Hysteroscopy: Procedure, Uses, Risks & Recovery
Hysteroscopy: Procedure, Uses, Risks & Recovery
A hysteroscopy is a minimally invasive procedure that allows a gynaecologist to look directly inside the uterus (womb) using a thin camera called a hysteroscope.
It can be used to investigate abnormal bleeding, polyps, fibroids, adhesions and some fertility or recurrent miscarriage problems. One of its important advantages is that certain problems found during hysteroscopy can sometimes be treated during the same procedure.
Unlike an ultrasound, which creates images from outside the uterus, hysteroscopy allows the doctor to directly see the inside of the uterine cavity.
Hysteroscopy = looking inside the uterus with a small camera, and sometimes treating the problem at the same time.
A doctor may recommend hysteroscopy when there is a suspected problem inside the uterine cavity.
Common reasons include:
Heavy menstrual bleeding
Irregular or abnormal vaginal bleeding
Bleeding between periods
Bleeding after menopause
A suspected uterine polyp
A fibroid that projects into the uterine cavity
Scar tissue or adhesions inside the uterus
An abnormality seen on ultrasound or another scan
Some cases of infertility
Selected cases of recurrent miscarriage
Removal of an intrauterine contraceptive device when the threads cannot be seen or removed normally
Taking a biopsy of the uterine lining when indicated
Hysteroscopy can be both diagnostic and operative. This means the doctor may identify the problem and, when appropriate, treat it during the same procedure.
Hysteroscopy is particularly useful for identifying problems inside the uterine cavity, including:
Polyps are small growths arising from the lining of the uterus. They may cause:
Irregular bleeding
Bleeding between periods
Heavy periods
Abnormal bleeding after menopause
Some polyps can be removed during hysteroscopy.
Some fibroids grow partly or mainly into the uterine cavity. These are called submucosal fibroids.
Depending on their size, location and depth, they may sometimes be removed hysteroscopically.
Not every fibroid can be removed through hysteroscopy. Fibroids located mainly within the uterine muscle or on the outer surface of the uterus usually require a different approach, if treatment is needed.
Scar tissue inside the uterus is called intrauterine adhesions or synechiae.
They can sometimes occur after procedures involving the uterus, including after pregnancy-related events or uterine surgery.
Hysteroscopy allows the doctor to see these adhesions directly and, when appropriate, treat them.
Hysteroscopy can help identify certain abnormalities in the shape or cavity of the uterus.
Depending on the suspected condition, additional imaging such as 3D ultrasound or MRI may also be needed.
Yes, some fibroids can be removed during hysteroscopy.
The type most suitable for hysteroscopic removal is generally a submucosal fibroid, meaning a fibroid that projects into the uterine cavity.
The doctor passes instruments through the hysteroscope and removes the fibroid, sometimes using a specialised hysteroscopic tissue-removal system or resectoscope.
However, not every fibroid can be removed through hysteroscopy.
The decision depends on factors such as:
Size of the fibroid
Location
How much of the fibroid projects into the uterine cavity
How deeply it extends into the uterine muscle
Number of fibroids
Symptoms
Fertility plans
A fibroid that is mainly within the uterine wall or on the outer surface may require another treatment approach, if treatment is indicated.
The exact process depends on whether it is a diagnostic outpatient hysteroscopy or an operative hysteroscopy.
Generally:
You are positioned for the procedure.
The hysteroscope is gently passed through the vagina and cervix into the uterus.
Saline is introduced into the uterine cavity to expand it and provide a clear view.
The doctor examines the uterine lining and cavity.
If necessary, a biopsy may be taken.
If a suitable polyp, fibroid or adhesion is found, it may sometimes be treated during the same procedure.
A simple diagnostic hysteroscopy may take only around 10–15 minutes, although the total procedure can take longer when treatment or biopsy is required.
Not always.
The type of pain relief or anaesthesia depends on:
Whether the procedure is diagnostic or operative
The size of the instruments required
Whether treatment such as fibroid removal is planned
The patient's medical history
Cervical anatomy
Pain tolerance and previous experiences
The facility and procedure being performed
Without general anaesthesia in an outpatient setting
With local anaesthetic in selected cases
With intravenous sedation in some settings
Under general anaesthesia, particularly for operative procedures
An outpatient hysteroscopy may therefore be possible without being put completely to sleep. However, larger operative procedures may be performed under general anaesthesia.
If you are worried about pain, tell your doctor before the procedure. Pain during hysteroscopy can vary considerably between individuals, and you should have a discussion about available pain-relief options rather than assuming that the procedure must be done without adequate analgesia.
The main purpose is to look inside the uterus and identify an abnormality.
A biopsy may also be taken if required.
The procedure is used to treat a problem inside the uterus.
Depending on the condition, this may include:
Removing an endometrial polyp
Removing a suitable submucosal fibroid
Treating intrauterine adhesions
Removing a retained intrauterine device in selected cases
The advantage is that diagnosis and treatment can sometimes be combined.
Some women with recurrent pregnancy loss may be evaluated for abnormalities inside the uterus, such as:
Endometrial polyps
Submucosal fibroids
Intrauterine adhesions
Certain uterine structural abnormalities
Hysteroscopy can accurately identify abnormalities within the uterine cavity.
However, finding an abnormality does not automatically mean that treating it will prevent another miscarriage. The benefit of treatment depends on the specific condition, and evidence varies between different abnormalities.
After a simple outpatient hysteroscopy, many women can return home the same day.
You may experience:
Mild period-like cramps
Light vaginal bleeding or spotting
Tiredness for a short period
Recovery depends on whether additional treatment was performed.
If general anaesthesia or sedation was used, you will need to follow the hospital's instructions regarding driving, work and having someone accompany you home.
Recovery is usually relatively quick after a straightforward hysteroscopy.
Mild cramps and spotting can occur for several days. If a biopsy, polyp removal or fibroid treatment was performed, recovery may take longer.
Your doctor will advise you when you can resume:
Exercise
Sexual intercourse
Work
Other normal activities
Follow the specific instructions given by the hospital or gynaecologist, as recovery depends on exactly what was done.
Hysteroscopy is generally considered a safe procedure, but like any medical procedure, it has potential risks.
These can include:
Pain or cramping
Bleeding or spotting
Infection
Feeling faint or nauseated
Difficulty passing the hysteroscope through the cervix
Injury to the uterus, including uterine perforation
Rarely, injury to nearby structures or the need for additional treatment
The risk depends partly on whether the procedure is diagnostic or operative and what treatment is performed.
Seek medical advice if you develop:
Heavy or increasing vaginal bleeding
Severe or worsening abdominal/pelvic pain
Fever or chills
Foul-smelling vaginal discharge
Feeling significantly unwell
These symptoms can indicate complications such as infection or, rarely, another procedure-related problem
No. Hysteroscopy examines the inside of the uterus. It can show the openings of the fallopian tubes inside the uterine cavity, but it cannot reliably determine whether the entire tubes are open. HSG, HyCoSy or selected laparoscopic dye testing may be used to assess tubal patency.
Yes, some fibroids can be removed through hysteroscopy. This is particularly applicable to fibroids that project into the uterine cavity, known as submucosal fibroids. Fibroids located mainly within the uterine wall or on its outer surface may require a different treatment approach.
It can in selected situations. If hysteroscopy identifies and treats a cavity-distorting abnormality such as a suitable submucosal fibroid, treatment may improve the chance of pregnancy. But hysteroscopy itself is not a general fertility-enhancing treatment, and a normal hysteroscopy does not automatically increase fertility.
No. Some diagnostic hysteroscopies are performed as outpatient procedures without general anaesthesia. Local anaesthesia, sedation or general anaesthesia may be used depending on the procedure, patient and clinical setting. Operative hysteroscopy is more likely to require anaesthesia.
A straightforward diagnostic hysteroscopy may take around 10–15 minutes, while procedures involving biopsy or removal of a polyp, fibroid or adhesions can take longer.
Hysteroscopy does not diagnose every cause of infertility. It is mainly used to evaluate the uterine cavity. Infertility can also result from ovulation problems, fallopian-tube disease, endometriosis, age-related fertility decline and male-factor causes, so a complete fertility evaluation may require several investigations.
Yes. Many endometrial polyps can be removed during hysteroscopy, sometimes during the same procedure in which they are diagnosed.
Hysteroscopy can identify an abnormal area inside the uterus and allow a biopsy to be taken. The tissue is then examined in a laboratory to determine whether abnormal, precancerous or cancerous cells are present.
Yes, in many cases. Hysteroscopy itself does not prevent future pregnancy. If a condition affecting the uterine cavity has been treated, your doctor will advise you when it is appropriate to start trying to conceive, depending on the procedure performed and your individual circumstances.
Hysteroscopy is a minimally invasive procedure used to directly examine the inside of the uterus.
It is particularly useful for diagnosing and treating conditions such as endometrial polyps, suitable submucosal fibroids and intrauterine adhesions, and may form part of an evaluation for infertility or recurrent miscarriage.
Remember:
Hysteroscopy looks inside the uterus.
It does not reliably test whether the fallopian tubes are open.
Some fibroids and polyps can be removed during hysteroscopy.
It does not automatically increase fertility.
Fertility may improve when a relevant uterine-cavity problem is identified and appropriately treated.
General anaesthesia is not always necessary.
The procedure and anaesthesia should be tailored to the patient and the treatment required.
For women with abnormal bleeding, suspected polyps or fibroids, infertility, or recurrent pregnancy loss, the decision to undergo hysteroscopy should be based on the individual clinical situation rather than the test being used routinely for everyone.