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Hysteroscopy

A hysteroscopy is a procedure to look inside your womb (uterus). It’s done with a narrow tube-like telescope with a camera called a hysteroscope. A hysteroscopy can be used to diagnose and/or treat a problem with your womb.

Your gynaecologist (a doctor who specialises in women’s reproductive health) may recommend that you have a hysteroscopy for one of a number of different reasons. These include the following.

  • To help find out what is causing you to have unusual bleeding from your vagina, for example heavy periods or bleeding after your menopause. See our FAQ ‘What is unusual vaginal bleeding?‘ for more information.
  • To check for polyps (small growths of tissue in your womb lining) or some types of fibroids (non-cancerous growths of muscle in your womb). These may then be treated during your hysteroscopy.
  • To see if there are any problems within your womb if you’re having problems getting pregnant or have had several miscarriages.
  • To treat scar tissue (adhesions) within the lining of your womb.
  • To take out an intra-uterine system (IUS), or coil, that has moved out of place.
  • To carry out a permanent form of contraception (sterilisation).
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An image showing where a hysteroscope is passed

Details

  • Preparation Preparing for a hysteroscopy

    Your hospital will give you some guidance telling you how to prepare for your hysteroscopy procedure. If you’re still having periods you should make sure there’s no chance that you’re pregnant at the time of your procedure by using contraception.

    If you’re bleeding at the time of your procedure don’t worry. Your hysteroscopy can usually go ahead in most cases.

    Hysteroscopy is often done as an outpatient procedure, especially if it’s being done to look for problems in your womb. You won’t need to stay in hospital overnight and you’ll be awake during your procedure. You may have local anaesthesia. Your gynaecologist may suggest that you take an over-the-counter painkiller such as ibuprofen (a non-steroidal anti-inflammatory medicine) about an hour before your procedure.

    If you’re having treatment during your hysteroscopy, your gynaecologist may recommend that you have the procedure under general anaesthesia. This will probably be as a day case. This means you’ll be asleep during the operation, but you’ll go home later the same day. If you’re having a general anaesthetic, you’ll 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 gynaecologist’s advice. If you know you’re going to have a general anaesthetic, make arrangements beforehand for someone to drive you home after your hysteroscopy.

    Your gynaecologist will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to ask questions so that you understand what will be happening. You don’t have to go ahead with the procedure if you decide you don’t want it. Once you understand the procedure and if you agree to have it, you’ll be asked to sign a consent form.

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  • Alternatives What are the alternatives to a hysteroscopy?

    Depending on your symptoms and circumstances, there may be alternative investigations which may help your gynaecologist find out if you have problems with your womb. These include the following tests.

    • A pelvic ultrasound scan can be used to diagnose some conditions that affect the womb. An ultrasound scan uses sound waves to produce an image of the inside of your womb. Other types of scan, such as an MRI, can sometimes be used.
    • An endometrial biopsy is an alternative to a hysteroscopy if your gynaecologist needs to take a sample of the lining of your womb. Your gynaecologist will pass a narrow tube through your cervix and into your womb. They will then use gentle suction 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.

    If your gynaecologist recommends treatment for problems with your womb ask them to explain any different options that may be available to you.

  • The procedure What happens during a hysteroscopy?

    A hysteroscopy usually takes between 10 and 30 minutes. Your gynaecologist will put a medical instrument called a speculum into your vagina to see your cervix (the neck of your womb). You may be familiar with this instrument from having cervical smear tests. They 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 TV screen. The cavity of the womb is gently distended with saline (sterile fluid) allowing a view of the inside of your womb to be seen. On occasions other sterile fluids or even carbon dioxide gas is used. Your gynaecologist will look at these images and, if necessary, take a biopsy or carry out any treatment.

    An image showing where a hysteroscope is passed

    If you have a general anaesthetic, you’ll need to rest until the effects have passed. Once you feel ready, you can be collected by the person you’ve arranged to drive you home. You should try to have a friend or relative stay with you for the first 24 hours.

    You will probably need to wear a sanitary towel home as the procedure can make you have some vaginal bleeding.

    The medicines used for general anaesthesia can stay in your body for a while. Because of this it’s safest not to drive, drink alcohol, operate machinery or make important decisions for 24 hours after your anaesthetic. If you’re in any doubt about driving, contact your motor insurer so that you’re aware of their recommendations, and always follow your gynaecologist’s 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.

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  • Recovery Recovering from a hysteroscopy

    After your hysteroscopy, you may feel ready to go back to work the next day, or you may need to rest and take it easy for a day or two. Ask your gynaecologist when you can get back to your usual activities.

    It’s normal to have some mild period-like cramping pains and some bleeding for a few days after your hysteroscopy. 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.

    Most women don’t have any problems after having a hysteroscopy. However, if you develop any of the following symptoms, contact your doctor.

    • Heavy bleeding that lasts for longer than 12 days.
    • Vaginal discharge that is dark or smells unpleasant.
    • Severe pain or pain that lasts for more than 48 hours.
    • A high temperature.
  • Side-effects What are the possible side-effects?

    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 or 10 days.

  • Complications What are the possible complications?

    Complications are when problems occur during or after your procedure, but most women don’t get any complications after a hysteroscopy. The following are possible complications of hysteroscopy.

    • A tear (perforation) in the wall of your uterus or your cervix caused by the instruments used to look inside. If this happens, you may need further surgery to repair any damage caused.
    • Excessive bleeding during or after your hysteroscopy. If it’s severe your gynaecologist may place a special balloon inside your uterus to stop the bleeding.
    • Absorbing too much of the fluid used to open up your womb during your hysteroscopy. This can make you feel confused, and have seizures.
    • Infection inside your uterus, which means you may need antibiotics.

    Speak to your gynaecologist if you want to know more about complications of hysteroscopy. But remember, hysteroscopy is considered a safe procedure and the vast majority of women don’t get complications.

  • Is dilation and curettage (D&C) similar to hysteroscopy? Is dilation and curettage (D&C) similar to hysteroscopy?

    Answer

    Dilation and curettage (D&C) is a surgical procedure where a gynaecologist opens (dilates) your cervix (the neck of your womb). They then use a thin spoon-like instrument to remove some of the tissue lining your womb (curettage). Hysteroscopy is a procedure that allows a gynaecologist to look inside your womb with a special telescope. Both procedures can be used to diagnose or treat a problem with your womb, although D&C is used much less often these days.

    More information

    D&C can be used to take a sample of, or to remove, the lining of your womb to diagnose or treat conditions like abnormal bleeding. It was used more often in the past but now there are newer techniques which doctors tend to prefer, like hysteroscopy. D&C may 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 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. Your gynaecologist can also takes samples of tissue and treat certain conditions during a hysteroscopy procedure.

  • What is unusual vaginal bleeding? What is unusual vaginal bleeding?

    Answer

    There are different kinds of unusual vaginal bleeding. You may have very heavy periods and/or long-lasting periods. You may bleed between periods, or after having sex. Or you may begin to bleed again a year or so after your menopause. See your GP if you have unusual vaginal bleeding.

    More information

    There are a number of conditions that can cause unusual vaginal bleeding. These include 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.

    Unusual vaginal bleeding is very common, and you shouldn’t be embarrassed to go and see your GP if you have it. Your GP will ask you about your symptoms and examine you. They may then arrange for you to have some tests – these will depend upon the type of bleeding you have.

  • Resources Resources

    Further information

    Sources

    • Hysteroscopy. Medscape. www.emedicine.medscape.com, published 17 October 2013
    • Diagnostic hysteroscopy. Medscape. www.emedicine.medscape.com, published 11 July 2013
    • Operative hysteroscopy. Medscape. www.emedicine.medscape.com, published 9 April 2014
    • Best practice in outpatient hysteroscopy. Royal College of Obstetricians and Gynaecologists. www.rcog.org.uk, 2011
    • Hysteroscopy. The American Congress of Obstetricians and Gynecologists. www.acog.org, published October 2011
    • Laparoscopy and hysteroscopy. American Society for Reproductive Medicine. www.asrm.org, published 2012
    • Womb cancer tests. Cancer Research UK. www.cancerresearchuk.org, published 17 September 2014
    • How is uterine cancer diagnosed? American Cancer Society. www.cancer.org, published 17 March 2015
    • How womb cancer (endometrial cancer) is diagnosed. Macmillan cancer support. www.macmillan.org.uk, reviewed 1 August 2012
    • Diagnostic dilation and curettage. Medscape. www.emedicine.medscape.com, published 8 August 2013
    • Dilation and Curettage (D&C). The American Congress of Obstetricians and Gynecologists. www.acog.org, published May 2012
    • Assessment of vaginal bleeding. BMJ Best practice. bestpractice.bmj.com, published 5 December 2014
    • Abnormal uterine bleeding. The American Congress of Obstetricians and Gynecologists. www.acog.org, published December 2012
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    Reviewed by Dylan Merkett, Bupa Health Information Team, July 2015.

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