Hysteroscopy

This information is for you if you have been offered a hysteroscopy. It may also be helpful if you are a partner, relative or friend of someone who has been offered this procedure.

A hysteroscopy may be carried out as an outpatient procedure while you are awake, or as a day-case procedure under anaesthetic. Your healthcare professional will discuss the most appropriate option for you.

What is a hysteroscopy?

A hysteroscopy is a procedure that involves examining the inside of your uterus (womb). This is done by passing a thin telescope-like device, called a hysteroscope, fitted with a small camera, through the neck of the womb (cervix). The healthcare professional carrying out the procedure can then see whether there are any problems inside your uterus that may need further investigation or treatment.

It may be possible for a minor procedure to be carried out at the same visit, such as:

Endometrial biopsy, taking a sample from the lining of the uterus.
Polyp removal.
Removal of a small fibroid.
Insertion of a hormone-releasing intrauterine device (for example Mirena®).
Removal of a coil where the threads are not visible.

Key points

Hysteroscopy is used to investigate and sometimes treat conditions affecting the uterus.
It can be performed as an outpatient procedure or under anaesthetic in an operating theatre.
The actual procedure usually takes 10 to 15 minutes but may take longer if additional treatment is required.
You may experience pain or discomfort during or after the procedure.
The procedure can be stopped at any time if you find it too uncomfortable.
Possible risks include pain, bleeding, infection, feeling faint or sick, and rarely damage to the wall of the uterus (uterine perforation).

Why have I been referred for a hysteroscopy?

You may have been referred for one of the following reasons:

Bleeding after the menopause (postmenopausal bleeding).
Heavy periods.
Bleeding between periods.
Irregular bleeding while taking hormone treatment.
Removal of a coil where the threads cannot be seen.
Fertility concerns.
Following a miscarriage.
To investigate a polyp, fibroid or other abnormality seen on an ultrasound scan.

The purpose of your appointment is to find the cause of your symptoms and plan or undertake treatment if required.

What should I do before my appointment?

Eat and drink normally if you are attending for an outpatient procedure.
If you are having your hysteroscopy under anaesthetic, follow the fasting instructions given by the hospital.
Take pain relief such as 400mg ibuprofen or 1g paracetamol around one hour before an outpatient appointment unless advised otherwise.
Bring a list of any medications you are taking.
You may wish to bring a friend or family member with you.

Do I need to use contraception?

The procedure must not be performed if there is any possibility that you are pregnant. It is important to use contraception or avoid sexual intercourse between your last period and your appointment. You may be offered a urine pregnancy test when you arrive.

Can I still have a hysteroscopy if I am bleeding?

It is usually best to keep your appointment. Occasionally heavy bleeding may make the procedure more difficult. If you are concerned, contact your healthcare professional before attending.

About intimate examinations

Gynaecological care often involves intimate examinations. We understand that some people may find these difficult, particularly if they have experienced anxiety, trauma, physical abuse or sexual abuse.

Please tell your healthcare professional if you are feeling anxious, uncomfortable or distressed. If you find this difficult to discuss, you may communicate your concerns in writing.

You can ask for the procedure to stop at any time. You are also entitled to request a chaperone and may bring a friend or relative with you if you wish.

Are there alternatives to hysteroscopy?

You may choose to have the procedure under general or spinal anaesthetic rather than as an outpatient.
You may decide not to have a hysteroscopy.
Your healthcare professional may recommend ultrasound scans, biopsies or ongoing monitoring instead.
Without hysteroscopy it may be more difficult to identify the cause of your symptoms and recommend the most appropriate treatment.

What happens during an outpatient hysteroscopy?

On arrival

You will meet with your healthcare professional who will explain the procedure, answer your questions and ask for your consent.

There will usually be two or three healthcare professionals present. One member of staff will stay with you throughout the procedure to provide support.

The procedure

The hysteroscope is gently passed through the cervix and into the uterus. No cuts or incisions are required.

A sterile saline solution is used to expand the uterus and provide a clear view of the lining.

If required, a biopsy may be taken or a polyp, fibroid or coil removed during the same appointment.

Many people choose to watch the procedure on the screen. Photographs may be taken and stored in your healthcare record.

Sometimes a local anaesthetic or Entonox (gas and air) may be offered to improve comfort.

What happens if my hysteroscopy is carried out under anaesthetic?

Some people choose, or are advised, to have their hysteroscopy under general or spinal anaesthetic. This is usually performed as a day-case procedure in an operating theatre.

Before your procedure

You will receive admission instructions before your operation. If you are having a general anaesthetic, you will need to follow fasting instructions provided by the hospital.

A member of the healthcare team will review your medical history, confirm your procedure and answer any questions before treatment begins.

During your procedure

Once you are under anaesthetic, the hysteroscope is inserted through the cervix into the uterus. Any planned investigations or treatments can then be carried out safely and comfortably.

After your procedure

You will recover in a recovery area until you are fully awake and comfortable. Most patients return home on the same day.

You must arrange for a responsible adult to take you home and stay with you following a general anaesthetic.

For 24 hours after a general anaesthetic you should not:

Drive.
Operate machinery.
Drink alcohol.
Sign important legal documents.

What are the possible risks?

Pain: Usually mild and similar to period pain, although occasionally severe.
Feeling faint or sick: A small number of people may feel dizzy, faint or nauseous during or shortly after the procedure.
Bleeding: Light bleeding or spotting is common for a few days after the procedure.
Infection: Uncommon, affecting approximately 1 in 400 people. Symptoms include increasing pain, fever or an unpleasant discharge.
Unsuccessful procedure: Occasionally it may not be possible to pass the hysteroscope into the uterus.
Uterine perforation: Rarely, a small hole may be made in the wall of the uterus. This occurs in fewer than 1 in 1,000 diagnostic procedures but is slightly more common when removing a polyp or fibroid. Further treatment or overnight observation may be required.

Will a hysteroscopy hurt?

Most people experience little or only mild discomfort. A thin telescope is often used without the need for a speculum, making the procedure more comfortable.

Everyone experiences pain differently, however, and some people may find the procedure painful.

If it becomes too uncomfortable, tell your healthcare professional immediately. The procedure can be paused or stopped at any time.

A local anaesthetic may be offered and, for certain procedures, Entonox (gas and air) may also be available.

How long does the visit take?

The hysteroscopy itself usually takes around 10 to 15 minutes.

Your total visit may last between one and two hours, allowing time for consultation, preparation, the procedure and recovery.

If additional treatments such as polyp or fibroid removal are carried out, the appointment may take longer.

How will I feel afterwards?

You may experience period-like pain for one or two days and light bleeding or spotting for up to a week.

Most people feel able to return to normal activities on the same day, although recovery from procedures carried out under anaesthetic may take a little longer.

You can shower normally.

Sexual activity and exercise can usually be resumed once any bleeding and discomfort have settled.

If required, pain relief such as ibuprofen or paracetamol can be taken according to the manufacturer’s instructions.

If your pain is not controlled by pain relief, if bleeding becomes heavy, or if you develop signs of infection such as fever, increasing pain or offensive discharge, contact a healthcare professional urgently, call NHS 24 on tel:111111 or attend your nearest Emergency Department.