Introduction 

A hysteroscopy is a procedure used to examine the inside of the uterus (womb).

It's carried out using a hysteroscope, which is a narrow tube with a telescope at the end. Images are sent to a computer in order to get a close-up of the womb.

Why it is used

A hysteroscopy can be used to diagnose cases when a woman’s symptoms suggest there could be a problem with their womb. Symptoms can include:



heavy periods or irregular periods



bleeding between normal periods, after sexual intercourse or aftermenopause



pelvic pain



unusual vaginal discharge



repeated miscarriage



infertility



A hysteroscopy can also be used to remove abnormal growths from the womb, such as:



fibroids – non-cancerous growths that can develop inside the womb and can sometimes cause symptoms such as pain and heavy periods



polyps – small growths that develop on the lining of the womb and can cause irregular and heavy periods



intrauterine adhesions – sections of scar tissue that can cause absent periods and infertility



thickening of the uterus' lining (endometrial hyperplasia) – this can increase the risk of womb cancer



A procedure called dilatation and curettage (D&C) used to be commonly used to examine the womb and remove abnormal growths, but nowadays hysteroscopies are carried out instead.

What happens during a hysteroscopy

A hysteroscopy is a common procedure that is often carried out on an outpatient basis. This means you do not have to stay in hospital overnight.

It can be performed under local anaesthetic (when medication is used to numb a small area) or general anaesthetic (when you are asleep during the procedure), depending on the reason for your hysteroscopy.

The surgeon will use a device called a speculum to open up the walls of the vagina, in the same way it is used during a cervical smear test. The surgeon will then insert the hysteroscope through the cervix, into the womb.

Gas or fluid is often used to inflate the womb, to give the surgeon a better view.

If a biopsy or treatment is needed, such as the removal of polyps, other instruments will be passed into the womb.

A hysteroscopy usually takes between 10 and 30 minutes, depending on what needs to be done.

Recovering from a hysteroscopy

Some women will experience cramping similar to period pains after a hysteroscopy, but this usually passes after a few days.

Most women feel they can return to normal activities, such as work, the day after the procedure.

Risks

A hysteroscopy is a very safe procedure, with a low risk of complications.

The two most commonly reported complications of a hysteroscopy are:



accidental damage to the womb or cervix, which may require further treatment to correct – this occurs in around 1 in 135 cases



excessive bleeding during or after surgery, which happens in around 1 in 400 cases



In almost all cases, the benefits of having a hysteroscopy far outweigh the potential risks.


Hysteroscopy illustration key

 

1. Scope
2. Pelvic bone
3. Bladder
4. Uterus
5. Anus






About periods


 



Find out everything you need to know about the causes, symptoms and management of periods



 

How a hysteroscopy is performed 

Before having a hysteroscopy, you may need to do a few tests to check whether you can undergo surgery.

These may include blood tests, a pregnancy test and a cervical smear test, which will check for any infections or abnormalities with your cervix.

GnRH agonists

If you are having a hysteroscopy to remove abnormal tissue growth, such as fibroids or polyps, you may be given a type of medication called a gonadotropin-releasing hormone (GnRH) agonist. If you are given these, you will have to take them for a little while before you have surgery.

This may help shrink abnormal tissue growth, which will increase the chances of successful surgery and reduce the risk of excessive bleeding.

GnRH can cause menopausal-like side effects, such as hot flushes and excessive sweating. However, these should go away when you stop taking the medication.

Choice of anaesthetic

You can have a hysteroscopy either with or without a local anaesthetic, depending on what type of procedure you are having. It will usually be carried out in the outpatients department of a hospital.

Having a hysteroscopy is similar to having a smear test, but takes a little longer. It should not hurt. There is usually some discomfort, similar to period pain. If you are not having any anaesthetic, you may wish to take a painkiller, such as ibuprofen, beforehand.

The procedure can also be carried out under general anaesthetic(when you are asleep) as a day case operation. This may be recommended if your surgeon expects to do extensive treatment at the same time, or if you request it.

The procedure

The surgeon will gently put an instrument called a speculum into your vagina. This holds the walls of the vagina open, enabling easy access to your womb.

Next, the vagina and cervix are cleaned with an antiseptic solution. The surgeon will then insert the hysteroscope through your cervix, into your womb. A hysteroscope is a long, thin tube with a light source and a camera on the end.

As the womb is small, gas or fluid may be pumped inside to make it larger. This helps the surgeon see the lining of the womb, and any abnormalities, more clearly. The camera at the end of the hysteroscope sends pictures from the inside of your womb to a video screen.

Surgical instruments similar to a hysteroscope can also be passed into your womb, if required, where they can be used to cut or burn away abnormal tissue growth. Tissue can be removed using a number of techniques such as lasers, an electrical current and specially designed blades.

A sample of tissue can also be removed for further testing (biopsy) if required.

A hysteroscopy usually takes between 10 and 30 minutes, depending on what needs to be done. You will need some recovery time after the procedure.


Hysteroscopy illustration key

 

1. Scope
2. Pelvic bone
3. Bladder
4. Uterus
5. Anus





Alternatives to hysteroscopy

Depending on your symptoms and circumstances, your womb could also be examined by using a:



pelvic ultrasound – a technique that uses sound waves to produce an image of the inside of your womb



endometrial aspiration – when a narrow tube is passed through your cervix into your womb, with suction used to remove a sample of your womb's lining



These alternatives may be performed alongside a hysteroscopy, but do not provide as much information. Sometimes, simple treatments can also be performed during a hysteroscopy.

After the procedure 

You should be able to go home on the same day you have your hysteroscopy. If you had an anaesthetic, you may have to stay in hospital until it has worn off.

When you get home, rest as much as possible. Some women experience cramping afterwards that is similar to period pain. You may also get shoulder pain – a result of the gas or fluid used to inflate your womb. Any cramps or pain should pass within a few days. You can take painkillers in the meantime.

Most women feel they can return to normal activities, such as work, the day after having a hysteroscopy. However, you may wish to have a few days off to rest. The amount of time you need will depend on if you had additional treatment at the same time (for example, to remove fibroidsor polyps).

If you are undergoing treatment at the same time as your hysteroscopy, you will probably experience some bleeding afterwards. Should this happen, you may find it helpful to wear a sanitary towel until it wears off.

Even if you are not having treatment at the same time as your hysteroscopy, you may still experience some vaginal bleeding and discharge. This is normal and should pass in a few days, although it can last for several weeks.

You shouldn't use tampons for at least a month after having a hysteroscopy, as this will help reduce the risk of infection.

If you have had a general anaesthetic, avoid drinking alcohol and driving a car for at least 24 hours.

Follow your surgeon’s advice on exercise, sex and contraception.

When to contact your doctor

After having a hysteroscopy, you should contact your doctor if you suffer from:



severe pain that can't be controlled by over-the-counter painkillers



heavy bleeding



vaginal discharge that is smelly or unpleasant



a fever (temperature over 38°C/100.4°F)



Getting your results

Your surgeon may give you your hysteroscopy results immediately if it is to explore conditions such as polyps or fibroids. 

If a biopsy is needed, it can take between two and six weeks to get your results. These may be sent through the post to your home address or to your doctor’s surgery. Before leaving the hospital, check how you will get your results.

Risks of hysteroscopy 

Complications after a hysteroscopy are rare, but can include accidental damage, excessive bleeding or infection.

Accidental damage

Accidental damage to the womb or cervix is the most common complication of a hysteroscopy. This happens in around 1 in every 135 cases.

A section of the cervix can sometimes tear, or the lining of the womb can sometimes become perforated (a hole is made in it).

Minor damage that does not cause excessive bleeding is not usually a cause for concern. However, if a more serious injury is suspected, you may need a procedure known as a diagnostic laparoscopy. This is where a tiny camera is passed into your womb, through an incision in your abdomen, to look at the damage.

In rare cases (around 1 in every 700) further surgery is then needed to repair the damage.

Excessive bleeding

Excessive bleeding during or after surgery occurs in around 1 in 400 cases. This happens because a blood vessel is accidentally damaged.

If the bleeding begins during surgery, the surgeon may be able to stem the bleeding by increasing the amount of fluid or gas in the womb. This will usually stop the bleeding.

If bleeding continues after surgery, a small balloon filled with fluid can be inserted inside the womb. Much like gas or fluid, the balloon's pressure can help stem the bleeding. The balloon is then removed after 24 hours.

An alternative method is to use medications such as vasopressin, which narrows the blood vessels, or tranexamic acid, which helps stabilise blood clots.

It can sometimes be necessary to plug the blood vessel shut with small pieces of plastic or gel (known as embolisation). 

In very rare cases, if the above methods don't work, it may be necessary to remove the womb (hysterectomy).

Infection

Occasionally, the womb or cervix can become infected after surgery. This can lead to:



heavy bleeding



vaginal discharge that is smelly or unpleasant



a fever (temperature over 38°C/100.4°F)



stomach cramps



If you experience any of these symptoms, it's important to either contact the hospital or your own GP. Most infections can be treated using a short course of antibiotics.









Dilatation and curettage (D&C)