Investigations
Hysteroscopy
A closer look inside the womb to diagnose and treat gynaecological problems.
If you have experienced heavy or irregular periods, bleeding between periods, bleeding after the menopause or difficulties becoming pregnant, your specialist may recommend a hysteroscopy.
A hysteroscopy is a procedure that allows your consultant to look directly inside the womb (uterus) using a thin telescope with a small camera. It can be used to investigate symptoms, identify abnormalities and, in many cases, treat problems during the same procedure.
At Gynae Solution, we believe that understanding your investigation is an important part of feeling comfortable with your care. Mr Jafaru Abu will explain why a hysteroscopy has been recommended, what the procedure involves and what your results may mean.
What is a hysteroscopy?
A hysteroscopy is an examination of the inside of the womb.
A narrow instrument called a hysteroscope is gently passed through the vagina and cervix (the neck of the womb) into the uterine cavity. The hysteroscope has a small camera that allows the inside of the womb to be viewed on a screen.
Sterile fluid is introduced into the womb to gently expand the cavity, allowing the lining and the shape of the womb to be examined clearly.
Unlike an ultrasound, which produces images from outside the womb, hysteroscopy allows your specialist to see the inside of the uterine cavity directly.
It can therefore be particularly useful when there is concern about a polyp, a fibroid growing into the cavity or an abnormality of the womb lining.
Why might I need a hysteroscopy?
There are several reasons why your consultant may recommend a hysteroscopy.
It may be used to investigate:
- Heavy or prolonged periods
- Bleeding between periods
- Unexplained abnormal vaginal bleeding
- Bleeding after the menopause
- An abnormality seen on an ultrasound scan
- Suspected polyps
- Suspected fibroids growing into the womb cavity
- Thickening or abnormalities of the womb lining
- Some fertility problems
- Repeated miscarriages in selected circumstances
- A contraceptive coil (IUD or IUS) that cannot easily be removed because its threads are not visible
A hysteroscopy can also be used to investigate the womb lining when there is concern about endometrial disease, including changes that may require further investigation.
Not everyone with abnormal bleeding needs a hysteroscopy. The most appropriate investigation depends on your symptoms, examination, medical history and any previous ultrasound or other test results.
Diagnostic and operative hysteroscopy
There are two broad types of hysteroscopy.
Diagnostic hysteroscopy
A diagnostic hysteroscopy is primarily used to look inside the womb and find out whether there is an abnormality.
Your consultant may be able to identify a polyp, fibroid, abnormal-looking womb lining or another structural problem during the examination.
A small tissue sample, known as an endometrial biopsy, may also be taken if appropriate.
Operative hysteroscopy
An operative hysteroscopy goes one step further.
Specialist instruments can be passed through the hysteroscope to treat certain problems during the same procedure.
For example, your consultant may be able to:
- Remove a polyp
- Remove a small fibroid that is projecting into the womb cavity
- Take a targeted biopsy
- Remove some scar tissue or adhesions
- Remove a displaced or embedded intrauterine contraceptive device
This approach can sometimes mean that diagnosis and treatment are carried out during the same appointment rather than requiring separate procedures.
Hysteroscopy for heavy periods
Heavy menstrual bleeding can have many different causes.
In some women, the cause is related to an abnormality within the womb cavity, such as a polyp or a submucosal fibroid.
NICE recommends considering outpatient hysteroscopy when symptoms or other findings suggest a polyp, submucosal fibroid or endometrial pathology. It can also allow a problem such as a polyp or suitable fibroid to be treated at the same time.
A hysteroscopy does not, however, assess every possible cause of heavy bleeding. Conditions such as adenomyosis or fibroids growing within the wall or on the outside of the womb may require ultrasound or other imaging.
Hysteroscopy for bleeding after the menopause
Any vaginal bleeding after the menopause should be assessed.
A hysteroscopy may be recommended if your symptoms or ultrasound findings suggest that the womb lining needs closer examination.
During the procedure, your consultant can inspect the lining directly and take a targeted biopsy if necessary.
This can help establish whether the bleeding is related to a benign condition such as a polyp or changes in the womb lining, or whether further investigation or treatment is required.
Hysteroscopy and fertility
A hysteroscopy can sometimes form part of an investigation into difficulties becoming pregnant or repeated miscarriages.
It allows the inside of the womb to be examined for structural abnormalities such as polyps, fibroids, adhesions or an unusual shape.
If an abnormality is found, treatment during hysteroscopy may sometimes improve the environment within the womb, although the benefit will depend on the underlying problem and your individual fertility circumstances.
Your consultant will explain whether hysteroscopy is appropriate as part of your fertility assessment.
What happens before a hysteroscopy?
Before your procedure, you will have an opportunity to discuss your symptoms, medical history and the reason for the hysteroscopy.
You may already have had investigations such as:
- A pelvic or transvaginal ultrasound
- Blood tests
- Cervical screening
- Other gynaecological examinations
You may be asked to take a pregnancy test before the procedure because hysteroscopy should not be performed during pregnancy. You will also receive advice about contraception and any medication you should take before your appointment.
If a larger fibroid is expected to require treatment, medication may occasionally be recommended beforehand to help prepare for the procedure.
What happens during a hysteroscopy?
The precise experience depends on whether you are having an outpatient diagnostic hysteroscopy or a procedure involving treatment.
For an outpatient hysteroscopy, you will usually be awake.
A small hysteroscope is gently passed through the vagina and cervix into the womb. The cavity is then expanded with sterile fluid so that your consultant can see the womb lining clearly.
The camera displays the inside of the womb on a monitor.
If appropriate, your consultant may take a small biopsy or remove a polyp or other suitable abnormality during the procedure.
A diagnostic hysteroscopy can be relatively quick, although the length of the appointment varies depending on what needs to be investigated or treated.
Will a hysteroscopy hurt?
Everyone experiences hysteroscopy differently.
Some women experience little discomfort, while others may experience period-like cramping during or after the procedure.
Your comfort is an important part of the procedure. Pain-relief options should be discussed with you beforehand, and you should tell your healthcare professional if you are worried about pain or have previously found gynaecological examinations particularly difficult.
If an outpatient hysteroscopy is not appropriate for you, or if you would prefer not to undergo the procedure while awake, hysteroscopy can also be performed under anaesthesia in an appropriate setting. NICE recommends discussing the available options with patients so that they can make an informed choice.
Can I have treatment during the same hysteroscopy?
Often, yes.
One of the advantages of hysteroscopy is that certain abnormalities can be diagnosed and treated during the same procedure.
For example, if a suitable polyp is identified, it may be possible to remove it immediately.
Similarly, some fibroids that project into the womb cavity can be removed hysteroscopically.
However, not every abnormality can be treated during hysteroscopy. The size, position and type of fibroid or other abnormality will determine whether hysteroscopic treatment is appropriate. Larger or more complex problems may require a different approach.
What is a hysteroscopic polypectomy?
A polypectomy is the removal of a polyp from inside the womb.
Polyps are usually benign growths arising from the womb lining. They can sometimes contribute to irregular or heavy bleeding.
If a polyp is identified during hysteroscopy, it can often be removed using instruments passed through the hysteroscope.
The removed tissue is sent to a laboratory for examination, allowing the pathology team to confirm what it is.
What is a hysteroscopic fibroid removal?
Some fibroids grow into the cavity of the womb. These are known as submucosal fibroids.
If appropriate, they can sometimes be removed through the hysteroscope without the need for an abdominal operation.
This is known as hysteroscopic myomectomy.
Whether this is possible depends on the size, position and depth of the fibroid. In some cases, more than one procedure may be necessary.
Will I need a biopsy?
Not everyone undergoing hysteroscopy needs a biopsy.
If there is a reason to investigate the womb lining more closely, your consultant may take a small sample of tissue during the hysteroscopy.
This may be recommended where there are symptoms or risk factors suggesting endometrial pathology.
Importantly, the decision to take a biopsy is individualised. NICE recommends that endometrial sampling for heavy menstrual bleeding should be carried out in the context of hysteroscopy when clinically indicated, rather than routinely taking a blind biopsy.
If tissue is removed, it is sent to a laboratory for specialist examination. The results can help determine whether further treatment or investigation is required.
How long does a hysteroscopy take?
The length of the procedure varies depending on what is being done.
A straightforward diagnostic hysteroscopy may only take a short time, while removing a fibroid or carrying out additional treatment can take longer.
Some hospital guidance gives a typical procedure time of around 10 to 30 minutes, although this should not be taken as a fixed timeframe for every patient.
Your consultant will explain how your particular procedure is expected to be carried out.
What are the risks of hysteroscopy?
Hysteroscopy is generally considered a safe procedure, but as with any medical procedure, complications are possible.
Potential risks include:
- Cramping or pelvic discomfort
- Vaginal spotting or bleeding
- Infection
- Difficulty passing the hysteroscope through the cervix
- Injury to the cervix
- Perforation, or a small hole in the wall of the womb
- Incomplete treatment or the need for a further procedure
- Rarely, injury to surrounding structures or complications requiring additional treatment
The risk of complications can vary depending on whether you are having a diagnostic hysteroscopy or additional treatment such as removal of a fibroid or polyp.
Your individual risks will be discussed with you before you give consent.
What happens after hysteroscopy?
After an outpatient hysteroscopy, most women are able to return home the same day.
You may experience mild period-like cramps and light vaginal bleeding or spotting for a short time afterwards.
Your consultant will give you advice about:
- Pain relief
- When you can return to work
- Exercise and other physical activities
- Sexual activity
- Using tampons
- When you can drive
- Caring for yourself if you have had additional treatment
If you have had a procedure under general anaesthetic, your recovery instructions will be different and you may need someone to accompany you home.
When should I seek medical advice after hysteroscopy?
Most women recover without significant problems.
However, you should seek medical advice if you develop symptoms such as:
- Heavy or persistent vaginal bleeding
- Severe or worsening abdominal pain
- A high temperature or fever
- Foul-smelling vaginal discharge
- Feeling increasingly unwell
These symptoms can indicate an infection or another complication and should be assessed promptly.
Hysteroscopy or ultrasound, which is better?
The two investigations provide different information.
An ultrasound can assess the womb, ovaries and surrounding pelvic structures and is particularly useful when investigating larger fibroids, ovarian problems or conditions such as adenomyosis.
A hysteroscopy provides a direct view of the inside of the womb and can be particularly useful when a problem within the uterine cavity is suspected.
NICE recommends choosing between hysteroscopy and ultrasound based on the individual's symptoms and examination findings. Where polyps, submucosal fibroids or endometrial pathology are suspected, hysteroscopy is specifically recommended as an appropriate first-line investigation.
Sometimes both investigations are needed because they answer different clinical questions.
What happens after the hysteroscopy?
If no abnormality is found, your consultant will explain the results and discuss whether any further investigation is needed.
If a polyp, fibroid or another abnormality has been identified and treated, you may simply need follow-up.
If a biopsy or other tissue has been taken, the sample will be examined by specialist pathologists. You will be informed when the results are available and whether any further treatment is recommended.
Your results and next steps will always be considered in the context of your symptoms and medical history.
Specialist hysteroscopy at Gynae Solution
A hysteroscopy can provide valuable information about problems affecting the womb, but we understand that the thought of an internal examination or procedure can feel daunting.
At Gynae Solution, we take the time to explain what is happening and why.
Mr Jafaru Abu provides specialist gynaecological care, including the investigation and treatment of abnormal uterine bleeding, fibroids, polyps and other conditions affecting the womb.
Where appropriate, hysteroscopy can offer the advantage of diagnosing and treating a problem during the same procedure, helping to avoid unnecessary delays between investigation and treatment.
Every patient is different, and your recommended approach will be based on your symptoms, medical history, previous investigations and individual preferences.
Take the next step
If you have been experiencing heavy, irregular or unexplained vaginal bleeding, or have been told that you may need a hysteroscopy, a specialist consultation can help you understand what is causing your symptoms and which investigations or treatments may be appropriate.
Book a consultation with Mr Abu to discuss your symptoms and whether hysteroscopy could help diagnose or treat the problem.
Common questions
How soon can I be seen?
Daily appointments are available at The Park Hospital. Call the secretary on 0115 966 2049, or send an enquiry below and we will reply within 24 hours on business days.
Do I need a GP referral?
Referrals from GPs are welcome, and you can also enquire directly. If you are using private medical insurance, check with your insurer whether a referral is required for your policy. See GP referrals and fees and insurance.
What does a consultation cost?
A new consultation is £250 and a follow-up consultation is £150. The cost of any tests, procedures or surgery is quoted individually after your consultation. See fees and insurance.
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