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Hysteroscopy

A hysteroscopy is a procedure to look inside your womb (uterus). It can check for a problem with your womb, and in some cases can treat the problem at the same time.

It’s done with a narrow tube-like telescope with a camera. This is called a hysteroscope. The hysteroscope is put into your vagina and then passed up through your cervix and into your womb.

An image showing where a hysteroscope is passed

About hysteroscopy

Hysteroscopy can be used to find out what’s causing your symptoms. It can also be used to treat several different conditions. You may have a hysteroscopy for the following reasons.

  • To find out what’s causing any unusual bleeding from your vagina. This can include heavy periods, bleeding between periods, or bleeding after menopause. See our FAQ ‘What is unusual vaginal bleeding?’ for more information.
  • To check for polyps (small growths of tissue) and some types of fibroids (non-cancerous growths of muscle). These can sometimes be treated during your hysteroscopy.
  • To see if there are any problems that might be making it difficult for you to get pregnant.
  • To see if there is anything that might be causing repeated miscarriages.
  • To treat scar tissue in the lining of your womb.
  • To take out an intra-uterine system (IUS) or coil that has moved out of place.

Deciding on a hysteroscopy

This information can help you understand the pros and cons of having a hysteroscopy. Think about how important each issue is to you, and then talk to your surgeon. You can work together to decide what's right for you. Your decision will be based on your surgeon’s expert opinion and your personal values and preferences.

Pros

  • Hysteroscopy is usually done in the out-patient department with no anaesthetic. This means you should be able to get back to your usual activities quickly.
  • You may be able to have your condition treated in the same operation as your diagnosis.

Cons

  • There is a risk that you’ll have some complications during or after the operation. These can include bleeding or damage to your cervix or womb.
  • Some women find having the procedure without anaesthetic makes them feel anxious and stressed.
  • You may have some cramping during and after the procedure.

Preparing for a hysteroscopy

Your hospital will tell 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.

Don’t worry if you’re bleeding at the time of your procedure. Your hysteroscopy can usually go ahead, unless the bleeding is heavy.

If you’re having a hysteroscopy to diagnose a condition, you can often go home a short time later. You may not need an anaesthetic at all, or you may have local anaesthetic. You might be asked to take an over-the-counter painkiller such as ibuprofen (a non-steroidal anti-inflammatory medicine) about an hour before your procedure.

For some women, the thought of having the procedure without an anaesthetic makes them feel anxious and stressed. If you’re worried about it, talk to your doctor for more information.

If you’re having a longer and more complicated operation, such as having fibroids treated, you may have a general anaesthetic. This means you’ll be asleep during the operation. You’ll usually have the procedure and go home on the same day.

If you’re having a general anaesthetic, it can make you sick so it's important that you don't eat or drink anything for six hours before your hysteroscopy. Follow the advice from your anaesthetist or doctor. If you have any questions, just ask.

Your nurse or surgeon will discuss with you what will happen before, including any pain you might have. If you’re unsure about anything, ask. No question is too small. Being fully informed will help you feel more at ease and will allow you to give your consent for the procedure to go ahead. You may be asked to do this by signing a consent form.

What are the alternatives to a hysteroscopy?

Depending on what’s causing your symptoms, there may be other investigations available. These include the following.

  • An ultrasound can be used to diagnose some gynaecological conditions such as fibroids. You may have an ultrasound scan that looks at your womb from the outside, through your lower abdomen, and from the inside using a device that goes into your vagina. Other investigations such as an MRI scan are also used to diagnose conditions such as endometriosis and fibroids.
  • 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 put into your womb through your cervix and gentle suction is used to remove samples of the lining. These can then be looked at under a microscope. You can have this done at the same time as a hysteroscopy.

Your surgeon will talk to you about the treatment or investigation options for you.

What happens during a hysteroscopy?

A hysteroscopy usually takes about 10 minutes. You’ll be asked to lie down with your legs up and put into supports. Sometimes a speculum is put inside your vagina to help your doctor see your cervix. This is the same instrument that’s used when you’re having a cervical smear test.

Your vagina and cervix are cleaned with an antiseptic solution and the hysteroscope is passed through your cervix and into your womb. A sterile (clean) fluid or gas is put into your womb to make it bigger, which helps your doctor to see clearly. The camera on the hysteroscope sends pictures of the inside of your womb to a TV screen where your doctor can see it. They will look at these images and take a biopsy or carry out any treatment that’s needed. You can usually see this screen too.

Hysteroscopy can be uncomfortable and sometimes painful, and you might have some pain like period pains while the hysteroscopy is being done. If you’re having the procedure and it’s painful, tell your doctor. 

What to expect afterwards

If you have a general anaesthetic, you’ll need to rest until the effects have passed. Make sure someone can take you home. And ask someone to stay with you for a day or so while the anaesthetic wears off.

If you’ve had a general anaesthetic, it can really take it out of you. You might find that 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 sign anything important.

When you feel ready, you can go home. You might have some discomfort as any anaesthetic or painkiller wears off. But you'll be offered pain relief as you need it.

You may have some bleeding from your vagina. You can use sanitary pads until the bleeding stops.

Your nurse may give you a date for a follow-up appointment. If you’ve had any tissue samples taken it can take a few weeks to get the results. These are usually sent to the doctor who did the hysteroscopy and they will talk to you about them.

Recovering from a hysteroscopy

If you’ve had your hysteroscopy as an out-patient, with no anaesthetic, you should be able to go back to your usual activities the same day. If you’ve had a general anaesthetic and treatment, it’s likely to take longer for you to get back to normal. Ask your doctor when you can get back to your usual activities.

It’s normal to have some 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.

What are the possible side-effects?

Side-effects are the unwanted but mostly temporary effects you may get after having the procedure.

After a hysteroscopy, you may have cramping pains, like those you get during a period. You may also have some vaginal bleeding. This usually gets better after a few days, but can last for up to two weeks, depending on any treatment you may have had.

What are the possible complications?

All medical procedures come with some risk. But how these risks apply to you will be different to how they apply to others. Be sure to ask for more information if you have any concerns.

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
  • signs of an infection, such as a fever, shivering and chills, or foul-smelling discharge from your vagina
  • severe abdominal (tummy) pain

Complications are when problems occur during or after your procedure. The following are possible complications of hysteroscopy.

  • Damage to the wall of your uterus or your cervix, caused by the instruments used to look inside. If this happens, you may need another operation to repair the damage.
  • Heavy bleeding during or after your hysteroscopy. If it’s severe, your doctor may put a special water-filled balloon inside your uterus to stop the bleeding.
  • Very rarely, your body can absorb too much of the fluid that’s used to open up your womb during your hysteroscopy.
  • An infection, which means you may need antibiotics.

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

Dilation and curettage (D&C) is a surgical procedure. Your cervix is opened (dilated) and an instrument is used to remove some of the lining of your womb (curettage). Hysteroscopy is where your doctor uses a camera to look at the inside of your womb. They may then use special instruments to take a sample of tissue or treat a gynaecological condition. You would usually have a hysteroscopy first to examine the womb, with the D&C then following this if necessary.

D&C can be used to take a sample of the lining of your womb. This can help to diagnose and treat a condition that may be causing any abnormal bleeding. You might also have a D&C after a miscarriage, to remove any tissue that’s left behind in your womb.

D&C is used less and less, now that newer techniques have replaced it.

FAQ: What is unusual vaginal bleeding?

Unusual vaginal bleeding is relatively common, and around one in every four women will have it at some time. Some kinds of unusual bleeding are linked to your periods, and others aren’t. Here are some of the main types of unusual bleeding.

  • Heavy periods (menorrhagia). This is heavy bleeding that interferes with your day-to-day life and affects your quality of life. Some women pass large blood clots and have other symptoms such as feeling light headed.
  • Bleeding between your periods.
  • Bleeding after the menopause (a year or more after your periods have completely stopped).
  • Bleeding after you’ve had sex.
  • Frequent periods (bleeding more often than every three weeks).

There are several conditions that can cause unusual vaginal bleeding, but sometimes your doctor won’t be able to find a specific cause. If you have unusual vaginal bleeding, you should always see your GP.

Details

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    Further information

    Sources

    • Hysteroscopy. Medscape. emedicine.medscape.com, updated December 2015 
    • Best practice in outpatient hysteroscopy. Royal College of Obstetricians and Gynaecologists. 2011. www.rcog.org.uk, 
    • Assessment of vaginal bleeding. BMJ Best Practice. bestpractice.bmj.com, last updated November 2017 
    • Ahmad G, O'Flynn H, Attarbashi S, et al. Pain relief for outpatient hysteroscopy. Cochrane Database of Systematic Reviews 2010, Issue 11. Art. No.: CD007710. DOI: 10.1002/14651858.CD007710.pub2
    • Hysteroscopic morcellation of uterine leiomyomas (fibroids). National Institute for Health and Care Excellence (NICE). 2015. www.nice.org.uk
    • Uterine fibroids. BMJ Best Practice. bestpractice.bmj.com, last updated February 2017 
    • Endometrial sampling. PatientPlus. patient.info, last checked October 2015
    • Biopsy of the womb lining. Cancer Research UK. www.cancerresearchuk.org, last reviewed August 2017 
    • Cervical screening. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised August 2017 
    • Diagnostic hysteroscopy. Medscape. emedicine.medscape.com, updated August 2015 
    • Operative hysteroscopy. Medscape. emedicine.medscape.com, updated April 2017
    • Diagnostic dilation and curettage. Medscape. https://emedicine.medscape.com/article/1848239-overview#a1, updated December 2015
    • Diagnostic dilation and curettage. Medscape. emedicine.medscape.com, updated December 2015
    • Tunçalp Ö, Gülmezoglu AM, Souza JP. Surgical procedures for evacuating incomplete miscarriage. Cochrane Database of Systematic Reviews 2010, Issue 9. Art. No.: CD001993. DOI: 10.1002/14651858.CD001993.pub2
    • Map of Medicine. Abnormal vaginal bleeding. International View. London: Map of Medicine; 2016 (Issue 2)
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    Reviewed by Graham Pembrey, Lead Health Editor, Bupa Health Content Team, January 2018
    Expert reviewer, Miss Shirin Irani, Consultant Gynaecologist
    Next review due January 2021

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