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Management of patients after hysteroscopy
Last reviewed: 06.07.2025

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Management of patients after hysteroscopic manipulations and operations
Postoperative management of patients after hysteroscopy depends on many factors: the nature of the pathology, the initial general condition of the patient and the condition of the genitals, the volume of endoscopic manipulation or surgery.
After performing hysteroscopy in combination with separate diagnostic curettage of the uterine mucosa or performing simple hysteroscopic operations (removal of endometrial polyps, remnants of the ovum or placental tissue, destruction of delicate intrauterine adhesions, dissection of small partitions, removal of submucous nodes on a narrow base), no special recommendations are required. The patient can be discharged from the hospital on the day of the operation or the next day.
For patients after hysteroscopy against the background of an inflammatory process in the uterine cavity (pyometra, infected remnants of the fertilized egg, postpartum endometritis, etc.), it is advisable to undergo antibacterial and anti-inflammatory therapy before and after hysteroscopy using the usual method or a short course: cephalosporins intravenously 1 g 30 minutes before surgery, then in the same dose 2 times 12 hours after surgery.
Bloody or scanty bloody discharge from the genital tract occurs almost always after surgical hysteroscopy for 2-4 weeks. Sometimes pieces of resected tissue remain in the uterine cavity. In such cases, there is no need to prescribe anything. The woman should simply be warned about such discharge.
After dissection of intrauterine adhesions, almost all endoscopists suggest inserting an IUD for 2 months, since the risk of recurrent adhesions is more than 50%. Asch et al. (1991) suggested inserting an IUD containing estrogens. An alternative measure is insertion of a Foley catheter or a special silicone balloon into the uterine cavity, which is left in the uterine cavity for a week under the cover of broad-spectrum antibiotics. To improve re-epithelialization of the wound surface, hormone replacement therapy is recommended for 2-3 months.
Some doctors prefer to insert the IUD for 1-2 months (Lipsa loop) and prescribe hormone replacement therapy for 3 months to restore the endometrium. In the early postoperative period, a prophylactic course of antibacterial therapy is administered.
After dissection of the intrauterine septum, women with repeated spontaneous miscarriages are given a prophylactic course of antibacterial therapy. Others may not be prescribed such treatment.
The need for inserting an IUD and prescribing hormonal therapy after hysteroscopic dissection of the intrauterine septum remains debatable. Most endoscopists do not recommend inserting an IUD after hysteroscopic metroplasty, but prescribe estrogens. However, there are opponents of prescribing estrogens, since microscopic examinations after the operation have shown complete re-epithelialization of the operation site. In the postoperative period, it is necessary to conduct a control ultrasound during the second phase of the menstrual-ovarian cycle to determine the size of the remaining part of the septum; if it exceeds 1 cm, it is advisable to perform a repeat hysteroscopy in the first phase of the next menstrual cycle.
Some doctors do not insert the IUD after dissection of the intrauterine septum, but recommend a 2-month course of hormone replacement therapy. If after the therapy the normal uterine cavity is restored (according to ultrasound with contrast of the uterine cavity or hysterosalpingography), the patient can become pregnant.
After endometrial resection (ablation), some surgeons recommend prescribing antigonadotropins (danazol), GnRH agonists (decapeptyl, zoladex) for 3-4 months to avoid regeneration of the remaining areas of the endometrium, but this is quite an expensive treatment. It is more convenient and accessible for the patient to administer 1500 mg of medroxyprogesterone acetate (depo-provera). This treatment is especially recommended for patients with adenomyosis.
After electrosurgical or laser myomectomy with the formation of a large wound surface and in patients who received GnRH agonists in the preoperative period, it is recommended to prescribe estrogens (Premarin 25 mg for 3 weeks) for better re-epithelialization of the mucous membrane of the uterine cavity.