Hysteroscopy Explained: Understanding this Diagnostic Procedure
Hysteroscopy procedure illustration. 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 have been referred for this procedure or are simply curious about what it involves, this guide will explain the process, why it is 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
Important: A hysteroscopy must not be performed if you are or could be pregnant. If there is any possibility you might be pregnant, make sure to inform your healthcare provider before the procedure.
Preparing for your hysteroscopy
If your GP or hospital doctor refers you for a hysteroscopy, you will receive information about the procedure, including details about pain relief options. Here is 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 are 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 is important to discuss pain management with your healthcare provider, especially if:
- You experience painful periods that make you faint
- You have had painful vaginal examinations or cervical smears in the past
- You have 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 are 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 is what typically happens:
- You will meet the healthcare professional performing the procedure (the hysteroscopist)
- They will explain the procedure again, discuss pain relief options, and answer any questions
- You will be asked to sign a consent form
- You will 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.
Your Control: You can ask to stop the procedure at any time if you are experiencing significant discomfort or pain. You may be offered additional pain relief, or you might choose to reschedule the procedure with different pain management options.
Hysteroscopy with general anesthetic or sedation
If you are having a hysteroscopy under general anesthetic or with intravenous sedation:
- You will have a separate appointment before the procedure for health checks
- You may need to stay in hospital overnight if you have general anesthetic
- You will need someone to accompany you home afterward
- You should not drive yourself home
General anesthetic or sedation might be recommended if you have 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 will be moved to a recovery area until you feel ready to go home. Here is what to expect during recovery:
- It is 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 hospital overnight for observation. In most cases, this heals on its own, but occasionally surgery may be required to repair it.
When to Seek Help: Contact the hospital or clinic where you had the procedure urgently if you experience:
- Bleeding that gets worse or does not stop after a few days
- Abdominal pain that worsens and is not relieved by pain medication
- A high temperature
- Smelly vaginal discharge
You can also call 111 or get help from 111 online if you are concerned about your symptoms.
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 will be informed when and how you will 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 do not hesitate to ask questions about your results or treatment plan.
Frequently asked questions
A hysteroscopy is a minimally invasive procedure used to examine the inside of the womb. A thin, flexible tube with a camera at the end, called a hysteroscope, is inserted through the vagina and cervix, allowing your doctor to see high-resolution images of the uterine cavity on a monitor. It is used both for diagnosis (finding the cause of symptoms) and treatment (removing polyps or fibroids). No incisions are needed and the procedure typically takes 10 to 15 minutes.
A hysteroscopy may be recommended to investigate abnormal bleeding such as unusually heavy periods, bleeding between periods, or post-menopausal bleeding. It is also used to identify or remove fibroids and polyps, investigate repeated miscarriages or difficulty conceiving, and to locate or remove a lost contraceptive coil. A hysteroscopy cannot be performed during pregnancy, so inform your team if there is any possibility you might be pregnant.
Many women describe the sensation as similar to period cramps, though everyone's pain threshold is different. To manage discomfort, you can take ibuprofen or paracetamol about an hour before the appointment. A local anaesthetic can be used to numb the cervix during the procedure. If you have a history of painful examinations or significant anxiety, you may be referred to a facility offering sedation or general anaesthetic. You are in control throughout and can ask to stop at any time if you feel too uncomfortable.
You will be positioned on an examination table similar to a smear test. The hysteroscope is gently passed through the vagina and cervix into the uterus, no cuts are required. A small amount of saline is used to expand the uterus slightly to give a clear view. If necessary, the doctor may take a tiny tissue sample (biopsy) or remove small growths through the tube during the same procedure. The whole process usually takes 10 to 15 minutes.
Most women return to normal activities within 24 to 48 hours. Period-like cramping for a few days and light spotting or bleeding for up to a week are entirely normal. Avoid strenuous exercise and sexual intercourse until any bleeding has stopped. Use sanitary pads rather than tampons during recovery to reduce the risk of infection. Contact your clinic immediately if you experience heavy bleeding that will not stop, severe abdominal pain that does not respond to painkillers, a high temperature, or unusual vaginal discharge.
Hysteroscopy is a very safe procedure. Rare risks include infection, which is usually treatable with a short course of antibiotics, and perforation, a tiny hole in the uterine wall, which is uncommon and often heals on its own but may require observation. Your consultant will discuss these risks with you before the procedure. Direct visualisation of the uterine cavity is the gold standard for diagnosing many gynaecological conditions, making hysteroscopy a fast and effective way to get the answers you need.
Final thoughts
A hysteroscopy is a valuable diagnostic and treatment tool that allows for direct visualisation of the uterine cavity with minimal invasion. While it can cause temporary discomfort, the procedure provides important information about your reproductive health that can guide appropriate treatment decisions.
Remember that your experience matters, and you have the right to discuss pain management options that work for you. Open communication with your healthcare provider before, during, and after the procedure is key to ensuring the best possible experience and outcomes.
If you have any questions or concerns about an upcoming hysteroscopy, do not hesitate to discuss these with your healthcare provider. They can provide personalised advice based on your specific medical history and circumstances.