During a hysteroscopy, your surgeon may take a biopsy (a small sample of tissue) for examination in a laboratory, and/or treat the inside of your womb. He or she can remove polyps and fibroids during a hysteroscopy. Your surgeon can also treat scar tissue (adhesions) within the lining of your womb during the procedure. You can have an intra-uterine system (IUS), or coil, put in during a hysteroscopy, or your surgeon can take out a coil that has moved out of place.

What are the alternatives?

Depending on your symptoms and circumstances, there may be alternative treatments or investigations available to you.

A pelvic ultrasound scan can be used to diagnose some conditions. An ultrasound scan uses sound waves to produce an image of the inside of your womb.
An endometrial biopsy is an alternative to a hysteroscopy if your surgeon wants to take a sample of the lining of your womb. A narrow tube is passed through your cervix and into your womb, then gentle suction is used toremove samples of your womb lining that will be examined under a microscope. Sometimes you may have this at the same time as a hysteroscopy. Your doctor will explain the different options to you.

Preparing for a hysteroscopy

Your surgeon will explain how to prepare for your procedure. For example, if you smoke you will be asked to stop, as smoking increases your risk of getting a chest infection and slows your recovery.
Hysteroscopy is usually done as a day-case procedure. This means you have the procedure and go home the same day. It can be done under either local or general anaesthesia. Local anaesthesia completely blocks feeling in your cervix and you stay awake during the procedure. General anaesthesia means you will be asleep during the operation.

If you’re having a general anaesthetic, you will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. However, it’s important to follow your surgeon’s advice.

At the hospital, your nurse may do some tests such as checking your heart rate and blood pressure, and testing your urine.

Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.

If you’re having a hysteroscopy to diagnose your condition, your surgeon may go on to treat your condition during the procedure. Your surgeon will talk to you about any possible treatment before your operation, and you will be asked to sign a consent form that includes these possible treatments.

You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs. You may need to have an injection of an anticlotting medicine called heparin as well as, or instead of, wearing compression stockings.

What happens during a hysteroscopy?

The procedure usually takes about 1O minutes to over half an hour, depending on what needs to be done. A speculum is put into your vagina to show your cervix. This is similar to the instrument used when you have a smear test. Your surgeon will clean your vagina and cervix with an antiseptic solution and pass the hysteroscope through the cervix and into your womb.

He or she may inject gas or fluid into your womb. This opens up the cavity of your womb, and makes it easier for your surgeon to clearly see the womb lining.

The camera at the end of the hysteroscope sends pictures from the inside of your womb to a video screen. Your doctor will look at these images and if necessary take a biopsy or carry out any treatment.

This is done using special instruments passed inside the hysteroscope.

When the examination is finished, the hysteroscope is gently taken out. Your surgeon may then carry out an endometrial biopsy to take a sample of your womb.

Where a hysteroscope is passed
What to expect afterwards

If you have general anaesthesia, you will need to rest until the effects of the anaesthetic have passed. You may need pain relief to help with any discomfort as the anaesthetic wears off.

You may need to wear a sanitary towel, as you may have some vaginal bleeding.

You will usually be able to go home when you feel ready. Your nurse may give you a date for a follow-up appointment.

You will need to arrange for someone to drive you home. You should try to have a friend or relative stay with you for the first 24 hours.

Recovering from a hysteroscopy
General anaesthesia can temporarily affect your coordination and reasoning skills, so you should not drive, drink alcohol, operate machinery or sign legal documents for 48 hours afterwards. If you’re in any doubt about driving, please contact your motor insurer so that you’re aware of their recommendations, and always follow your surgeon’s advice.

If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

If you have a diagnostic hysteroscopy, you will need to rest and take it easy for a day or two. If you have had treatment during the hysteroscopy, for example if you have had a polyp or fibroid removed, your recovery will take longer. Your surgeon will tell you when you can get back to your usual activities.

If you have a biopsy or polyps removed, the results will usually be sent in a report to your doctor.

What are the risks?
Hysteroscopy is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications of this procedure.

Side-effects
Side-effects are the unwanted but mostly temporary effects you may get after having the procedure. Aftera hysteroscopy, you may have cramping pains, like those you get during a period. You may also have vaginal bleeding which usually gets better after a few days, but it can last for up to a week.

Complications

This is when problems occur during or after the procedure. Most women aren’t affected. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or developing a blood clot, usually in a vein in the leg (deep vein thrombosis, DVT).

Specific complications of hysteroscopy are uncommon, but it’s possible you may develop an infection afterwards. The surgery may damage your womb and, rarely, your bladder, bowel and blood vessels. You may need further surgery to repair any damage caused.

Occasionally, it may not be possible for your surgeon to pass the telescope into your womb to get a clear view of the lining. If this happens, your surgeon will discuss alternative options with you.
Most women have no problems after having a hysteroscopy.

However, if you develop any of the following symptoms, contact your doctor:
• long-lasting heavy bleeding
• vaginal discharge that is dark or smells unpleasant
• severe pain or pain that lasts for more than 48 hours
• a high temperature

The exact risks are specific to you and will differ for every woman, so we haven’t included statistics here.

Ask your surgeon to explain how these risks apply to you.