Your surgeon will explain how to prepare for your procedure. For example, if you smoke you will be asked to stop, as smoking increases your risk of getting a chest infection and slows your recovery.
Hysteroscopy used for diagnosis is usually done as an outpatient procedure. This means you don’t need to stay in hospital overnight and may not need anaesthesia. Your surgeon may suggest that you take a painkiller such as paracetamol about half an hour before your appointment.
Alternatively, you may have the procedure as a day-case under general anaesthesia, which means you will be asleep during the operation. If you're having a general anaesthetic, you will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. However, it's important to follow your surgeon’s advice.
At the hospital, your nurse may do some tests such as checking your heart rate and blood pressure, and testing your urine.
Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.
Depending on your symptoms and circumstances, there may be alternative treatments or investigations available to you.
A pelvic ultrasound scan can be used to diagnose some gynaecological conditions. An ultrasound scan uses sound waves to produce an image of the inside of your womb. Other types of scan, such as an MRI or CT can sometimes be used.
An endometrial biopsy is an alternative to a hysteroscopy if your surgeon needs to take a sample of the lining of your womb. A narrow tube is passed through your cervix and into your womb, then gentle suction is used to remove samples of your womb lining that will be examined under a microscope. Sometimes you may have this at the same time as a hysteroscopy.
Your surgeon will explain the different options to you.
The procedure used for a diagnosis usually takes about 10 to 15 minutes. It can take about one hour if you’re having a general anaesthetic.
Your surgeon will put a medical instrument called a speculum into your vagina to see into your cervix (neck of your womb). He or she will then clean your vagina and cervix with an antiseptic solution and pass a hysteroscope into your womb. The camera on the end of the hysteroscope sends pictures from the inside of your womb to a video screen. Your surgeon will look at these images and, if necessary, take a biopsy or carry out any treatment. He or she may inject some gas or fluid, which can make it easier to see your womb lining.
If you have a general anaesthetic, you will need to rest until the effects have passed. Once you feel ready, you will need to arrange for someone to drive you home and you should try to have a friend or relative stay with you for the first 24 hours.
General anaesthesia can temporarily affect your coordination and reasoning skills, so you should not drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards. If you're in any doubt about driving, contact your motor insurer so that you're aware of their recommendations, and always follow your surgeon's advice.
You may need to wear a sanitary towel as the procedure can cause you to have some vaginal bleeding. If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.
Your nurse may give you a date for a follow-up appointment. If you have a biopsy or polyps removed, the results will usually be sent in a report to your doctor.
If you have a diagnostic hysteroscopy, you will need to rest and take it easy for a day or two. If you have had treatment during the hysteroscopy, for example if you have had a polyp or fibroid removed, your recovery may take longer. Your surgeon will advise you when you can get back to your usual activities.
As with every procedure, there are some risks associated with hysteroscopy. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your surgeon to explain how these risks apply to you.
Side-effects are the unwanted but mostly temporary effects you may get after having the procedure. For example, you may have cramping pains, like those you get during a period. You may also have some vaginal bleeding, which usually gets better after a few days, but can last for up to a week.
This is when problems occur during or after the procedure. Most women aren't affected. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or developing a blood clot, usually in a vein in your leg (deep vein thrombosis, DVT).
Specific complications of hysteroscopy are uncommon, although it's possible you may develop an infection afterwards, which can lead to infertility – but this is rare. The surgery may damage your womb and, rarely, your bladder, bowel and blood vessels. If this happens, you may need further surgery to repair any damage caused.
During the procedure, it may not be possible for your surgeon to pass the hysteroscope into your womb to get a clear view of the lining. If this happens, he or she will discuss alternative options with you. You may need to have a laparoscopy (keyhole surgery) or laparotomy (open surgery) instead.
Most women don’t have any problems after having a hysteroscopy. However, if you develop any of the following symptoms, contact your doctor.
- Long-lasting, heavy bleeding.
- Vaginal discharge that is dark or smells unpleasant.
- Severe pain or pain that lasts for more than 48 hours.
- A high temperature.
Speak to your surgeon for more information about complications of hysteroscopy.
How will I know if my intra-uterine system (IUS) is in the right place?
The contraceptive intra-uterine system (IUS) has short threads that hang down a little way into the top of your vagina. Sometimes an IUS can move out of place. If this happens, you won't be able to feel the threads.
An IUS is a plastic frame that is placed in your womb (uterus) to prevent your eggs from reaching any sperm and being fertilised. An IUS can be pushed out of place or move inside your uterus. This is more likely to happen when the IUS has just been put in, and you may not be aware of it. Your nurse or doctor will show you how to check that it's in the right place.
An IUS has one or two threads attached to the end of it that hang a little way into the top of your vagina. You can feel for the threads to make sure it's still in the right place. It’s a good idea to do this a few times in the first month after the IUS is fitted and then check again after each period.
If you can't feel the threads, or if you think you can feel the IUS itself, see your doctor or nurse straight away. Your doctor may organise for you to have an X-ray or ultrasound to check its location. In the meantime, you should use extra contraception, such as condoms, as the IUS may not be working well enough to prevent pregnancy.
If your IUS has moved out of place, you may need to have a hysteroscopy to remove it.
I’ve heard of a procedure called dilation and curettage (D&C) – what is the difference between this and a hysteroscopy?
The dilation and curettage (D&C) procedure used to be used to diagnose or treat conditions that may be causing unusual vaginal bleeding, but is no longer used in medical practice for this. A hysteroscopy is a procedure that allows a surgeon to look inside your womb in order to diagnose or treat a gynaecological condition.
D&C was previously used to take a sample of, or to remove, the lining of your womb. It can now be used if you have had a miscarriage to remove any tissue that is left behind in your womb. During this procedure the lining of your womb is gently scraped away.
A hysteroscopy is a procedure that allows a gynaecologist to look inside your womb (uterus) using a narrow tube-like telescopic camera called a hysteroscope. It can be used to help find out what is causing your symptoms, for example if you have heavy periods.
What is unusual vaginal bleeding?
Unusual vaginal bleeding is very heavy periods and/or long-lasting periods, bleeding between periods or bleeding after sex. Bleeding after you have had your menopause is also unusual.
There are a number of conditions that can cause unusual vaginal bleeding, including changes in your hormone levels or conditions that affect your womb, such as polyps and fibroids. Unusual vaginal bleeding can also be caused by sexually transmitted infections (STIs) and, more rarely, cancer.
If you have unusual vaginal bleeding, see your GP.
- Diagnostic hysteroscopy under general anaesthesia. Royal College of Obstetricians and Gynaecologists. www.rcog.org.uk, published December 2008
- Edmonds DK. Dewhursts’s textbook of obstetrics and gynaecology. 8th ed. Chichester: Wiley Blackwell; 2012
- Hysteroscopy. eMedicine. www.emedicine.medscape.com, published November 2011
- Womb cancer. Cancer Research UK. http://cancerhelp.cancerresearchuk.org, published 1 June 2012
- Best practice in outpatient hysteroscopy. Royal College of Obstetricians and Gynaecologists. www.rcog.org.uk, published 2011
- I am bleeding from my vagina. Family Planning Association (fpa). www.fpa.org.uk, accessed 9 August 2012
- IUS (intrauterine system): your guide. Family Planning Association (fpa). www.fpa.org.uk, accessed 9 August 2012
- Dilation and curettage: frequently asked questions. The American College of Obstetricians and Gynaecologists. www.acog.org, accessed 9 August 2012
- Personal communication, Mr Robin Crawford, Consultant Gynaecologist, Spire Cambridge Lea Hospital, 26 September 2012
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