Hysteroscopy

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A hysteroscopy is a procedure used to examine the inside of the womb (uterus).

 

It is carried out using a hysteroscope, which is a narrow telescope with a light and camera at the end. Images are sent to a monitor so your doctor or specialist nurse can see inside your womb.

 

The hysteroscope is passed into your womb through your vagina and cervix (entrance to the womb), which means no cuts need to be made in your skin.

 

 

When a hysteroscopy may be carried out

 

A hysteroscopy can be used to:

 

• investigate symptoms or problems – such as heavy periods, unusual vaginal bleeding, bleeding after the menopause, pelvic pain, repeated miscarriages or difficulty getting pregnant

 

• diagnose conditions – such as fibroids and polyps (non-cancerous growths in the womb)

 

• treat conditions and problems – such as removing fibroids, polyps, displaced intrauterine devices (IUDs) and intrauterine adhesions (scar tissue that causes absent periods and reduced fertility)

 

A procedure called dilatation and curettage (D&C) used to be common to examine the womb and remove abnormal growths, but now hysteroscopies are carried out instead.

 

 

Is a hysteroscopy painful?

 

This seems to vary considerably between women. Some women feel no or only mild pain during a hysteroscopy, but for others the pain can be severe.

 

If you find it too uncomfortable, tell the doctor or nurse. They can stop the procedure at any time.

 

If you're worried, speak to the doctor or nurse before having the procedure about what to expect and ask them about pain relief options.

 

 

Risks of a hysteroscopy

 

A hysteroscopy is generally very safe but, like any procedure, there is a small risk of complications. The risk is higher for women who have treatment during a hysteroscopy. 

 

Some of the main risks associated with a hysteroscopy are:

 

• accidental damage to the womb – this is uncommon but may require treatment with antibiotics in hospital or, in rare cases, another operation to repair it

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• accidental damage to the cervix – this is rare and can usually be easily repaired

 

• excessive bleeding during or after surgery – this can occur if you had treatment under general anaesthetic and can be treated with medication or another procedure; very rarely, it may be necessary to remove the womb (hysterectomy)

 

• infection of the womb – this can cause smelly vaginal discharge, a fever and heavy bleeding; it can usually be treated with a short course of antibiotics from your GP

 

• feeling faint – this affects 1 in every 200 women who have a hysteroscopy carried out without an anaesthetic or just a local anaesthetic

 

 

What happens during a hysteroscopy

 

A hysteroscopy is usually carried out on a day-case basis. This means you do not have to stay in hospital overnight.

 

General anaesthetic is used if you're having treatment during the procedure or you would prefer to be asleep while it's carried out.

 

A hysteroscopy can take up to 30 minutes in total, although it may only last around 5 to 10 minutes if it's just being done to diagnose a condition or investigate symptoms.

 

 

Preparing for a hysteroscopy

 

In the days and weeks before a hysteroscopy, you may be advised to:

 

• have tests to check whether you can have the procedure, such as blood tests and a pregnancy test – these may be done at an appointment about a week before your hysteroscopy

 

• use contraception – a hysteroscopy cannot be carried out if you're pregnant or have had unprotected sexual intercourse since your last period

 

• stop smoking – if you're due to have a general anaesthetic and you smoke, stopping smoking in the lead-up to the procedure can help reduce your risk of complications from the anaesthetic

 

• If you're going to have fibroids removed, you may be given medicine to help shrink them beforehand.

 

 

On the day of your hysteroscopy

 

If you're having a general anaesthetic, you'll need to avoid eating or drinking for a few hours before the procedure. Your appointment letter will mention whether this applies to you.

 

It's a good idea to wear loose, comfortable clothes when you arrive for your appointment, as you'll be asked to remove any clothes from below your waist and change into a hospital gown for the procedure.

 

You can bring a friend or relative with you for support, although they will not be allowed into the operating theatre.

 

 

The actual procedure

 

A hysteroscopy usually takes between 5 and 30 minutes. During the procedure:

 

• you lie on a couch with your legs held in supports, and a sheet is used to cover your lower half

 

• an instrument called a speculum may be inserted into your vagina to hold it open (the same instrument used for a cervical screening test), although this is not always needed

 

• the vagina and cervix are cleaned with an antiseptic solution

 

• a hysteroscope (long, thin tube containing a light and camera) is passed into your womb 

 

• fluid is gently pumped into the womb to make it easier for your doctor to see inside

 

• the camera sends pictures to a monitor so your doctor or specialist nurse can spot any abnormalities

 

Usually, a small sample of tissue from the womb lining may be removed for further testing. This is known as an endometrial biopsy.

 

If you're having a hysteroscopy to treat a condition such as fibroids or polyps, fine surgical instruments can be passed along the hysteroscope. These are used to cut or burn away the abnormal tissue.

 

 

Recovering from a hysteroscopy

 

You may wish to have a few days off to rest if general anaesthetic was used.  Following general anaesthetic, you won't be able to drive for at least 24 hours, so you'll have to arrange for someone to take you home.

 

While you're recovering:

 

• you can eat and drink as normal straight away

 

• you may experience cramping that's similar to period pain and some spotting or bleeding for a few days – this is normal and nothing to worry about unless it's heavy

 

• you should avoid having intercourse for a week, or until any bleeding has stopped, to reduce the risk of infection (see below)

 

• Your doctor or nurse will discuss the findings of the procedure with you before you leave the hospital.

 

Recovering at home

 

It's a good idea to rest when you get home.

 

If you had a general anaesthetic, someone should stay with you for at least 24 hours until the effects of the anaesthetic have worn off. Don't drive or drink alcohol during this time.

 

While you recover, you may experience:

 

• cramping that's similar to period pain – this should pass in a few days and you can take regular painkillers such as paracetamol or ibuprofen in the meantime

 

• spotting or bleeding – this can last up to a week or more; use sanitary towels rather than tampons until your next period to help reduce the risk of your womb or cervix (entrance to the womb) becoming infected

 

These side effects are normal and nothing to worry about, but you should seek medical advice if they are severe.

 

 

Returning to your normal activities

 

You may wish to have a few days off to rest, particularly if you had treatment such as fibroids or polyps removal and a general anaesthetic was used.

 

Your doctor or surgeon can advise you about any activities you need to avoid while you recover, but generally speaking:

 

• you can eat and drink as normal straight away – if you feel a bit sick after a general anaesthetic, try eating small, light meals at first

 

• you can have a shower the same day and a bath the next day, unless your doctor advises you differently. Following general anaesthetic you may still be feeling dizzy so it is a good idea to make sure there is another adult around to help you

 

• you should avoid having sex for a week, or until any bleeding stops – this will help to reduce the risk of infection

 

 

Getting your results

 

Your doctor or nurse will let you know whether they found anything unusual during your hysteroscopy, or discuss how any treatment went, straight away.

 

A follow-up appointment will be organised to discuss the histology results as well plan any further necessary steps.

 

 

When to get medical advice

 

Contact your GP or the hospital clinic if you:

 

• have severe pain that isn't relieved by regular painkillers

 

• have heavy bleeding that means you have to change sanitary pads frequently

 

• pass bright red blood or large clots

 

• have foul-smelling vaginal discharge

 

• feel hot and shivery

 

These symptoms could be a sign of a problem, such as an infection.