Hysteroscopy

What is a hysteroscopy?

Hysteroscopy is primarily used to diagnose and treat the causes of abnormal uterine bleeding. The procedure allows your surgeon to look inside of your uterus with a tool called a hysteroscope. A hysteroscope is a thin, lighted tube that a surgeon inserts through your vagina to examine your cervix and the inside of your uterus.

Hysteroscopy can be a part of the diagnostic process, as well as the treatment process.

What is diagnostic hysteroscopy?

Diagnostic hysteroscopy identifies structural irregularities in your uterus that may be causing abnormal bleeding. Hysteroscopy may also be used to confirm the results of other tests, such as an ultrasound or hysterosalpingography (HSG). HSG is an X-ray dye test used to check whether your fallopian tubes are blocked. Blocked fallopian tubes may make it difficult to become pregnant.

What is operative hysteroscopy?

Operative hysteroscopy treats an abnormality detected during a diagnostic hysteroscopy. Your provider may perform a diagnostic and operative hysteroscopy at the same time, avoiding the need for a second surgery. During operative hysteroscopy, your surgeon uses a device to remove abnormalities that may be causing abnormal uterine bleeding.

Endometrial ablation is a procedure that treats abnormal uterine bleeding. Your surgeon uses the hysteroscope to look inside your uterus before using a device to destroy your uterine lining.

Why would I need a hysteroscopy?

Hysteroscopy is primarily used to identify and treat conditions that cause abnormal uterine bleeding, heavy menstrual bleeding, irregular spotting between periods and bleeding after menopause.

Your doctor may perform hysteroscopy to diagnose and correct the following uterine conditions:

• Polyps and fibroids: Hysteroscopy is used to find and remove these uterine structural abnormalities. Surgical removal of a polyp is called a hysteroscopy polypectomy. Surgical removal of a fibroid is called a hysteroscopy myomectomy.
• Adhesions: Also known as Asherman’s syndrome, uterine adhesions are bands of scar tissue that can form in your uterus and may lead to changes in menstrual flow and cause infertility. Hysteroscopy can help your doctor locate and remove the adhesions.
• Septums: Hysteroscopy can help determine whether you have a uterine septum, a malformation (defect) of the uterus that’s present from birth.

Hysteroscopy may also be used to:

• Diagnose the cause of repeated miscarriages or fertility problems.
• Locate an intrauterine device (IUD).
• Diagnose and remove placental tissue after birth.

Who is a candidate for hysteroscopy?

Your surgeon will review your medical history and evaluate your current health to determine whether a hysteroscopy is appropriate. Although there are many benefits associated with hysteroscopy, it’s not right for everyone. For example, you shouldn’t have a hysteroscopy if:

• You’re pregnant.
• You have a pelvic infection.

When should hysteroscopy be performed?

If your periods are regular, your surgeon will likely recommend scheduling your hysteroscopy for the first week after you stop bleeding. This timing will allow the best view of the inside of your uterus. If you have irregular menstrual cycles, you may need to work with your surgeon to find the best time for your hysteroscopy. The procedure can take place at any time if you’ve gone through menopause.

What happens before a hysteroscopy?

Your surgeon will ensure you’re a good candidate for a hysteroscopy, talk you through the procedure and answer any questions you may have. You’ll receive instructions so you’re prepared for your procedure.

Your provider may:

• Take a medical history and ask what medicines you’re taking, including vitamins and supplements. Before the procedure, you may need to stop taking medications that prevent blood clotting (anticoagulants), including aspirin.
• Perform a physical exam, pelvic exam and pregnancy test. You may need to take a blood test or complete other diagnostic tests depending on the specifics of your procedure.
• Explain how to prepare, including the clothes you should wear for the procedure, whether you’ll need to fast beforehand and whether you’ll need someone to drive you home after your hysteroscopy.

What happens during a hysteroscopy?

On the day of the procedure, you’ll be asked to empty your bladder and change into a hospital gown. You may receive anesthesia or a sedative to help you relax. The type of anesthesia you receive depends on whether the hysteroscopy will take place in a hospital or your surgeon’s office and whether other procedures will occur simultaneously.

You’ll be positioned on the exam table with your legs in stirrups. Once you’re in position, your surgeon will:

1. Perform a pelvic exam.
2. Dilate (open) your cervix so the hysteroscope can be inserted.
3. Insert the hysteroscope through your vagina and cervix into your uterus.
4. Send a liquid solution through the hysteroscope and into your uterus, gently expanding it and clearing any blood or mucus. This step allows your surgeon to view your uterus, uterine lining and fallopian tubes.
5. Inspect your uterine cavity and the openings of your fallopian tubes. The light from the hysteroscope makes it easier for your surgeon to get a clear view.
6. Insert surgical instruments through the hysteroscope that can be used to remove any irregular abnormalities (if surgery is needed).

A hysteroscopy can last anywhere from five minutes to more than an hour. The length of the procedure depends on whether it’s diagnostic or operative and whether an additional procedure, such as laparoscopy, is done simultaneously. Diagnostic hysteroscopy usually takes less time than operative.

What can I expect after a hysteroscopy?

If you received anesthesia during your hysteroscopy, you might be observed for several hours in the recovery room. You may have some cramping or light bleeding that lasts for a few days. It’s also not unusual to feel somewhat faint or sick immediately following your procedure.

Will I have to stay in the hospital overnight after a hysteroscopy?

Hysteroscopy is considered minor surgery and usually doesn’t require an overnight hospital stay. If your provider is concerned about your reaction to anesthesia, you may need to stay overnight.

What are the benefits of hysteroscopy?

Hysteroscopy can allow your surgeon to diagnose and treat conditions with a single surgery. In addition, a hysteroscopy enables surgery that’s both minimally invasive and precise. Hysteroscopy can allow your surgeon to locate abnormalities and remove them without damaging surrounding tissue.

How safe is hysteroscopy?

Hysteroscopy is considered a safe procedure. As with any surgery, complications can occur. With hysteroscopy, complications occur in less than 1% of cases and can include:

• Infection.
• Heavy bleeding.
• Intrauterine scarring.
• Reaction to the anesthesia.
• Injury to your cervix, uterus, bowel or bladder.
• Reaction to the substance used to expand your uterus.

How long does it take to recover from hysteroscopy?

Your recovery time depends on how extensive your procedure was — for instance, if your hysteroscopy was both diagnostic and operative. People recovering from a hysterectomy are often advised to avoid douching, intercourse or inserting anything into their vagina (like tampons) for two weeks following the procedure. You may be advised to avoid baths, swimming and hot tubs during your recovery.

Follow your surgeon’s guidance based on your unique situation.

When should I see my healthcare provider?

Contact your provider if you experience any of the following symptoms:

• Fever.
• Severe abdominal pain.
• Heavy vaginal bleeding.

How painful is a hysteroscopy?

Everyone’s experience is different. Studies have shown that factors like how long the procedure is, whether or not a person has given birth before and how anxious a person is prior to surgery may affect their pain perception during hysteroscopy.

Speak with your surgeon about your concerns. Ask about what you can expect to feel during your hysteroscopy. Ask about what type of anesthesia you’ll receive in order to remain comfortable throughout the procedure.

Are you awake for a hysteroscopy?

It depends. Anesthesia for hysteroscopy may be local, regional or general. General anesthesia will put you to sleep.

• Local anesthesia: A small part of your body will be numb for a short time.
• Regional anesthesia: A larger portion of your body will be numb for a few hours.
• General anesthesia: Your entire body will be numb for the whole surgery.

If you're having general anesthesia, you may not be able to eat or drink for a certain amount of time before the hysteroscopy.

Is hysteroscopy major surgery?

An operative hysteroscopy is considered minor surgery. It doesn’t usually require a hospital overnight stay. Unlike more invasive procedures that open your abdomen to access organs, a hysteroscopy can be performed through your vagina.

Is a D&C the same as a hysteroscopy?

No. Both a D&C (dilation and curettage) and an operative hysteroscopy allow your surgeon to remove tissue from your uterus. While a hysteroscopy enables your provider to find growths and remove them with precise surgical instruments, a D&C allows your surgeon to sample greater amounts of tissue from your uterine lining by performing a gentle scraping.

Should I be worried about hysteroscopy?

You shouldn’t be. Hysteroscopy is widely considered a safe procedure, with minimal risks involved.

A note from Cleveland Clinic

Hysteroscopy allows your provider to diagnose and treat a variety of conditions that may be causing abnormal bleeding. To prepare for your hysteroscopy, ask your surgeon about the specifics of your procedure, including how long it will last and what your recovery period will be like. Ask if additional procedures will occur simultaneously, like a laparoscopy. Understanding what’s involved during the day of your procedure and in the weeks ahead can provide you peace of mind as you prepare for your hysteroscopy.