Hysteroscopy

Overview

A hysteroscopy is a test to look inside a woman's womb, using a thin tube with a small camera inside it. The womb is where a baby grows in pregnancy.

Anyone with a womb can have a hysteroscopy, as long as they are not pregnant.

Why a hysteroscopy is done

A hysteroscopy can be done to find out why you're having certain symptoms such as unexplained vaginal bleeding.

It can help diagnose or treat many different health issues, including:

very heavy periods or bleeding between periods
bleeding after the menopause
fibroids or small growths (polyps)
problems getting pregnant or repeated miscarriages
removal of a coil (IUS or IUD) if the threads are missing

Sometimes a sample of tissue (biopsy) is taken during a hysteroscopy, or fibroids and polyps are removed.

Preparing for a hysteroscopy

A GP or hospital doctor can refer you for a hysteroscopy if they think you need one. You'll get printed information about the procedure, including details of pain relief options, or a link to where you can read this information online.

Before you go in for your hysteroscopy, let staff at the hospital or clinic know if you'd like to bring a friend or family member with you. There will also be a nurse or other trained member of staff with you during the test (a chaperone).

Pain relief options

Having a hysteroscopy can be uncomfortable and may feel like period pain. Taking ibuprofen or paracetamol 1 hour before the procedure can help.

However, for many people a hysteroscopy can be very painful. If you're worried about pain, or have questions about pain relief, you may want to speak to staff at the hospital or clinic before the day of your hysteroscopy.

Tell them in advance if:

you have painful periods that make you faint
you've had painful vaginal examinations or cervical smears in the past
you've experienced sexual violence, which could make the procedure difficult for you

It may be possible to have a general anaesthetic or an injection to help you relax (intravenous sedation) during the hysteroscopy. Not all hospitals or clinics offer this, so you may need to be referred to one that does.

Before having a hysteroscopy with general anaesthetic or sedation, you'll be invited to a separate appointment for some health checks.

Do not have a hysteroscopy if you could be pregnant

Use contraception, or avoid sex, in the weeks between your last period and having your hysteroscopy.

You may also be given a pregnancy test on the day of the procedure.

How a hysteroscopy is done

Before the hysteroscopy, you'll meet the healthcare professional who will be doing the procedure (the hysteroscopist).

They'll explain what will happen, including your pain relief options, and can answer any questions. They'll ask you to sign a consent form.

During your hysteroscopy, a thin tube with a small camera inside is inserted into your vagina, passed through your cervix and into your womb. Salt water (saline solution) is injected through the tube, to make it easier to see inside your womb.

The camera sends images to a screen, so the hysteroscopist can see what they're doing. You can also watch the screen if you want to.

You may feel sick or faint during the procedure.

If you're in a lot of discomfort or pain, you may be offered gas and air or a local anaesthetic to help with the pain. Or you can ask to stop the procedure at any time.

You may be able to have the test at a later date with local anaesthetic or general anaesthetic, or an injection to relax you (intravenous sedation).

A hysteroscopy usually takes 10 to 15 minutes but can take longer if any tissue samples are taken, or a fibroid or small growth is removed.

Afterwards, you'll be moved to a recovery area until you feel ready to go home.

Hysteroscopy with general anaesthetic or sedation

If you have a hysteroscopy with a general anaesthetic, you may need to stay in hospital overnight.

If you have a general anaesthetic or intravenous sedation, a friend or family member will need to collect you afterwards. Do not drive yourself.

Recovering from a hysteroscopy

It's normal to have pain, similar to period pain, for a couple of days after a hysteroscopy. Taking paracetamol, ibuprofen or your usual period pain medicine should help.

You may also have some bleeding, or spots of blood (spotting), for up to a week. Use pads not tampons.

Avoid exercise or having sex until the pain and bleeding has stopped.

Possible complications of a hysteroscopy

Most hysteroscopies are quick and safe, without any problems. But like any procedure there's a small chance that something can go wrong.

It happens rarely, but there's a risk of:

developing an infection afterwards – this can be treated with antibiotics
making a small hole in the wall of the womb when removing a polyp

If there's a hole in the wall of your womb after removing a polyp, you may need to stay in hospital overnight. This often gets better on its own, but sometimes an operation is needed to repair it.

Contact the hospital or clinic where you had the procedure urgently if:

you have bleeding that gets worse or does not stop after a few days
you have tummy pain that gets worse and painkillers or your usual period pain tablets have not helped
you have a high temperature
you have smelly vaginal discharge

You can also call 111 or get help from?111 online.

How is it performed?

A hysteroscopy is a simple procedure usually carried out on an outpatient or day-case basis. This means you won't normally need to stay in hospital overnight.

Preparing for a hysteroscopy

In the days and weeks before a hysteroscopy, you may be advised to:

have tests to check whether you can have the procedure, such as blood tests and a pregnancy test – these may be done at an appointment about a week before your hysteroscopy
use contraception – a hysteroscopy cannot be carried out if you're pregnant
stop smoking – if you're due to have a general anaesthetic and you smoke, stopping smoking in the lead up to the procedure can help reduce your risk of complications from the anaesthetic

If you're going to have fibroids removed, you may be given medicine to help shrink them beforehand.

Choice of anaesthetic

A hysteroscopy is not usually carried out under anaesthetic, as it's a relatively quick procedure and does not involve making cuts (incisions) in your skin.

Taking painkillers such as ibuprofen or paracetamol about an hour beforehand can help reduce discomfort after the procedure.

Occasionally, a local anaesthetic may be used to numb your cervix (entrance to the womb) during the procedure.

Longer or more complicated procedures, such as the removal of fibroids, may be done under general anaesthetic. This means you'll be asleep while the operation is carried out.

On the day of your hysteroscopy

If you're having a general anaesthetic, you'll need to avoid eating or drinking for a few hours before the procedure. Your appointment letter will mention whether this applies to you.

If you're having no anaesthetic or just a local anaesthetic, you can eat and drink as normal.

It's a good idea to wear loose, comfortable clothes when you arrive for your appointment, as you'll be asked to remove any clothes from below your waist and change into a hospital gown for the procedure.

You can bring a friend or relative with you for support, although they may not be allowed in the room during your hysteroscopy.

The hysteroscopy procedure

A hysteroscopy usually takes between 5 and 30 minutes. During the procedure:

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 is not always needed
the vagina and cervix are cleaned with an antiseptic solution
a hysteroscope (long, thin tube containing a light and camera) is passed into your womb – you may experience some cramping and discomfort as it passes through your cervix
fluid is gently pumped into the womb to make it easier for your doctor to see inside
the camera sends pictures to a monitor, so your doctor or specialist nurse can spot any abnormalities

If at any point you are finding the procedure too uncomfortable, tell the doctor or nurse. They can stop at any time.

In some cases, a small sample of tissue from the womb lining may be removed for further testing. This is known as an endometrial biopsy.

If you're having a hysteroscopy to treat a condition such as fibroids or polyps, fine surgical instruments can be passed along the hysteroscope. These are used to cut or burn away the abnormal tissue.

After a hysteroscopy

You should be able to go home soon after a hysteroscopy, although you may need to stay in hospital for a few hours if you had a general anaesthetic.

Your doctor or nurse will discuss their findings with you before you leave, although it may take a few weeks to get the results of a biopsy.

You can usually return to your normal activities later the same day or the following day if no anaesthetic or just a local anaesthetic was used. If you had a general anaesthetic, you may need to take things easy for a day or 2.

Recovery

You should be able to go home on the same day as your hysteroscopy. If you had an anaesthetic, you may need to stay in hospital for a few hours until it has worn off.

You can drive yourself home if no anaesthetic or only local anaesthetic was used. If you had a general anaesthetic, you won't be able to drive for at least 24 hours, so you'll have to arrange for someone to take you home.

Recovering at home

It's a good idea to rest when you get home.

If you had a general anaesthetic, someone should stay with you for at least 24 hours until the effects of the anaesthetic have worn off. Don't drive or drink alcohol during this time.

While you recover, you may experience:

cramping that's similar to period pain – this should pass in a few days and you can take regular painkillers such as paracetamol or ibuprofen in the meantime
spotting or bleeding – this can last up to a week or more; use sanitary towels rather than tampons until your next period to help reduce the risk of your womb or cervix (entrance to the womb) becoming infected

These side effects are normal and nothing to worry about, but you should seek medical advice if they are particularly severe.

Returning to your normal activities

Most women feel they can return to normal activities, including work, the day after having a hysteroscopy. Some women return to work later the same day.

However, you may wish to have a few days off to rest, particularly if you had treatment such as fibroids removal and/or a general anaesthetic was used.

Your doctor or surgeon can advise you about any activities you need to avoid while you recover, but generally speaking:

you can eat and drink as normal straight away – if you feel a bit sick after a general anaesthetic, try eating small, light meals at first
you can have a shower the same day and a bath the next day, unless your doctor advises you differently. If you have had a general anaesthetic you may still be feeling dizzy so it is a good idea to make sure there is another adult around to help you
you should avoid having sex for a week, or until any bleeding stops – this will help to reduce the risk of infection

Getting your results

Your doctor or nurse will let you know whether they found anything unusual during your hysteroscopy, or discuss how any treatment went, straight away.

If a small sample of tissue (biopsy) was removed from the womb, it can take several weeks to get your results. These may be sent through the post to your home address or to your doctor’s surgery.

Make sure you know how you'll receive your results before leaving the hospital.

When to get medical advice

Contact your GP or the hospital clinic if you:

have severe pain that isn't relieved by regular painkillers
have heavy bleeding that means you have to change sanitary pads frequently
pass bright red blood or large clots
have foul-smelling vaginal discharge
feel hot and shivery

These symptoms could be a sign of a problem, such as an infection.

The information on this page has been adapted by NHS Wales from original content supplied by

NHS website nhs.uk