Hysteroscopy: Uterine Examination & Treatment Guide

What Is Hysteroscopy and Why Is It Done?

Hysteroscopy is a procedure where a doctor inserts a thin, lighted instrument called a hysteroscope through the vagina and cervix to examine the inside of the uterus. It is used to diagnose and treat conditions affecting the uterine lining, including polyps, fibroids, abnormal bleeding, and causes of infertility.

The hysteroscope is a slender tube equipped with a tiny camera that transmits images to a monitor, allowing the doctor to see the uterine cavity in real-time. This technology has revolutionized gynecological care by enabling minimally invasive diagnosis and treatment of many uterine conditions that previously required more extensive surgery.

Hysteroscopy falls into the category of endoscopic procedures, which means examining the inside of the body using a camera. Unlike laparoscopy, which involves making small incisions in the abdomen, hysteroscopy uses the body's natural opening and requires no external cuts. This makes it a particularly attractive option for women who want to avoid surgical scars and experience faster recovery times.

The procedure has become increasingly common over the past few decades as the technology has improved and the benefits have become clear. Modern hysteroscopes are much thinner than earlier versions, making the procedure more comfortable and allowing it to be performed in an office setting rather than requiring an operating room.

Diagnostic vs. Operative Hysteroscopy

There are two main types of hysteroscopy, and understanding the difference is important when preparing for your procedure:

Diagnostic hysteroscopy is performed solely to examine the uterus and identify any abnormalities. It typically takes 10-15 minutes and can often be done in a gynecologist's office with local anesthesia. During a diagnostic procedure, the doctor may take small tissue samples (biopsies) for laboratory analysis.

Operative hysteroscopy goes beyond examination to actually treat conditions found within the uterus. This might include removing polyps or fibroids, cutting through adhesions (scar tissue), or treating other abnormalities. Operative procedures take longer (30-60 minutes) and may require general anesthesia, though many can still be performed as outpatient procedures.

Common Reasons for Hysteroscopy

Your doctor may recommend hysteroscopy for various reasons, including:

• Abnormal uterine bleeding: Heavy, prolonged, or irregular periods that haven't responded to medication
• Postmenopausal bleeding: Any vaginal bleeding after menopause requires investigation
• Infertility evaluation: To examine the uterine cavity for problems that might prevent pregnancy
• Recurrent miscarriages: To identify uterine abnormalities that could contribute to pregnancy loss
• Polyp or fibroid removal: Growths on the uterine lining that cause symptoms
• Abnormal ultrasound findings: To further investigate suspicious findings seen on imaging
• Lost IUD: To locate and remove an intrauterine device that has migrated
• Asherman's syndrome: To diagnose and treat uterine adhesions (scar tissue)

How Should I Prepare for a Hysteroscopy?

Preparation for hysteroscopy depends on whether you're having a diagnostic or operative procedure. For outpatient diagnostic procedures, you can usually eat normally beforehand. For operative procedures under general anesthesia, you'll need to fast. Your doctor may prescribe medication to soften the cervix before the procedure.

Proper preparation helps ensure your hysteroscopy goes smoothly and that your doctor gets the best possible view of your uterus. The preparation requirements vary depending on the type of procedure you're having, where it will be performed, and whether you'll need general anesthesia.

Your healthcare provider will give you specific instructions tailored to your situation. However, there are several general preparation guidelines that apply to most hysteroscopy procedures. Following these instructions carefully will help minimize complications and optimize your results.

Eating and Drinking Before Hysteroscopy

If you're having a diagnostic hysteroscopy or minor treatment at an outpatient clinic with local anesthesia, you can typically eat and drink normally before your appointment. This is one of the advantages of having the procedure done with local anesthesia rather than general anesthesia.

If you're having an operative hysteroscopy under general anesthesia, you'll need to fast beforehand. This typically means no food or drink for 6-8 hours before the procedure. Your hospital or surgical center will provide specific fasting instructions. It's important to follow these carefully because having food or liquid in your stomach during general anesthesia can be dangerous.

Timing and Menstruation

Hysteroscopy is ideally performed when you are not menstruating. Blood in the uterus makes it difficult for the doctor to see the uterine lining clearly. For this reason, the procedure is typically scheduled for the first half of your menstrual cycle, after your period has ended but before ovulation.

If you have irregular periods or difficulty predicting when your period will start, your doctor may prescribe medication to help control the timing. Hormonal medications can be used to postpone menstruation, typically starting about 10 days before the scheduled procedure.

Contact your healthcare provider if you start bleeding the day before your scheduled hysteroscopy. The procedure may need to be rescheduled to ensure optimal conditions for examination.

Medications That May Be Prescribed

Your doctor may prescribe several medications to prepare for hysteroscopy:

• Cervical softening medication: Tablets placed in the vagina or under the tongue a few hours before the procedure to make it easier to insert the hysteroscope through the cervix
• Pain medication: Over-the-counter pain relievers such as ibuprofen or acetaminophen, taken 1-2 hours before the procedure to reduce cramping
• Antibiotics: Sometimes prescribed to prevent infection, particularly for operative procedures
• Sedatives: Mild sedatives may be offered for anxiety management

Tell Your Doctor About Your Medications

Before your hysteroscopy, inform your healthcare provider about all medications you take, including prescription drugs, over-the-counter medications, vitamins, and supplements. This is particularly important if you take:

• Blood thinners: Medications like warfarin, aspirin, or newer anticoagulants may need to be stopped before the procedure
• Diabetes medications: Fasting requirements may affect your dosing schedule
• Heart medications: Your doctor needs to know about all cardiovascular medications
• Herbal supplements: Some can increase bleeding risk

How Is a Hysteroscopy Performed?

During hysteroscopy, you lie in a gynecological position while the doctor inserts a thin camera (hysteroscope) through your vagina and cervix into the uterus. The uterus is gently expanded with fluid or gas for better visibility, and the doctor examines the uterine lining on a monitor. The procedure takes 10-60 minutes depending on whether treatment is performed.

Understanding what happens during hysteroscopy can help reduce anxiety and allow you to feel more prepared. The procedure follows a systematic approach, whether performed in an office setting or operating room. While experiences vary, most women describe the procedure as uncomfortable but manageable.

Positioning and Anesthesia

You will be asked to undress from the waist down and lie on an examination table in a gynecological position, similar to having a Pap smear. Your feet rest in stirrups, and you may have a drape over your legs for privacy.

The type of anesthesia depends on the procedure:

• Local anesthesia: For diagnostic procedures, the doctor may inject local anesthetic around the cervix to numb the area. You remain awake and can communicate throughout.
• Sedation: Some patients receive medication to help them relax. You're conscious but may feel drowsy and might not remember much of the procedure.
• General anesthesia: For operative procedures, you may be put to sleep completely. An anesthesiologist monitors you throughout.

The Hysteroscopy Procedure Step by Step

Once you're positioned and anesthesia is administered, the procedure follows these steps:

1. Vaginal preparation: The doctor gently inserts a speculum (the same instrument used for Pap smears) to open the vaginal walls and visualize the cervix. The area is cleaned with an antiseptic solution.

2. Cervical dilation: If needed, the cervix is gently dilated to allow the hysteroscope to pass through. Cervical softening medication taken earlier makes this step easier and more comfortable.

3. Hysteroscope insertion: The hysteroscope, a thin tube about 3-5mm in diameter, is carefully inserted through the cervix into the uterine cavity. You may feel pressure or cramping at this stage.

4. Uterine distension: A sterile fluid (saline or glycine) or carbon dioxide gas is gently pumped into the uterus. This expands the uterine cavity, separating the walls so the doctor can see clearly. You might feel a sensation of fullness or mild cramping.

5. Examination: The camera at the tip of the hysteroscope transmits images to a monitor. The doctor carefully examines the entire uterine lining, including the areas where the fallopian tubes connect to the uterus.

6. Tissue sampling or treatment: If abnormalities are found, the doctor may take small tissue samples for biopsy or perform treatment. Specialized instruments can be passed through channels in the hysteroscope to remove polyps, cut adhesions, or treat other conditions.

7. Completion: Once the examination or treatment is complete, the hysteroscope is gently removed. The fluid drains from the uterus, and the speculum is removed.

How Long Does Hysteroscopy Take?

The duration depends on the type of procedure:

What Is Recovery After Hysteroscopy Like?

Most women recover quickly from hysteroscopy. After diagnostic procedures, you can usually return to normal activities the same day or the next day. Mild bleeding and cramping for 1-2 weeks is normal. Avoid baths, tampons, and sexual intercourse for at least 2 weeks to reduce infection risk.

Recovery from hysteroscopy is generally straightforward, though the timeline depends on whether you had a diagnostic or operative procedure and what type of anesthesia was used. Understanding what to expect during recovery helps you plan accordingly and know when something might require medical attention.

Immediately After the Procedure

After a diagnostic hysteroscopy with local anesthesia, you can typically leave the clinic within 30-60 minutes once you feel ready. You may experience mild cramping and light spotting. Many women return to work or normal activities the same day, though some prefer to rest.

After an operative hysteroscopy or general anesthesia, you'll spend time in a recovery area while the anesthesia wears off. This typically takes 1-2 hours. You may feel groggy, tired, or slightly nauseous. You should arrange for someone to drive you home, as you should not drive for at least 24 hours after general anesthesia.

What to Expect in the Days Following

In the days after hysteroscopy, you may experience:

• Light bleeding: Spotting or light bleeding similar to a light period is common for up to 1-2 weeks
• Cramping: Mild to moderate cramping, similar to menstrual cramps, may last a few days
• Brownish discharge: Some women notice brown or reddish-brown discharge for 1-2 weeks
• Shoulder pain: If carbon dioxide gas was used to distend the uterus, you might experience temporary shoulder pain as the gas is absorbed
• Throat discomfort: If you had general anesthesia with intubation, your throat may feel scratchy for 2-3 days

Activity Recommendations

Your specific activity restrictions depend on the type of procedure performed, but general guidelines include:

First 24-48 hours:

• Rest as needed
• Light walking is encouraged to prevent blood clots
• Avoid strenuous exercise or heavy lifting
• Don't drive if you had sedation or general anesthesia

For at least 2 weeks:

• No baths or swimming: Showers are fine, but avoid submerging in water
• No tampons or menstrual cups: Use pads instead
• No sexual intercourse: To allow healing and reduce infection risk
• No vaginal douching: This can introduce bacteria

First week (operative procedures):

• Avoid heavy lifting (more than 10-15 pounds)
• Take it easy with exercise - light walking is fine
• Return to work when you feel ready, typically within 1-3 days

Managing Discomfort

Over-the-counter pain medications are usually sufficient for managing post-procedure discomfort:

• Ibuprofen (Advil, Motrin): Helps with both pain and cramping
• Acetaminophen (Tylenol): Good alternative if you can't take ibuprofen
• Heating pad: Applied to the lower abdomen can help relieve cramping

Your doctor may prescribe stronger pain medication if needed after operative procedures. Take medications as directed and contact your healthcare provider if pain is not adequately controlled.

What Are the Risks and Complications of Hysteroscopy?

Hysteroscopy is a safe procedure with serious complications occurring in less than 1% of cases. Common minor effects include bleeding and cramping. Rare but serious complications include uterine perforation, infection, and fluid overload. Seek immediate medical care for heavy bleeding, fever, or severe pain.

While hysteroscopy is considered a safe procedure, it's important to understand the potential risks and know when to seek medical attention. The overall complication rate is low, with serious problems being rare. Being informed helps you make educated decisions about your care and recognize warning signs.

Common and Expected Effects

These are normal parts of recovery, not true complications:

• Light bleeding: Spotting for up to 2 weeks is expected
• Cramping: Similar to menstrual cramps, lasting a few days
• Watery discharge: The distending fluid may continue to drain

Rare Complications

Serious complications are uncommon but can include:

Uterine perforation: The hysteroscope or surgical instruments can accidentally puncture the uterine wall. This occurs in about 1 in 100 operative procedures. Most perforations are small and heal on their own, but occasionally additional treatment is needed.

Infection: Though rare due to sterile technique, infection can develop in the uterus (endometritis) or pelvis. Symptoms include fever, increasing pain, and foul-smelling discharge.

Excessive bleeding: While some bleeding is normal, heavy bleeding requiring treatment occurs in less than 1% of cases.

Fluid overload: The fluid used to distend the uterus can sometimes be absorbed into the bloodstream in significant amounts, potentially causing electrolyte imbalances. This is more common with longer operative procedures.

Cervical trauma: The cervix can occasionally be injured during dilation, though this is uncommon.

What Happens After Hysteroscopy? Results and Follow-Up

Some findings are visible immediately during hysteroscopy and your doctor can discuss them right away. If tissue samples were taken, laboratory results typically take 1-2 weeks. Your doctor will explain the results and discuss any recommended treatment or follow-up.

Understanding what to expect after your hysteroscopy, including when and how you'll receive results, helps reduce anxiety and ensures you get appropriate follow-up care. The timeline for receiving information varies depending on what was found and whether biopsies were taken.

Immediate Findings

Some conditions are visible during the procedure, and your doctor may be able to discuss these findings immediately or shortly after:

• Polyps: Soft growths on the uterine lining that can be seen and often removed during the same procedure
• Fibroids: Benign muscle tumors that project into the uterine cavity
• Adhesions: Scar tissue bands that can distort the uterine cavity
• Uterine septum: A wall of tissue dividing the uterus
• Normal findings: If your uterus appears normal, your doctor can tell you this right away

Biopsy and Laboratory Results

If tissue samples were taken during your hysteroscopy, they are sent to a laboratory for analysis. The pathologist examines the tissue under a microscope to determine:

• Whether cells are normal or abnormal
• If any precancerous or cancerous changes are present
• The nature of any growths (benign vs. concerning)
• Whether there are signs of infection or inflammation

Results typically take 1-2 weeks, though this varies by laboratory and region. Your healthcare provider will inform you how you'll receive your results - by phone call, patient portal, mail, or at a follow-up appointment.

Follow-Up Appointments

Depending on your findings and any treatment performed, you may need follow-up care:

• Normal findings with no treatment: You may not need follow-up unless you develop new symptoms
• Polyp or fibroid removal: A follow-up appointment in 4-6 weeks to ensure proper healing
• Abnormal biopsy results: Discussion of findings and any additional treatment needed
• Fertility-related hysteroscopy: Follow-up to discuss next steps in your fertility plan

Frequently Asked Questions About Hysteroscopy