A hysteroscopy is a procedure used to examine the inside of the uterus (womb). It is done using a hysteroscope, a narrow tube with a telescope at the end. Images are sent to a computer to give a close-up of the womb.

A hysteroscopy is a common procedure done routinely as an out-patient operation or day case, so you do not have to stay in hospital overnight. It can help to give a clear diagnosis of problems you are experiencing and help to decide the right treatment for you.

There are two types of hysteroscopy:

Diagnostic hysteroscopy

A diagnostic hysteroscopy is used to look for abnormalities in the womb and find the cause of any symptoms. These can include:

• heavy or irregular periods
• pelvic pain
• unusual vaginal discharge
• repeated miscarriage 
• infertility

It can be performed with or without a local anaesthetic that numbs the area around the womb.

Operative hysteroscopy

A hysteroscopy is described as operative when it involves an additional procedure such as a biopsy or treatment.

If an abnormality is suspected when viewing the inside of your womb, a small sample of tissue, called a biopsy, may be taken to be examined.

If a medical condition is diagnosed straight away, such as a polyp (a projecting mass of overgrown tissue), it may be treated at the same time as your hysteroscopy.

The most common treatments carried out during a hysteroscopy include the removal of:

• polyps
• adhesions and scar tissue in the womb
• fibroids (non-cancerous growths) in the womb
• a lost or stuck contraceptive device

A contraceptive device can also be fitted during it.

If your surgeon thinks they may have to treat a condition or take a biopsy during your hysteroscopy, they will discuss this with you and ask for your consent before the procedure.

If extensive treatment is expected, an operative hysteroscopy may require a general anaesthetic (when you are asleep).

You should not have a hysteroscopy if you are pregnant, have a vaginal or urinary tract infection or if you have cancer of the womb.

Before the procedure

It is possible to have a hysteroscopy with or without a local anaesthetic (that numbs the area around the womb). This will be done in the outpatients department of a hospital.

The procedure can also be done under general anaesthetic (when you are asleep) as a day case operation. This may be recommended if your surgeon expects to do extensive treatment at the same time, or if you request it. You can discuss the best option for you with your surgeon.

A hysteroscopy should not hurt, as it is a similar sensation to having a smear test. However, if you are not having any anaesthetic, you may wish to take a painkiller, such as ibuprofen, beforehand.

The procedure

Your surgeon will use a speculum to gently open up your cervix, the entrance to your womb.  The speculum is inserted into your vagina, similar to having a smear test. Next, the vagina and cervix are cleaned with an antiseptic solution. The surgeon will then insert the hysteroscope through your cervix into your womb.

As the womb is small, gas or fluid may be pumped inside to make it larger. This helps the surgeon see the lining of the womb, and any abnormalities, more clearly. The camera at the end of the hysteroscope sends pictures from the inside of your womb to a video screen.

If a biopsy or treatment, such as removal of polyps, is needed, other instruments will be passed into the womb.

A hysteroscopy usually takes between 10 and 30 minutes depending on what needs to be done.

You should be able to go home the same day after having a hysteroscopy. If you had a general anaesthetic you may have to stay in hospital until the effects have fully worn off.

Once at home you should rest as much as possible. Some women experience cramping, similar to period pain, afterwards. You may also get shoulder pain, which is an effect of the gas or fluid used to inflate your womb. Any pain should go within a few days and can be controlled with painkillers.

Getting back to normal

Most women feel they can return to normal activities, such as work, the day after having a hysteroscopy. You may wish to have a few days off to rest. The amount of time you need off may depend on whether you had treatment at the same time, and the type of treatment you had.

If you have had treatment at the same time as your hysteroscopy, such as the removal of polyps or fibroids, you will probably experience some bleeding afterwards. You will need to wear a sanitary towel until this wears off.

Even if you did not have treatment, you may find you get some vaginal bleeding and discharge. This is normal and should pass in a few days, although it can last for a few weeks.

You should not use tampons for at least one month after having a hysteroscopy, to help reduce the risk of any infection.

Follow your surgeon’s advice on exercise, sex and contraception.

Getting your results

Your surgeon may be able to give you immediate feedback on conditions such as polyps or fibroids as they will be visible on the computer screen.

If a biopsy is needed, it can take between two and six weeks to get the results. These results may be sent to your home address by letter or to your doctor’s surgery. Check how you will get your results before leaving the hospital.

When to contact your doctor

After having a hysteroscopy, you should contact your doctor if you suffer from:

• severe pain that can not be controlled by household painkillers
• heavy bleeding,
• vaginal discharge that is smelly or unpleasant
• a fever (temperature over 38°C/100.4°F)

A hysteroscopy is a commonly performed procedure and considered relatively safe. The majority of women who have a hysteroscopy do not experience any complications.

Although the risks are small, it is important to be aware of potential side effects and complications.

Side effects

Side effects after having a hysteroscopy are usually temporary but may include:

• pelvic pain and cramps
• pain in your shoulders, caused by the gas or fluid used to inflate your womb (usually clears up within 48 hours)
• vaginal bleeding and discharge. This usually clears up after a few days but can take several weeks.

Complications

Serious complications from diagnostic hysteroscopy occur in around two in every 1,000 women.

Complications that are specific to a hysteroscopy and occur very rarely include:

• an infection of the womb or pelvis, usually treated with antibiotics
• accidental damage to the womb during the procedure, such as perforation (a hole), which may lead to bleeding. In very rare cases you might need further surgery or a blood transfusion.

Less serious complications of a hysteroscopy include the need for a repeat procedure if the doctor failed to get a clear enough picture of the inside of the uterus. Some women also report prolonged pain in the pelvis or shoulder (deferred pain) after having the procedure.

The complications of any operation can include an unexpected reaction to the anaesthetic, excessive bleeding or developing a blood clot, usually in a vein in the leg.

Your risk of complications is slightly increased if you have had previous surgery to your uterus or cervix, you have a pre-existing medical condition or are clinically obese.