What is a hysteroscopy?

A hysteroscopy is an examination of the inside of the uterus (womb) using a fine telescope.

The telescope is inserted via the vagina and the opening of the uterus (cervix). The inside of the uterus can be then seen and assessed in terms of its shape, the lining (endometrium) and for focal lesions (polyps, fibroids, septa, adhesions). This can help identify the cause of the symptoms you are experiencing.

A small biopsy (removal of some cells from the endometrium - lining of the uterus) is often done at the end of the procedure to allow further analysis under a microscope. We can sometimes remove polyps as well during the procedure. The procedure is relatively simple and takes a few minutes. It can be easily performed as an out-patient procedure without you having to have a general anaesthetic.

Some women benefit from local anaesthetic injections into the cervix to numb the area, but most patients do not need this and often the injections can be more uncomfortable than the hysteroscopy.

Why is a hysteroscopy performed?

Women who are experiencing certain gynaecological symptoms relating to their womb (uterus) are often recommended to undergo a hysteroscopy. Some of the more common complaints include:

  • Heavy or irregular periods.
  • Bleeding between periods or after the menopause.
  • Fibroids (non-cancerous growths).
  • Unusual vaginal discharge.
  • Repeated miscarriages.
  • Problems with fertility.
  • To insert or remove coils.

Risks and side-effects

A hysteroscopy is a very safe procedure with a low risk of complications. The most common side effects are discomfort (similar to period pain), feeling faint and bleeding. You should contact your GP or A&E if following the procedure you develop:

  • A temperature.
  • Increased pain, not relieved with your usual painkillers.
  • Increased discharge which is smelly and unpleasant.
  • Heavy bleeding.

Before your hysteroscopy

No preparation is needed before a hysteroscopy. You can eat and drink normally before your procedure. You must take the usual tablets that you would use for pain relief (e.g. paracetamol) about an hour before your appointment time.

If you are between the ages of 12 and 55 years old, you will be asked to provide a urine sample for a pregnancy test. If there is any chance you may be pregnant, please tell a member of the team immediately. We will not be able to perform a hysteroscopy if you are pregnant. Please avoid unprotected sex (use a condom) between your last period and your appointment.

Hysteroscopies can be performed during a period, however, please call for advice prior to your appointment on the contact number below.

What happens during a hysteroscopy?

Sedation is not usually required for a hysteroscopy and you will be awake at all times. You will be asked to remove the bottom half of your clothing and lie on a couch with your legs in leg supports. The hysteroscope will then be inserted into your vagina to locate your cervix. To guide the hysteroscope, we use high pressure sterile water.

Once your cervix has been located, the doctor will very gently push the hysteroscope into your uterus to examine the area. If at any point you find the procedure too uncomfortable, you can ask the doctor for a local anaesthetic.

If you wish to have a local anaesthetic, the procedure will be stopped and the hysteroscope removed to allow the doctor to inject the local anaesthetic. A speculum (a smooth, tubeshaped tool) will be inserted into your vagina so the doctor can locate your cervix and inject the anaesthetic. You may feel some discomfort from the injection. The local anaesthetic can also cause an increase in heart rate and shaky legs. These side effects will ease within a couple of minutes.

The local anaesthetic only numbs the cervix, so you might still feel discomfort when the uterus is filled with water. If the procedure it still too painful, you can have the procedure under a general anaesthetic. This will not be done on the same day, and you will need to be assessed beforehand. The team will arrange this for you and give you all the details.

If the doctor finds a polyp, they will stop the procedure and explain the finding. They will ask you if you wish to have the polyp removed that day or if you wish to have it done under general anaesthetic. If you wish to have it done on the day, the hysteroscope will need to be changed to a larger one (the difference between scopes is roughly 2mm).

You are more than welcome to watch the procedure on the screen. Straightforward procedures normally last about three minutes but can take up to 20 minutes if you require a local anaesthetic and removal of a polyp.

After your hysteroscopy

We will ask you to stay in the waiting area until you feel ready to leave. You may get period like cramps during or after the procedure, but many women only feel little discomfort. Very occasionally, some women can feel a little faint or nauseated. If this happens to you, you will be able to lie down until you feel better.

It is usual to have some light bleeding after a hysteroscopy and you might need to wear a sanitary towel for a few days. There is no reason why you should not drive home, but you may prefer to take things easy for the day. You should be able to return to work the following day, as well as resume normal activities such as sport and sexual intercourse.

When will I find out my results?

We will discuss the findings on the day of your hysteroscopy, and you will find out the results of the biopsy and implications either by letter or a follow-up appointment. We can also treat some conditions such as uterine polyps on the same visit within the clinic meaning no further appointments are needed.

If you still then require additional investigations or surgery, we will arrange this for you. The results of any biopsies up to four weeks and then we will write to you and your GP with the outcome.