nice.org.uk/guidance/ng12 (accessed October 2019).Google Scholar
Scottish Intercollegiate Guidelines Network. Investigation of Post-Menopausal Bleeding: A National Clinical Guideline. Edinburgh: Royal College of Physicians; 2002.Google Scholar
Gupta, J, Chien, P, Voit, D, Clark, TJ, Khan, KS. Ultrasonographic endometrial thickness for diagnosing endometrial pathology in women with postmenopausal bleeding: a meta-analysis. Acta Obstet Gynecol Scand 2002; 81: 799–816.Google Scholar
Timmermans, A, Opmeer, BC, Khan, KS, et al. Endometrial thickness measurement for detecting endometrial cancer in women with postmenopausal bleeding: a systematic review and meta-analysis. Obstet Gynecol 2010; 116: 160–7.Google Scholar
Wong, ASW, Lao, TTH, Cheung, CW, et al. Reappraisal of endometrial thickness for the detection of endometrial cancer in postmenopausal bleeding: a retrospective cohort study. BJOG 2016; 123: 439–46.Google Scholar
Colombo, N, Preti, E, Carinelli, S, et al. Endometrial cancer: ESMO Clinical Practice Guidelines. Ann Oncol 2013; 24(Suppl 6): vi33–8.CrossRefGoogle ScholarPubMed
Clark, TJ, Voit, D, Gupta, J, et al. Accuracy of hysteroscopy in the diagnosis of endometrial cancer and hyperplasia: a systematic quantitative review. JAMA 2002; 288: 1610–21.CrossRefGoogle ScholarPubMed
Cooper, NAM, Clark, TJ, Middleton, L, et al. Outpatient versus inpatient uterine polyp treatment for abnormal uterine bleeding: randomised controlled non-inferiority study. BMJ 2015; 350: h1398.CrossRefGoogle ScholarPubMed
Cooper, NAM, Middleton, LJ, Smith, P, et al. A patient-preference cohort study of office versus inpatient uterine polyp treatment for abnormal uterine bleeding. Gynecol Surg 2016; 13: 313–22.CrossRefGoogle ScholarPubMed
Royal College of Obstetricians and Gynaecologists. Management of Endometrial Hyperplasia. Green-top Guideline No. 67. London: RCOG; 2016. www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg67 (accessed November 2019).Google Scholar
Jivraj, S, Dass, M., Panikkar, J, Brown, V. Outpatient hysteroscopy: an observational study of patient acceptability. Medicina (Kaunas) 2004; 40: 1207–10.Google ScholarPubMed
Campaign Against Painful Hysteroscopy. Patients’ stories. www.hysteroscopyaction.org.uk/patients-stories (accessed November 2019).Google Scholar
Royal College of Obstetricians and Gynaecologists. Providing Quality Care for Women: Standards for Gynaecology Care. London: RCOG; 2016. www.rcog.org.uk/globalassets/documents/guidelines/working-party-reports/gynaestandards.pdf (accessed November 2019).Google Scholar
Swedlow, AJ, Jones, M. Tamoxifen treatment for breast cancer and risk of endometrial cancer: a case control study. J Natl Cancer Inst 2005; 97: 375–84.Google Scholar
Salim, S, Won, H, Nesbitt-Hawes, E, Campbell, N, Abbott, J. Diagnosis and management of endometrial polyps: a critical review of the literature. J Minim Invasive Gynecol 2011; 18: 569–81.Google Scholar
Cohen, I. Endometrial pathologies associated with postmenopausal tamoxifen treatment. Gynecol Oncol 2004; 94: 256–66.CrossRefGoogle ScholarPubMed
Ascher, SM, Imaoka, I, Lage, JM. Tamoxifen-induced uterine abnormalities: the role of imaging. Radiology 2000; 214: 29–38.CrossRefGoogle ScholarPubMed
Taylor, E, Gomel, V. The uterus and fertility. Fertil Steril 2008; 89: 116.CrossRefGoogle ScholarPubMed
Seshadri, S, Khalil, M, Osman, A, et al. The evolving role of saline infusion sonography (SIS) in infertility. Eur J Obstet Gynecol Reprod Biol 2014; 185C: 66–73.Google Scholar
Pritts, E, Parker, W, Olive, D. Fibroids and infertility: an updated systematic review of the evidence. Fertil Steril 2009; 91: 1215–23.Google Scholar
Jayaprakasan, K, Polanski, L, Sahu, B., Thornton, JG, Raine-Fenning, N. Surgical intervention versus expectant management for endometrial polyps in subfertile women. Cochrane Database Syst Rev 2014; (8): CD009592.Google Scholar
Pérez-Medina, T, Bajo-Arenas, J, Salazar, F, et al. Endometrial polyps and their implication in the pregnancy rates of patients undergoing intrauterine insemination: a prospective, randomized study. Hum Reprod 2005; 121: 149–53.Google Scholar
Bosteels, J, Weyers, S, Puttemans, P, et al. The effectiveness of hysteroscopy in improving pregnancy rates in subfertile women without other gynaecological symptoms: a systematic review. Hum Reprod Update 2010; 16: 1–11.Google Scholar
El-Toukhy, T, Campo, R, Sunkara, SK, Khalaf, Y, Coomaraswamy, A. A multi-centre randomised controlled study of pre-IVF outpatient hysteroscopy in women with recurrent IVF implantation failure: Trial of Outpatient Hysteroscopy – [TROPHY] in IVF. Reprod Health 2009; 6: 20.Google Scholar
Ludwin, A, Pityński, K, Ludwin, I, Banas, T, Knafel, A. Two- and three-dimensional ultrasonography and sonohysterography versus hysteroscopy with laparoscopy in the differential diagnosis of septate, bicornuate, and arcuate uteri. J Minim Invasive Gynecol 2013; 20: 90–9.Google Scholar
Nouri, K, Ott, J, Huber, JC, et al. Reproductive outcome after hysteroscopic septoplasty in patients with septate uterus: a retrospective cohort study and systematic review of the literature. Reprod Biol Endocrinol 2010; 8: 52.Google Scholar
Kowalik, CR, Goddijn, M, Emanuel, MH, et al. Metroplasty versus expectant management for women with recurrent miscarriage and a septate uterus. Cochrane Database Syst Rev 2011; (6): CD008576.Google Scholar
Yu, D, Wong, YM, Cheong, Y, Xia, E, Li, TC. Asherman syndrome: one century later. Fertil Steril 2008; 89: 759–79.Google Scholar
Asherman, JG. Traumatic intra-uterine adhesions. J Obstet Gynaecol Br Emp 1950; 57: 892–6CrossRefGoogle ScholarPubMed
Hooker, AB, Lemmers, M, Thurkow, AL, et al. Systematic review and meta-analysis of intrauterine adhesions after miscarriage: prevalence, risk factors and long-term reproductive outcome. Hum Reprod Update 2014; 20: 262–78.Google Scholar
Shalev, J, Meizner, I, Bar-Hava, I, et al. Predictive value of transvaginal sonography performed before routine diagnostic hysteroscopy for evaluation of infertility. Fertil Steril 2000; 73: 412–17.Google Scholar
Clark, TJ, Gupta, JK. Handbook of Outpatient Hysteroscopy: A Complete Guide to Diagnosis and Therapy. London: Hodder Arnold; 2005.Google Scholar
Critchley, HO, Warner, P, Lee, AJ. Evaluation of abnormal uterine bleeding: comparison of 3 outpatient procedures within cohorts defined by age and menopausal status. Health Technol Assess 2001; 8(34): iii–iv, 1–139.Google Scholar
Sambrook, AM, Elders, A, Cooper, KG. Microwave endometrial ablation versus thermal balloon endometrial ablation (MEATBall): 5-year follow up of a randomised controlled trial. BJOG 2014; 121: 747–53.Google Scholar
AlHilli, MM, Hopkins, MR, Famuyide, AO. Endometrial cancer after endometrial ablation: systematic review of medical literature. J Minim Invasive Gynecol 2011; 18: 393–400.Google Scholar
Hurskainen, R, Hovi, S-L, Gissler, M, et al. Hysteroscopic tubal sterilization: a systematic review of the Essure system. Fertil Steril 2010; 94: 16–19.Google Scholar
Gariepy, AM, Creinin, MD, Smith, KJ, et al. Probability of pregnancy after sterilization: a comparison of hysteroscopic versus laparoscopic sterilization. Contraception 2014; 90: 174–81.Google Scholar
Arjona Berral, JE, Rodríguez Jiménez, B, Velasco Sánchez, E, et al. Essure® and chronic pelvic pain: a population-based cohort. J Obstet Gynaecol 2014; 34: 712–13.Google Scholar
Arora, P, Arora, RS, Cahill, D. Essure® for management of hydrosalpinx prior to in vitro fertilisation-a systematic review and pooled analysis. BJOG 2014; 121: 527–36.Google Scholar
Conforti, A, Alviggi, C, Mollo, A, De Placido, G, Magos, A. The management of Asherman syndrome: a review of literature. Reprod Biol Endocrinol 2013; 11: 118.Google Scholar
Kodaman, PH, Arici, A. Intra-uterine adhesions and fertility outcome: how to optimize success? Curr Opin Obstet Gynecol 2007; 19: 207–14.Google Scholar
Hassan, R, Bhal, K, Joseph, B. The need for repeat evacuation of retained products of conception: how common is it? J Obst Gynaecol 2013; 33: 75–6.Google Scholar
Smorgick, N, Barel, O, Fuchs, N, et al. Hysteroscopic management of retained products of conception: meta-analysis and literature review. Eur J Obst Gynecol Reprod Biol 2014; 173: 19–22.Google Scholar

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