Hysteroscopy Explained: Understanding this Diagnostic Procedure

Image: Hysteroscopy procedure illustration by BruceBlaus, CC BY-SA 4.0, via Wikimedia Commons

A hysteroscopy is a valuable diagnostic and treatment procedure that allows healthcare professionals to examine the inside of the womb (uterus). If you've been referred for this procedure or are simply curious about what it involves, this guide will explain the process, why it's performed, and what you can expect before, during, and after the procedure.

What is a Hysteroscopy?

A hysteroscopy is a minimally invasive procedure that uses a thin tube with a small camera (hysteroscope) to look inside the uterus. The uterus is where a baby grows during pregnancy. The camera sends images to a screen, allowing the doctor to examine the uterine cavity in detail.

The procedure can be performed for diagnostic purposes (to investigate symptoms) or for treatment (to remove or treat certain conditions). Anyone with a uterus can have a hysteroscopy, as long as they are not pregnant.

Why Might You Need a Hysteroscopy?

There are several reasons why your doctor might recommend a hysteroscopy. These include investigating:

• Unexplained vaginal bleeding
• Very heavy periods or bleeding between periods
• Bleeding after menopause
• Fibroids or small growths (polyps) in the uterus
• Fertility problems or repeated miscarriages

A hysteroscopy can also be used to perform certain treatments, such as:

• Taking a sample of tissue (biopsy) for further testing
• Removing fibroids or polyps
• Retrieving a coil (IUS or IUD) when the threads are missing

Preparing for Your Hysteroscopy

If your GP or hospital doctor refers you for a hysteroscopy, you'll receive information about the procedure, including details about pain relief options. Here's what you should know before your appointment:

• You can usually bring a friend or family member for support – let the staff know in advance
• A nurse or other trained healthcare professional will be present during the procedure (a chaperone)
• Use contraception or avoid sexual intercourse between your last period and the hysteroscopy to ensure you're not pregnant
• You may be given a pregnancy test on the day of the procedure
• Take ibuprofen or paracetamol about 1 hour before the procedure to help manage discomfort

Pain Management Options

A hysteroscopy can cause discomfort similar to period pain, but for some people, the procedure can be very painful. It's important to discuss pain management with your healthcare provider, especially if:

• You experience painful periods that make you faint
• You've had painful vaginal examinations or cervical smears in the past
• You've experienced sexual violence, which could make the procedure difficult for you

Pain relief options may include:

• Over-the-counter pain medication (ibuprofen or paracetamol) taken before the procedure
• Local anesthetic
• Gas and air (if needed during the procedure)
• General anesthetic or intravenous sedation (not available at all facilities)

If you're particularly concerned about pain, discuss this with your healthcare provider in advance. You may be referred to a facility that offers general anesthetic or sedation options if appropriate.

The Hysteroscopy Procedure: What to Expect

On the day of your hysteroscopy, here's what typically happens:

• You'll meet the healthcare professional performing the procedure (the hysteroscopist)
• They'll explain the procedure again, discuss pain relief options, and answer any questions
• You'll be asked to sign a consent form
• You'll be positioned on an examination table, similar to having a smear test
• The hysteroscope (a thin tube with a camera) is inserted through your vagina and cervix into your uterus
• Salt water (saline solution) is gently injected through the tube to expand the uterus slightly and provide a clearer view
• The camera sends images to a screen, which you can watch if you wish
• If required, small instruments can be passed through the hysteroscope to take tissue samples or remove growths

The procedure usually takes 10 to 15 minutes, but may take longer if any treatments are performed, such as removing fibroids or polyps.

Hysteroscopy with General Anesthetic or Sedation

If you're having a hysteroscopy under general anesthetic or with intravenous sedation:

• You'll have a separate appointment before the procedure for health checks
• You may need to stay in the hospital overnight if you have general anesthetic
• You'll need someone to accompany you home afterward
• You should not drive yourself home

General anesthetic or sedation might be recommended if you've experienced severe pain during a previous attempt, have a history of painful examinations, or if additional procedures are planned during the hysteroscopy.

Recovery After a Hysteroscopy

After your hysteroscopy, you'll be moved to a recovery area until you feel ready to go home. Here's what to expect during recovery:

• It's normal to experience period-like pain for a couple of days
• You may have some bleeding or spotting for up to a week
• Over-the-counter pain medications like paracetamol, ibuprofen, or your usual period pain medicine can help manage discomfort
• Use sanitary pads rather than tampons until the bleeding stops
• Avoid exercise and sexual intercourse until the pain and bleeding have stopped
• Most people can return to normal activities within 24-48 hours

Potential Complications

Most hysteroscopies are quick and safe procedures with minimal complications. However, as with any medical procedure, there are some risks to be aware of:

• Infection – this can be treated with antibiotics if it occurs
• Perforation (a small hole in the wall of the uterus) – this is rare and usually occurs during the removal of polyps

If a perforation occurs, you may need to stay in the hospital overnight for observation. In most cases, this heals on its own, but occasionally surgery may be required to repair it.

Results and Follow-Up

Your healthcare provider will typically discuss the findings of your hysteroscopy with you after the procedure. If tissue samples were taken for biopsy, you'll be informed when and how you'll receive these results.

Depending on what was found during the hysteroscopy, your doctor may recommend:

• No further treatment if no abnormalities were found
• Additional tests or procedures if more investigation is needed
• Treatment options if a condition was diagnosed

Make sure to attend any follow-up appointments and don't hesitate to ask questions about your results or treatment plan.