What is a hysteroscopy?
A hysteroscopy is an examination of the inside of the uterus (womb) using a fine telescope.
When is a hysteroscopy required?
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
- 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.
What happens during a hysteroscopy?
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, you will be asked to remove the bottom half of your clothing and lie on a couch with you legs in leg supports. A speculum may be placed inside the vagina, similar to when you have a cervical smear. If you wish, you can watch the procedure on a screen. The procedure is likely to last about 20 minutes but will vary from patient to patient. You can bring a friend or partner with you if you wish.
What preparations are needed before a hysteroscopy?
Preparations for your hysteroscopy procedure will depend whether it is being performed as an inpatient or outpatient procedure:
Inpatient: You will be advised when you need to arrive at the hospital, you 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. You can eat and drink normally before the procedure. If you wish you can take the usual tablets that you would use for pain relief about an hour before your appointment.
In either case you 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 your doctor for advice beforehand.
Is a hysteroscopy painful?
An outpatient hysteroscopy can be uncomfortable and therefore you 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.
What can I expect after a hysteroscopy?
After the hysteroscopy you may have some discomfort, similar to period pain, and bleeding. If the hysteroscopy was performed as an outpatient you may feel faint.
When can I get the results of my hysteroscopy?
The results are often available within 5-7 days.
What are the risks of a hysteroscopy?
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 you develop a temperature, increased pain, increased discharge which is smelly and unpleasant or heavy bleeding following a hysteroscopy, you should seek medical advice.
How quickly can I return to normal routine?
For patients who have had an outpatient hysteroscopy, you 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 you should take the day of procedure and following day off work, you will also need someone to drive you home due to the anaesthesia. Sport and/or sexual intercouse can resume the day after the procedure.
Are there any alternatives to hysteroscopy?
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.