A hysteroscopy is an investigation that allows your doctor or nurse to look directly inside your womb (uterus) using a very small camera (hysteroscope).

An outpatient hysteroscopy is when the hysteroscopy is done without a general anaesthetic (where you are put to sleep) and you do not need to be admitted to hospital. Your consultant may also carry out other procedures during the hysteroscopy, such as taking a sample of the lining of your womb, removing polyps or inserting a coil, but they will only do this after discussing it with you and getting your consent.

Having the procedure without a general anaesthetic is beneficial because you will not need to be admitted to hospital or stay overnight, you will recover more quickly and there are fewer risks than with a general anaesthetic. The alternative is to have the hysteroscopy performed with a general anaesthetic (where you are put to sleep). This can be performed in Forth Valley Royal Hospital, usually as a day procedure where you can go home the same day if you can arrange for an adult to collect you from hospital and stay with you overnight.

What are the risks of an outpatient hysteroscopy?

• Pain: You may experience some discomfort during the procedure but most women do not experience significant pain. Please tell us if you are finding the procedure painful.
• Vaginal bleeding and discharge: Most women will experience some vaginal bleeding or discharge after the hysteroscopy, but this usually settles by itself within a few days.
• Infection: You may develop an infection in your womb or vagina after the procedure. This occurs in 1 – 10 out of 100 women.
• Damaging the uterus: There is a risk of making a small hole in the uterus with the telescope. This occurs in less than 1 in 100 women who have the procedure, but could cause bleeding which may need treatment.
• Not being able to complete the procedure: In less than 1 out of 100 women, the procedure cannot be completed because the hysteroscope cannot get into your womb.
• Damage to nearby structures: There is a risk that your bladder, bowel or major blood vessels could become damaged during the procedure. This occurs in less than one out of 1,000 women.
• Infertility: In less than 1one out of 1,000 women, the procedure can cause damage that leads to infertility.

Preparing for the procedure

• It is important that you are not pregnant when this procedure is carried out. If you are sexually active and have not reached the menopause you should use contraception for the month before your appointment. A pregnancy test may be performed prior to the procedure being attempted.
• You should eat, drink and take your medication as normal before the procedure.

When you arrive

Your hysteroscopy will be carried out in the Gynaecology outpatient department in the Women and Children’s building at Forth Valley Royal Hospital. Your appointment will take around 30-45 minutes.

The clinician performing your procedure will explain the procedure to you, answer any questions you have and you may be asked to confirm your consent by signing a consent form.

If you need pain relief medication for the hysteroscopy you may take paracetamol/ibuprofen at home 1 hour prior to your appointment.

The procedure

The hysteroscopy only takes a few minutes. This is what happens:

1. You will be asked to change into a hospital gown and lie on a couch with your legs rested on the supports on either side of it.
2. The couch will be raised to the appropriate height for the examination to begin.
3. Slowly and gently an instrument called a speculum (also used when you are having a smear test) may be inserted into your vagina. This allows the consultant to have a clear view of your cervix (neck of the womb).
4. A warm antiseptic solution may be used to clean the surface of your cervix.
5. A very fine telescope (hysteroscope) will be inserted into your womb through your vagina and cervix. A water-like solution is used during the procedure to help with the passage of the telescope so you will experience a wet feeling.
6. The camera sends images to a television monitor, which you may watch if you wish, allowing the consultant to have a clear view of the inside of your womb. Images are usually taken at this point and stored securely in your medical notes.
7. The consultant will then remove the hysteroscope carefully.

During and after the procedure you may have some crampy period-like pain and will have a small amount of bleeding; this is normal. You may be given local anaesthesia on your neck of the womb in order to carry out the procedure if you find it too painful.

After the procedure

Following a short recovery period you will be able to go home. It may be beneficial to have a friend or relative to accompany you as a small number of women will not want to drive or go back to work straight away. Sanitary towels are provided and painkillers are available if you need them. You will be able to carry out your normal activities when you are at home but should avoid sexual intercourse, using tampons and swimming for 10 days after the procedure.