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The London Breast Clinic
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Hysteroscopy Services

 

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Hysteroscopy Services available 108 Medical Chambers for Women with:

  • Heavy periods
  • Abnormal uterine bleeding
  • Recurrent IVF failures secondary to uterine polyps
  • Excessive vaginal discharge secondary to uterine polyps and fibroids

We are excited to announce new outpatient based hysteroscopy services at 108 Harley Street.
108 have installed state of the art cutting edge technology to perform outpatient hysteroscopy and if needed removal of pathology from the uterine cavity under local anaesthesia.
By having state of the art cutting edge technology, patients need not be put to sleep and also by using modern methods (Tissue retrieval system), the damage to the uterine lining is minimised as compared to the traditional techniques used elsewhere. In the traditional technique, patients are put to sleep, cervix is dilated to 11 mm (compared to modern equipment which requires 5mm.In the traditional technique to remove the polyp electrical heat energy used, because of this there are concerns that it may affect the embryo implantation in the subfertile women. In the modern technique available at 108, polyps are removed with mechanical energy.
Also, if suitable, patients can have Mirena, i.e., a hormonal intrauterine system inserted to control heavy periods.
Apart from the above evaluation of uterine cavity in women with abnormal periods can be undertaken.
The diagnostic hysteroscopy is performed with a 2mm hysteroscopy ( the size of ballpoint pen refill) compared to the traditional hysteroscopy size of 4mm.
The therapeutic hysteroscopy, i.e., removal of polyps and small fibroids projecting into the womb cavity can be removed with a 5mm hysteroscopy under local anaesthesia. The total procedure time usually is less than 15 minutes and patients can watch if they wish.

Uterine polyps

Uterine polyps are growths attached to the inner wall of the uterus that extend into the uterine cavity. Overgrowth of cells in the lining of the uterus (endometrium) leads to the formation of uterine polyps, also known as endometrial polyps.
They usually contain fibrous tissue and a feeding vessel. They are the common cause of abnormal uterine bleeding, such as heavy periods, bleeding in between periods and in few cases excessive discharge from vagina as well as postcoital bleeding. The incidence of polyps in a premenopausal woman is around 10-40% and symptoms do not correlate with polyp number.

More the number of polyps, higher the risk of pre-malignant and malignant transformation. Majority of polyps are asymptomatic. Polyp diameter more than one centimeter, menopausal status and presenting with abnormal bleeding increases the risk of pre-malignant and malignant tissue changes. Removal of polyp appears to have a favorable outcome in infertile women. One in three women with subfertility problems have polyps.

Uterine polyps are commonly associated with Tamoxifen use. On breast tissue, tamoxifen suppresses oestrogen receptor activity and on uterus, it stimulates the endometrium.
Women using Tamoxifen are at specific risk for development of polyps and the prevalence being 30-60%. About 3% of Tamoxifen related polyps are known for malignant transformation. 10% of polyps can show carcinomatous change.
A progestogen with high antioestrogenic as well as use of oral contraceptive pills may have a protective effect.

Endometrial polyps are usually benign although some may be precancerous or cancerous. About 0.5% of endometrial polyps contain adenocarcinoma cells. Polyps can increase the risk of miscarriage in women undergoing IVF treatment. If they develop near the fallopian tubes, they may lead to difficulty in becoming pregnant.  Although treatments such as hysteroscopy usually cure the polyp concerned, recurrence of endometrial polyps is frequent.
Once polyps are identified, patients are generally advised them to excised. With the introduction of hysteroscopic morcellators such as Truclear, patients will be told that, in majority of cases they need to be removed.

The removal can be accomplished by,

  • Traditional monopolar resectoscope. Here the main challenge is retrieval of tissue and it can cause serious complications.
  • The more safer option is to use , bipolar resectoscope. With this retrieval still remains a challenge.
  • The latest development is to use, hysteroscopic morcellator which can be cut and retrieved at the same time. With the use of this technology patient can be treated as awake and one can go home straight after the procedure.
  • It is important that, the base of the polyp has been completely excised as some studies have shown that the pre-malignant and malignant change can invariably happen at the root of the polyp
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