This information is for you if you have been offered hysteroscopy as an outpatient. It may also be helpful if you are a partner, relative or friend of someone who has been offered this procedure.
What is an OPH?
An OPH 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 doing 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 done at the same visit, such as:
- Endometrial biopsy – taking a sample from the lining of the uterus. This can be done through the hysteroscope or after inserting a speculum and passing a thin tube through the cervix. You may experience period-like pain during this procedure, but the pain should not last long.
- Polyp removal – a polyp inside the uterus is a skin tag that looks like a small grape, sometimes on a stalk. Polyps are usually non-cancerous (benign) overgrowths of the lining of the uterus.
- Small fibroid removal – fibroids are knots in the muscle of the uterus that are non-cancerous (benign). They can sometimes bulge like a polyp into the lining of your uterus and your healthcare professional may advise removal to help with your symptoms.
- Insertion of a hormone-releasing intrauterine device (for example Mirena®). Removal of a coil from the uterus where the threads are not visible.
Key points
- Outpatient hysteroscopy (OPH) is a procedure carried out in the outpatient clinic that involves examination of the inside of your uterus (womb) with a thin telescope.
- There are many reasons why you may be referred for an OPH, such as to investigate and/or treat abnormal bleeding, to remove a polyp seen on a scan or to remove a coil with missing threads.
- The actual procedure usually takes 10-15 minutes. It can take longer if you are having any additional procedures.
- You may feel some pain or discomfort during an OPH. It is recommended that you take pain relief (usually 1g paracetamol or 400mg ibuprofen) 1-2 hours before the appointment.
- If it is too painful, it is important to let your healthcare professional know as the procedure can be stopped at any time.
- You may choose to have the hysteroscopy carried out under general anaesthetic. This will be done in an operating theatre, usually as a day-case procedure.
- Possible risks with hysteroscopy include pain, feeling faint or sick, bleeding, infection and rarely uterine perforation (damage to the wall of the uterus). The risk of uterine perforation is low
Why have I been referred for an OPH?
You may have been referred for an OPH for one of the following reasons:
- Bleeding after the menopause (postmenopausal bleeding).
- Very heavy periods.
- Bleeding between periods.
- Irregular bleeding while on hormonal treatment.
- Removal of a coil when the threads are not visible at the cervix
- Fertility concerns.
- Following a miscarriage.
- To investigate something seen inside the uterus on an ultrasound scan, such as an endometrial polyp or fibroid.
The purpose of your appointment is to find the cause of your problem and plan or undertake treatment if needed.
Your healthcare professional will discuss your options and whether an OPH is right for you.
What should I do before my appointment?
- You should eat and drink normally.
- You do not need to fast before your appointment.
- It is recommended that you take pain relief (400mg of Ibuprofen or 1g Paracetamol or whatever pain relief you find useful for period pain) at least one hour before your appointment.
- Bring a list of any medications that you are taking with you.
- You may wish to have a friend of family member accompany you.
Do I need to use contraception?
The procedure must not be performed if there is any chance that you are pregnant. To avoid this possibility, it is important to use contraception or avoid sex between your last period and your appointment. You may be offered a urine pregnancy test on arrival at your appointment.
Can I still have an OHP if I am bleeding?
It is best to keep the appointment. Sometimes it can be difficult to do the test if you are bleeding heavily. If you have any concerns, please ring and speak to your healthcare professional.
About intimate examinations
The nature of gynaecological care means that intimate examinations are often necessary. We understand that for some people, particularly those who may have anxiety or who have experienced trauma, physical or sexual abuse, such examinations can be very difficult.
If you feel uncomfortable, anxious or distressed at any time before, during or after an examination, please let your healthcare professional know. If you find this difficult to talk about, you may communicate your feelings in writing. Your healthcare professionals are there to help and they can offer alternative options and support for you.
Remember that you can always ask them to stop at any time and that you are entitled to ask for a chaperone to be present. You can also bring a friend or relative if you wish.
Are there alternatives to an OPH?
There may be other things to consider when deciding whether an OPH is the right choice for you, such as:
- If you faint during your periods because of pain.
- If you have experienced severe pain during a previous vaginal examination.
- If you have experienced difficult or painful cervical smears.
- If you have had a previous traumatic experience that might make the procedure difficult for you.
- If you do not wish to have this examination while awake.
- You may choose to have your hysteroscopy with either a general or spinal anaesthetic. This will be done in an operating theatre, usually as a day-case procedure. You can discuss this option with your healthcare professional. The risks and complications are lower when hysteroscopy is done as an outpatient procedure rather than under anaesthesia.
- You may choose not to have a hysteroscopy at all, though this may make it more difficult for your healthcare professional to find the cause of your symptoms and to offer the right treatment for you. They may then recommend a scan and biopsy to find out more information and/or may ask you to come back if your symptoms continue
What happens during an OPH?
On arrival
You will meet with your healthcare professional, who will explain the procedure and ask for your consent. This is a good time to ask any questions you may have.
There will be two or three healthcare professionals in the room. One of them will be with you throughout the procedure to support you. They will help you get comfortably positioned in a special chair and will ensure you are kept as covered as possible.
The procedure
A hysteroscope is passed through the cervix to give a clear view of the inside of your uterus. No cuts are needed. Fluid (saline solution) is used to help see the inner lining of your uterus and you will feel wet as the fluid trickles back out.
If no problems are found, the actual procedure will only take about 10-15 minutes. Sometimes, a biopsy (small sample) from the lining of your uterus may be taken and sent to the Laboratory for examination. Taking a biopsy can be painful, but the pain should not last long.
If a fibroid or polyp is found, it can sometimes be removed at the same time by using additional instruments. You may be offered a local anaesthetic to make you more comfortable, particularly if a wider hysteroscope is to be used. Tell your healthcare professional if the procedure is becoming painful.
During the OPH, your healthcare professional will look inside your uterus on a screen and you can also watch on the screen if you choose to. Photographs of the findings inside your uterus are often taken and kept in your healthcare notes.
What are the possible risks?
- Pain during or after an OPH is usually mild and similar to period pain. Simple pain relief medications can help. On occasion, women may experience severe pain.
- Feeling or being sick or fainting can affect a small number or women. However, these symptoms usually settle quickly. Let your healthcare professional know if you are feeling unwell during or straight after the procedure.
- Bleeding is usually very mild and is lighter than a period, settling within a few days. It is recommended that you use sanitary towels, not tampons. If the bleeding does not settle and gets worse, contact a healthcare professional, call NHS 24 on 111 for advice or visit the nearest Emergency Department.
- Infection is uncommon (1 in 400 women). It may appear as a smelly discharge, fever or severe pain in the tummy. If you develop any of these symptoms, contact your healthcare professional urgently.
- A failed or unsuccessful OPH can occur if it is not possible to pass the hysteroscope inside your uterus. Usually this happens when the cervix is tightly “closed” or scarred. If this happens, a healthcare professional will discuss alternative options with you.
If this happens, your healthcare professional will discuss alternative options with you.
- Damage to the wall of the uterus (uterine perforation) – rarely, a small hole is accidentally made in the wall of the uterus. This could also cause damage to nearby tissues. This happens in less than 1 in 1000 diagnostic hysteroscopy procedures, but is slightly more common if someone has a polyp or fibroid removed at the same time. It may mean that you have to stay in hospital overnight. Usually, nothing more needs to be done, but you may need a further operation to repair the hole.
Will an OHP hurt?
For most women, OPH is quick and safe, and is carried out with little pain or discomfort. OPH is often done without inserting a speculum, by using a thin telescope (called vaginoscopic OPH) as this is more comfortable.
However, everyone’s experience of pain is different and some women will find the procedure very painful. If it is too painful for you, let your healthcare professional know as the procedure can be stopped at any time you wish.
Your healthcare professional may offer a local anaesthetic injection into your cervix. This will require using a speculum to see your cervix and your healthcare professional will discuss this with you.
If you feel anxious about the procedure, you should talk to your healthcare professional before your appointment.
We may offer you nitrous oxide (Entonox or gas and air) especially if we are doing additional procedure like removal of polyp. In this situation you may be advised to wait a bit longer for recovery before you can drive.
How long does the visit take?
The actual procedure may only take 10-15 minutes. However the total visit may take up to 1-2 hours including consultation, having the procedure and recovery. If the polyps or small fibroids are removed at same time, this may take a bit longer.
You can rest in the outpatient clinic’s recovery area for as long as you need (usually about 20 minutes).
How will I feel afterwards?
You may get some period-like pain for 1-2 days. You may also have some spotting or fresh (bright red) bleeding that may last up to one week. These symptoms usually settle very quickly. Most women feel able to go back to their normal activities on the same day.
You can shower as normal.
Normal physical activity and sex can be resumed when any bleeding and discomfort has settled.
If needed, you can take pain relief such as 400mg Ibuprofen every eight hours or 1g of Paracetamol every four hours, or your usual period pain tablets.
If your pain is not controlled with the above medication, you should contact a healthcare professional, call NHS 24 on 111 for advice or visit your nearest Emergency Department.
It’s OK to Ask
It’s important to know what’s going on with your own healthcare. Knowing the right questions to ask can make all the difference. By being more involved, you’ll be able to make better decisions about your own care and treatment. To help you get the most out of your next appointment, there are four key questions it’s worth remembering to ask.
- What are the benefits of my treatment?
- What are the risks of my treatment?
- Any alternative treatments I can try?
- What if I do nothing?
Healthcare staff are more than happy to answer these and any other questions you may have. Feel better informed at your next appointment. Remember, it’s OK to Ask.
Further information
- A glossary of medical terms is available on the Royal College of Obstetricians and Gynaecologists (RCOG) website.
- National institute for Health and Care Excellence (NICE) guideline NG88, Heavy Menstrual bleeding: Assessment and Management
- A full list of useful organisations is available on the RCOG Website.
This information has been developed by the RCOG Patient Information Committee, the British Society for Gynaecology Endoscopy (BSGE) Hysteroscopy Subcommittee and service users.
