Hysteroscopy procedure

A hysteroscopy (also known as a uterine endoscopy) is a minimally invasive procedure where a hysteroscope — a small camera and light inside a slim 3–5mm tube — is used to look inside your uterus (womb).

The hysteroscope is passed through the vagina and cervix (neck of the womb) into the uterus. Unlike other surgeries, there's no need for a cut to be made on your abdomen.

The procedure can be diagnostic, to monitor or confirm the presence of a condition, or operative, to treat it. Both diagnosis and treatment can be carried out during the same surgery. Your surgeon may take a sample of cells or tissues called a biopsy for further testing during your procedure.

Hysteroscopy is often done as an outpatient procedure. Complications are rare, and there are several anaesthetic options available for your comfort.

The benefits of having a hysteroscopy include fast diagnosis and treatment of a variety of conditions, and as the uterus is accessed through the vagina rather than through incisions in the wall of the abdomen, a faster recovery time than keyhole or traditional surgery.

Why you might need a hysteroscopy

You might need a hysteroscopy if you have had an abnormal cervical smear test or if you experience:

• Heavy or irregular periods or unexplained vaginal bleeding
• Infertility or recurrent miscarriages
• Ongoing unusual vaginal discharge
• Pelvic pain
• Postmenopausal bleeding

Your doctor might also recommend a hysteroscopy if you have a condition that needs treatment such as a uterine septum (where your womb is divided into parts by a membrane) or to remove:

• An intrauterine device (IUD) if the threads are not reachable
• Endometrial lining to treat heavy bleeding
• Non-cancerous growths such as fibroids (fibrous tissue), polyps (soft tissue), or scar tissue inside your womb that can cause bleeding or infertility

A hysteroscopy biopsy can be used to diagnose endometrial cancer, and can help in the diagnosis of cervical cancer, but it does not diagnose ovarian cancer or cancer anywhere outside the uterus.

Is a hysteroscopy right for you?

Anyone with a uterus can have a hysteroscopy unless they are pregnant.

You should use contraception between your period and the date of your procedure and inform your doctor if you think you might be pregnant.

You may not be able to have the procedure if you are on your period unless your flow is very light. Your doctor will be able to advise you about this, as well as talking you through the anaesthetic options so you feel as relaxed and comfortable as possible during your procedure.

Alternative treatments to a hysteroscopy

If a hysteroscopy isn’t right for you, there may be other options available to treat your uterine symptoms:

• Abdominal ultrasound scan — a painless scan to see inside the uterus
• Aspiration biopsy or fine needle aspiration — using a needle and syringe inserted into the vagina to collect cell samples for biopsy
• Medications (such a hormones) taken orally, by injection, or released by your IUD to reduce bleeding
• MRI scan — a non-invasive scan that creates precise images of your reproductive organs
• Myomectomy — surgery through an incision (cut) in your abdomen or performed vaginally to remove fibroids and other tissue

Lifestyle changes to manage your symptoms

Lifestyle changes can help to manage conditions such as irregular or heavy periods, pelvic pain, and fibroids. A healthy lifestyle can also improve some causes of infertility. Maintaining a healthy weight, staying active, and following a well-balanced diet can improve your overall health. You should also quit smoking, limit your alcohol intake, look after your mental health, and try to reduce your stress levels.

You’ll be asked to undress from the waist down and lie back with your legs raised in stirrups and your knees apart. When your anaesthetic has been administered, your doctor will gently dilate the cervix with a device called a speculum. The hysteroscope is passed through the vagina and into the uterus. A gas or sterile saline liquid (salt water) is used to expand the uterus so the surgeon can see the area clearly.

The doctor will examine your womb and take a biopsy if necessary. They may also be able to remove fibroids or polyps from the lining of the womb.

Preparing for your hysteroscopy procedure

You will need to complete a preadmission form detailing your medical history, any medications or supplements you’re taking, your allergies, and your support needs. You may need to attend a preadmission clinic for an in-person assessment and further tests such as blood tests. Any additional costs will be discussed before further tests are carried out.

You will be advised on whether you need to stop taking certain medications before your procedure. If you smoke, you will be advised to quit before your surgery as it can slow down the healing process.

Anaesthetic choices

We will discuss your anaesthetic options with you. If you are having a diagnostic hysteroscopy you may not need any anaesthetic. Other options include:

• General anaesthetic — you will be asleep and unable to feel any pain
• Local anaesthetic — this is injected into the cervix to numb the area; you will be awake and may still feel sensations of pressure
• Sedation — small amounts of anaesthesia or other medications will be administered to relax you, but you will be awake

If you’re having general anaesthetic, you will need to fast before your surgery ie you won’t be able to eat or drink for a number of hours. This will be explained in your admission letter. You will also need someone to drive you home and may feel drowsy or confused for up to 24 hours. You will not be able to drive or operate heavy machinery and should avoid making any significant decisions.

On the day of your procedure
On the day of your hysteroscopy, you’ll be asked to wash before you arrive, remove any jewellery and wear clean and loose, comfortable clothes. You’ll also need to bring your medications (including their packaging) or a list of what you’re taking and tell us about any allergies.

You’ll be given a hospital gown and disposable underwear to wear.

If you’re having an anaesthetic, your anaesthetist will administer it before you’re brought into the operating room.

How long does a hysteroscopy take?

The duration of a hysteroscopy depends on whether it is diagnostic, a biopsy is taken, or whether any fibroids or polyps are removed. Generally, it will take between 10–45 minutes.

After your hysteroscopy

After your procedure, you’ll be taken to a recovery room while your anaesthetic wears off. You may also receive pain relief if required.

You can usually leave hospital on the same day once you’ve eaten, used the toilet, and can walk around. You may be given an outpatient appointment a few weeks after your procedure if you have any sutures that need to be removed.

Biopsy results

If you had a biopsy during your procedure, the sample of tissue will be sent to the lab for examination. Results are sent directly to the referring consultant or GP, who will discuss them with you, often during a follow-up appointment.

You should be able to return to your usual activities in a day or 2. Most people return to work within 1–3 days.

Pain relief

You may experience abdominal cramps for 24–48 hours after your procedure. You should be able to manage this with pain killers, but seek medical advice if it doesn’t resolve in a few days or starts to get worse.

To reduce the risks of constipation, which can worsen pain and discomfort through straining, follow a high fibre diet after your procedure.

Vaginal bleeding

You may notice light bleeding or blood-stained vaginal discharge for several days or weeks. Use pads rather than tampons to reduce the risk of infection. Avoid having sex until you feel comfortable and the bleeding has stopped and continue to use your usual form of contraception.

While a hysteroscopy is a low-risk procedure, every surgery comes with the risk of complications such as bleeding, infection, and deep vein thrombosis.

Rare complications from a hysteroscopy include uterine perforation (a hole in the wall of the uterus), injury to other organs or blood vessels, uterine adhesion (fibrous tissue forming in the wall of the uterus), and blood clots.

If you experience any of the following symptoms seek urgent medical assistance:

• Difficulty passing urine
• Fever
• Heavy or ongoing bleeding
• Swelling in your calves
• Unfamiliar chest pain, coughing, or difficulty breathing
• Unusual or smelly vaginal discharge
• Worsening abdominal pain