Hysteroscopy
Your health expert: Dr Madhavi Vellayan, Consultant Gynaecologist
Content editor review by Pippa Coulter, October 2022
Next review due, October 2025
A hysteroscopy is a procedure to look inside your womb (uterus) to check for any problems. A hysteroscopy procedure is done using a narrow tube-like device called a hysteroscope. It’s passed into your vagina, past the neck of your womb (cervix) and up into your womb.
About hysteroscopy
There are several different reasons why you might have a hysteroscopy. As well as checking for problems, you may be able to have treatment during a hysteroscopy too. Reasons for having a hysteroscopy include the following.
- To find out what’s causing unusual bleeding from your vagina and/or womb. This can include heavy periods, bleeding between periods or bleeding after the menopause.
- To check for growths in your womb, such as polyps and fibroid and remove these if necessary.
- To investigate and treat developmental and structural differences in your womb, called Müllerian anomalies.
- To see if there are any problems that might be making it difficult for you to get pregnant.
- To investigate repeated miscarriages.
- To break up and remove scar tissue in the lining of your womb.
- To take out an intra-uterine system (IUS) or coil that has no visible threads to remove, or has moved out of position.
- To take an endometrial biopsy. This is a tissue sample to check for cancer in the lining of your womb (endometrial cancer).
If possible, your doctor or nurse will aim to treat any problems at the same time as the diagnosis. This means you won’t need a separate procedure. You might hear the procedure being called a diagnostic hysteroscopy if it’s investigating a problem, or an operative hysteroscopy if it involves treatment too.
Your doctor will explain why they’re recommending a hysteroscopy. They’ll discuss the benefits and potential risks involved, as well as any alternatives. They should give you some written information to take away.
Preparation for hysteroscopy
You usually have a hysteroscopy as an out-patient procedure, in a treatment room at a gynaecology unit. A specialist doctor, called a gynaecologist, or specialist nurse, carries out the procedure. You won’t usually need a general anaesthetic, which means you’ll be awake for the procedure.
If you’re having a longer or more complicated procedure, you may have a hysteroscopy under general anaesthesia in an operating theatre. This means you’ll be asleep during the operation. If you prefer the option of having your procedure under general anaesthesia, you can also discuss this with your gynaecologist. Whether you have a general anaesthetic or not, you’ll usually go home on the same day.
Contraception and periods
Your hospital will tell you how to prepare for your hysteroscopy procedure. You won’t usually be able to have a hysteroscopy if you’re pregnant. If you have periods, it’s important to use contraception or not have sex between your last period and the test. You might be offered a pregnancy test on the day of your procedure. Don’t worry if you’re bleeding on the day of your test. Your hysteroscopy can usually go ahead. But if the bleeding is heavy, check with your hospital.
Painkillers
Your hospital will usually recommend you take an over-the-counter painkiller, such as ibuprofen or paracetamol an hour or two before your hysteroscopy procedure. Make sure you have some painkillers at home too for after the procedure. It’s a good idea to have some sanitary pads ready too for any bleeding.
Eating and drinking
For an out-patient hysteroscopy, you can eat and drink as normal before your procedure. If you’re having a hysteroscopy under general anaesthesia, you’ll need to stop eating and drinking around six hours before your procedure. You can usually drink water up to two hours before your procedure. Check any fasting instructions with your hospital.
On the day
On the day of your procedure, you’ll meet the doctor or nurse who will be performing your hysteroscopy. They’ll discuss with you what will happen before, during and after your procedure, including any pain you might have. If you’re unsure about anything, don’t be afraid to ask. You’ll be asked to sign a consent form for the procedure to go ahead, so it’s important you feel fully informed.
What happens during a hysteroscopy?
A hysteroscopy procedure may take as little as 10 to 15 minutes, but it can be longer if you’re having treatment at the same time. When it’s time for your procedure, your doctor or nurse will ask you to remove your clothes below your waist. They may give you a gown to wear, or a sheet to cover yourself. You’ll need to lie down on a couch or special chair with your legs bent and resting in supports.
Your doctor or nurse will pass the hysteroscope through your cervix and up into your womb. Sometimes they may put a speculum inside your vagina first, to help them see your cervix. A speculum is the same instrument that’s used when you’re having a cervical smear test. It’s not always needed. They will then gently pump a sterile (clean) fluid into your womb to allow them to see more clearly.
The camera on the hysteroscope sends video images of the inside of your womb to a monitor. Your doctor or nurse will be able to view the images and do any treatment that’s needed.
A hysteroscopy can be uncomfortable and painful. But most people find the pain to be quite mild. It’s usually less painful than the worst pain you might get during a menstrual period. If you do find it painful, tell your doctor or specialist nurse and they can stop. They may also be able to offer you a local anaesthetic or nitrous oxide (‘gas and air’) to help with pain relief.
What to expect afterwards
If you had an out-patient hysteroscopy and were awake during your procedure, you should be able to go home a short time afterwards. You may need to wait a little longer if you had nitrous oxide (‘gas and air’) to help with pain relief.
If you had a hysteroscopy under general anaesthesia, you’ll need to rest until the effects have passed. You’ll still usually be able to go home on the same day. You’ll need someone to take you home and to stay with you for the first 24 hours while the anaesthetic wears off. After a general anaesthetic, you may find you’re not so coordinated or that it’s difficult to think clearly. This should pass within 24 hours. In the meantime, don't drive, drink alcohol, operate machinery or make any important decisions.
Your nurse may give you a date for a follow-up appointment. If your doctor or nurse took tissue samples during your hysteroscopy, it can take a couple of weeks to get the results. These will usually be sent to the doctor who requested the hysteroscopy. They will then contact you and go through the hysteroscopy results with you.
Recovery for hysteroscopy
Most people who have a hysteroscopy procedure as an out-patient without a general anaesthetic feel able to go back to their usual activities the same day. But you may want to take a day off work to recover. If you’ve had a general anaesthetic, you may need to rest for a few days before you get back to normal.
It’s normal to have some period-like cramping pains and some spotting or 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. You can use sanitary pads until the bleeding stops – it’s best not to use tampons..
Wait until any bleeding and pain has settled down until you do any exercise or have sex. This should be within a week.
Side-effects of hysteroscopy
Side-effects are the unwanted but mostly temporary effects that you may get after having the procedure.
Hysteroscopy side-effects may include:
- cramping pains for a day or two like those you get during a period
- bleeding or light spotting from your vagina for a few days
- feeling or being sick
- feeling faint
Complications of hysteroscopy
Complications are when problems occur during or after your procedure. The possible complications of a hysteroscopy include the following.
- Damage to the wall of your womb. This may be caused by the instruments used to look inside. This usually heals on its own, but sometimes you may need another operation to repair the damage.
- Heavy bleeding during or after your hysteroscopy. If this gets worse or doesn’t settle within a week, contact your hospital or seek urgent medical advice.
- Infection. Signs may include a fever, severe pain in your tummy, and foul-smelling discharge from your vagina. You may need antibiotics..
The risk of complications is higher if you have a hysteroscopy under general anaesthesia. You’re also at greater risk of complications if you’ve had treatments, such as removal of a fibroid or polyp.
Alternatives to hysteroscopy
Depending on your symptoms, there may be other types of tests available. These may include the following.
- Ultrasound. This may be abdominal ultrasound, which looks at your womb from the outside (through your tummy). It also includes transvaginal ultrasound, in which an ultrasound probe is inserted into your vagina.
- Magnetic resonance imaging (MRI) scan. This can be another option for investigating heavy periods or abnormal bleeding.
- Aspiration biopsy. This is an alternative way of taking a sample of the lining of your womb (an endometrial biopsy). Your doctor will put a narrow tube through your cervix and into your womb and use gentle suction to remove samples of the lining.
Your doctor will talk to you about the treatment or investigation options for you.
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Fibroids
Heavy periods (menorrhagia)
Ultrasound
Ultrasound is a type of scan that uses sound waves to produce images of the inside of your body
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Reviewed by Pippa Coulter, Freelance Health Editor, October 2022
Expert reviewer Dr Madhavi Vellayan, Consultant Gynaecologist
Next review due October 2025
