Hysteroscopy

Why would I be offered a hysteroscopy?

A diagnostic hysteroscopy is carried out to investigate abnormal uterine bleeding.

Abnormal bleeding is defined as menstrual periods becoming heavier, happening more frequently or lasting longer than usual. Abnormal bleeding can also occur in prepubescent or postmenopausal women, while bleeding between periods is another abnormality.

A second type of hysteroscopy called an operative hysteroscopy uses the hysteroscope as a surgical tool.

The goal is to diagnose or treat problems of the uterus or womb. The two types of hysteroscopy are diagnostic and operative.

A woman undergoing a diagnostic hysteroscopy may need a further operative hysteroscopy, depending on the findings.

What options are there?

There are 2 different types available:

Diagnostic hysteroscopy

Besides abnormal bleeding, patients would be offered adiagnostic hysteroscopy for reasons that include:

• To diagnose the cause of repeated miscarriages. This tends to be if a woman suffers two miscarriages in a row
• To diagnose some conditions, such as fibroids or polyps, which are non-cancerous growths in the womb
• To investigate fertility issues if becoming pregnant is a problem
• To investigate pelvic pain that is being experienced by a woman

Operative hysteroscopy

This procedure can be used in the following circumstances:

• To remove adhesions. These are scars that bind tissues together inside the uterus and may have occurred following infection or surgery. Adhesions can stop periods and reduce fertility
• To locate and remove an intrauterine device inserted into the uterus for birth control
• To remove fibroids or growths
• To perform a sterilisation procedure
• To take a biopsy of tissue for further investigations

Do I need to prepare for a hysteroscopy?

You may need to take a pregnancy test about a week before a hysteroscopy is performed and will be advised to use appropriate contraception in between. This is because a hysteroscopy cannot be carried out on someone who is pregnant.

If fibroids are to be removed during the procedure, medication to reduce their size may be prescribed beforehand.

What happens during the procedure?

A hysteroscopy is usually carried out on an outpatient or day-case basis. This means you don't have to stay in hospital overnight.

It may not be necessary to use anaesthetic for the procedure, although local anaesthetic is sometimes used.

General anaesthetic may be used if you’re having treatment during the procedure or you would prefer to be asleep while it’s carried out.

During a hysteroscopy:

• you lie on a couch with your legs held in supports and a sheet is used to cover your lower half
• an instrument called a speculum may be inserted into your vagina to hold it open (the same instrument used for a cervical screening test), although this isn't always necessary
• the hysteroscope is passed into your womb and fluid is gently pumped inside to make it easier for your doctor to see
• the camera sends pictures to a monitor so your doctor can spot and/or treat any abnormalities

How long does the procedure take?

A hysteroscopy can take up to 30 minutes in total, although it may only last around 5-10 minutes if it's just being done to diagnose a condition or investigate symptoms. You may experience some discomfort similar to period cramps while it's carried out, but it shouldn't be painful.

What is the recovery like?

Most women feel able to return to their normal activities the following day, although some women return to work the same day. You may wish to have a few days off to rest if general anaesthetic was used.

• you can eat and drink as normal straight away
• you may experience cramping that's similar to period pain and some spotting or bleeding for a few days – this is normal and nothing to worry about unless it's heavy
• you should avoid having sex for a week, or until any bleeding has stopped, to reduce the risk of infection

We will discuss the findings of the procedure with you before you leave hospital.