Hysteroscopy

A hysteroscopy is usually recommended for women who are experiencing certain gynaecological symptoms such as:

• Irregular or heavy periods
• Bleeding between periods or post-menopausal bleeding
• Fibroids
• Unusual vaginal discharge
• Repeated miscarriages
• Problems with fertility
• To insert or remove coils

A hysteroscopy can be performed as an outpatient procedure or as a day case procedure under a general anaesthetic.

A fine telescope is inserted via the vagina and opening of the uterus (cervix), and using water the telescope passes through the birth canal and into the womb. The inside of the womb can then be seen and assessed in terms of its shape, the lining (endometrium) and for focal lesions (polyps, fibroids, septa, adhesions). A small biopsy (removal of cells from the endometrium – lining of the womb) is often done at the end of the procedure to allow further analysis under a microscope.

If the procedure is being performed in an outpatient setting, women will be asked to remove the bottom half of their clothing and lie on a couch with their legs in leg supports. A speculum may be placed inside the vagina, similar to what happens in a cervical smear. If they wish, women can watch the procedure on a screen. The procedure is likely to last about 20 minutes but will vary from patient to patient. Women can bring a friend or partner with them if they wish.

Preparations for a hysteroscopy procedure will depend whether it is being performed as an inpatient or outpatient procedure:

Inpatient: Women will be advised when they need to arrive at the hospital, and will need to be nil by mouth at least 6 hours prior to time of the procedure.

Outpatient:  No preparation is needed before an outpatient hysteroscopy.  Women can eat and drink normally before the procedure. If they wish they can take the usual tablets that they would use for pain relief about an hour before the appointment. 

In either case women may be asked to provide a urine sample for a pregnancy test. Also, hysteroscopies can be performed during a period, however it is worth discussing this with the doctor for advice beforehand.

An outpatient hysteroscopy can be uncomfortable and therefore women may wish to take paracetamol or ibuprofen and hour before the procedure. It may be necessary to insert local anaesthesia into the cervix if a gentle stretch (dilatation) is required to allow the hysteroscope to be inserted.

After the hysteroscopy women may have some discomfort, similar to period pain, and bleeding. If the hysteroscopy was performed as an outpatient they may feel faint.

The results are often available within 5-7 days.

A hysteroscopy is a very safe procedure with a low risk of complications. The most common side effects are discomfort (similar to period pain), feeling faint (outpatient procedure only) and bleeding.

However if women develop a temperature, increased pain, increased discharge which is smelly and unpleasant or heavy bleeding following a hysteroscopy, they should seek medical advice.

For patients who have had an outpatient hysteroscopy, women could return to work the same day although it would not be unreasonable to take the day off. If the hysteroscopy was performed under general anaesthesia they should take the day of procedure and following day off work, and will also need someone to drive them home due to the anaesthesia. Sport and/or sexual intercourse can resume the day after the procedure.

Occasionally an MRI may tell us about what is going on inside the lining of the womb, however a hysteroscopy and biopsy is the ‘Gold Standard’ to have the best understanding and make a diagnosis.