Hysteroscopy

A hysteroscopy is a procedure to look inside your womb (uterus) to check for any problems. Sometimes, a problem can be treated at the same time. A hysteroscopy is done with a narrow tube-like telescope with a camera. This is called a hysteroscope. A specialist doctor (gynaecologist) will put the hysteroscope into your vagina and then pass it up through the neck of your womb (cervix) and into your womb.

About hysteroscopy

You may have a hysteroscopy for the following reasons.

• To find out what’s causing any unusual bleeding from your vagina and/or womb. This can include heavy periods, bleeding between periods or bleeding after menopause. For more information, see our FAQ ‘What is unusual vaginal bleeding?’
• To check for polyps (small growths of tissue) and some types of fibroid (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.
• To check for cancer in the lining of your womb (endometrial cancer).

Preparation for hysteroscopy

Your hospital will tell you how to prepare for your hysteroscopy procedure. If you’re still having periods, you need to be sure there’s no chance that you’re pregnant at the time of your procedure. For this reason, it’s important to use contraception or not have sex between your last period and the test.

Don’t worry if you’re bleeding at the time of your procedure. Your hysteroscopy can usually go ahead, unless it’s heavy, but check with your hospital.

You’ll usually have the procedure and go home on the same day.

Your hospital might tell you to take an over-the-counter painkiller such as ibuprofen (a non-steroidal anti-inflammatory medicine) an hour or two before your procedure.

You may not need an anaesthetic or you may have a local anaesthetic. You may be able to have a general anaesthetic if you prefer or if you’re having a longer and more complicated operation such as having fibroids treated. This means you’ll be asleep during the operation. A general anaesthetic can make you sick so it's important that you don't eat or drink anything for six hours before your hysteroscopy. Follow your anaesthetist or doctor or specialist nurse’s advice and if you have any questions, just ask.

Your nurse or doctor will discuss with you what will happen before, during and after your procedure, including any pain you might have. If you’re unsure about anything, ask. No question is too small. It’s important that you feel fully informed so you’re in a position to give your consent for the operation to go ahead. You’ll be asked to sign a consent form.

Hysteroscopy procedure

A hysteroscopy usually takes about 10 to 15 minutes but it depends on what you are having it for. Your doctor or specialist nurse will ask you to lie down with your legs up. You can put your legs into supports.

There are two main ways your doctor may do a hysteroscopy.

• Your doctor may put a speculum inside your vagina to help them see your cervix. This is the same instrument that’s used when you’re having a cervical smear test. They’ll then pass the hysteroscope through your cervix and into your womb.
• Sometimes another technique (called vaginoscopic hysteroscopy) is used in which your doctor or specialist nurse can avoid using a speculum by using a thin telescope instead. This can be more comfortable. They’ll pass the hysteroscope through your vagina and use the hysteroscope to find your cervix and pass through into your womb without a speculum. 

With both techniques, your doctor or specialist nurse will then put a sterile (clean) fluid into your womb to make it bigger, which helps your doctor or specialist nurse to see clearly. The camera on the hysteroscope sends pictures of the inside of your womb to a monitor where your doctor or specialist nurse can see it. They’ll look at these images and take a sample of tissue (biopsy) or do any treatment that’s needed. You can usually see this on the monitor too.

A hysteroscopy can be uncomfortable and sometimes painful, and you might have some pain like period pains while the hysteroscopy is being done. If you find it too painful, tell your doctor and they’ll stop. 

Aftercare for hysteroscopy

If you didn’t have an anaesthetic or had a local anaesthetic, you should be able to go home a short time after your procedure.

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

You might have some discomfort as the anaesthetic or painkiller wears off. You can take over-the-counter painkillers, such as paracetamol or ibuprofen if you need to.

You may have some bleeding from your vagina. You can use sanitary pads until the bleeding stops – it’s best not to use tampons.

Your nurse may give you a date for a follow-up appointment. If your doctor took tissue samples, it can take a couple of weeks to get the results. 

Most women don’t have any problems after having a hysteroscopy. But contact your doctor or go to the accident and emergency department of your local hospital if you have:

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

Recovery for hysteroscopy

If you had your hysteroscopy as an out-patient with no anaesthetic, you should be able to go back to your usual activities the same day. But take a day or two off work to recover if you can. If you’ve had a general anaesthetic and treatment, it’s likely to take longer to get back to normal so get plenty of rest for a few days.

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.

You can usually exercise when any bleeding and pain has settled down. It’s best to wait a week until you have sex. And most importantly, wait until you feel ready.

Side-effects of hysteroscopy

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

After a hysteroscopy, you may have:

• cramping pains for a day or two, like those you get during a period
• feeling or being sick
• bleeding from your vagina – this usually gets better after a few days, but can last for up to a week, depending on if you’ve had any treatment

Complications of hysteroscopy

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

• 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 or specialist nurse may put a special water-filled balloon inside your uterus to stop the bleeding.
• An infection, which means you may need antibiotics.

The risk of complications is higher if you have a hysteroscopy under general anaesthesia. 

Alternatives to hysteroscopy

Depending on what’s causing your symptoms, you may need to have other tests as well as or instead of a hysteroscopy. 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 tummy) 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 doctor needs to take a sample of the lining of your womb. They’ll put a narrow tube through your cervix and into your womb and use gentle suction to remove samples of the lining. These will be looked at under a microscope. You can have this done at the same time as a hysteroscopy.

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