A thin, rigid viewing tube, called a hysteroscope, is inserted through the vagina and cervix and into the uterus. Fiberoptic cables permit the examiner to directly inspect the uterine cavity and endometrium (the tissue that lines the uterus) for any signs of disease or abnormality. If necessary, instruments (such as a tiny scissors or small electrical loop used to cut tissue) may be passed through the scope to perform therapeutic procedures.
Purpose of the Hysteroscopy
- To help evaluate women with abnormal uterine bleeding, postmenopausal bleeding, infertility problems (when a deformity within the uterine cavity is suspected), or repeated miscarriages
- To detect or evaluate uterine abnormalities, such as polyps, fibroids, and intrauterine adhesions (scar tissue inside the uterine cavity)
- Used therapeutically to remove polyps, small fibroids, and displaced intrauterine devices (IUDs)
- To help determine the cause of heavy or irregular periods, bleeding after menopause and recurrent miscarriage
- To locate an intrauterine device (IUD)
Who Performs Hysteroscopy
- A gynecologist trained in hysteroscopy
Special Concerns about Hysteroscopy
- Hysteroscopy is not appropriate in women who have pelvic inflammatory disease (PID) or vaginal discharge.
- Hysteroscopy is sometimes performed in conjunction with other procedures, such as laparoscopy or endometrial biopsy.
- Depending on the extent of the procedure, hysteroscopy can be performed under general, regional, or local anesthesia, or with just a mild pain reliever and no anesthetic medication.
- If you still have menstrual periods, schedule the procedure for the week after the end of your menstrual cycle (before ovulation), to allow for better viewing conditions and to avoid interfering with a newly formed pregnancy.
Before the Hysteroscopy
- In some cases, blood work is done, usually within one week of the procedure.
- Shower or bathe the night before or the morning of the operation.
- If general anesthesia is required, do not eat or drink anything after midnight on the day before the procedure.
- If the procedure will be performed under local anesthesia, you may be given a sedative before the test to relax you.
- You will be asked to disrobe and put on a hospital gown.
- Empty your bladder just before the test.
- Before the procedure begins, the doctor may perform a complete pelvic exam and may take cultures of the vagina and cervix.
- For general anesthesia, an intravenous (IV) needle or catheter is inserted into a vein in your arm and the medication is administered. In some cases, a thin tube attached to a breathing machine will be inserted through your mouth and into your windpipe to ensure you breathe properly during the procedure.
What You Experience during Hysteroscopy
- You will lie on your back with your knees bent and your feet placed in stirrups and will be given an anesthetic to block pain.
- General anesthesia will make you unconscious during the operation and a breathing mask may be used to help you breathe.
- The vaginal area will be cleansed with an antiseptic, and the doctor will gently insert a lubricated speculum—a metal or plastic instrument that pushes apart the walls of the vagina to provide the examiner with a view of the cervix. This device may feel uncomfortable, but causes no pain. Relax and breathe through your mouth to ease the insertion.
- A local anesthetic is injected to numb the cervix. Alternatively, you will be under general anesthesia or a spinal (epidural) anesthetic will be injected into the spinal column to numb the pelvic region.
- The hysteroscope is carefully passed through the vagina and cervix and into the uterus. (If necessary, the cervix may be opened, or dilated, using blunt metal instruments of increasing diameter to ease insertion of the scope.) Magnifying devices provide the doctor with a direct view inside the cavity. An image of the area may also be transmitted onto a TV screen and photographs may be taken for later examination.
- The doctor may instill liquid or gas (such as carbon dioxide) through the hysteroscope to distend the uterine walls so that the tissue is easier to see.
- If appropriate, small instruments may be inserted through the scope to perform therapeutic procedures. If more detailed or complicated surgical procedures are necessary, the outside of the uterus may be viewed concurrently with laparoscopy.
- The hysteroscope is withdrawn.
- This procedure usually takes 30 minutes to 1 hour, but can take longer if extensive surgery is required.
Risks and Complications of Hysteroscopy
- If gas was used to distend the uterus, you may experience transient pain in the upper abdomen and shoulder and shortness of breath (as gas passes into the abdominal cavity).
- If general anesthesia is used, the procedure carries the associated risks.
- In some cases, the cervix is torn when the instruments used are passed through it or removed. This type of injury can make it difficult to carry any future pregnancies to term.
- Damage to organs near the uterus, such as the ovaries, bladder or bowel, may occur. Damage or uncontrollable bleeding may require a blood transfusion or additional surgery to repair.
- Infections, sometimes severe enough to require hospitalization for several days, can occur.
- Some women experience nausea, fatigue, muscle pain or shoulder pain after the procedure.
After the Hysteroscopy
- You will remain in the doctor’s office or hospital until you recover from the effects of anesthesia (usually for about 1 to 2 hours). During this time, your vital signs will be monitored, and you will be observed for any signs of complications.
- Arrange for someone to drive you home.
- If you experience any pain in the upper abdomen and shoulder and shortness of breath (due to the passage of instilled gas from the uterus to the abdominal cavity), it should subside within 24 to 36 hours.
- You may experience mild abdominal cramping and slight vaginal bleeding for 1 or 2 days. You may be given a pain reliever, if needed.
- Avoid sexual intercourse for one or two days.
- Contact your doctor immediately if you develop severe abdominal pain, excessive vaginal bleeding or discharge, or fever.
Results of Hysteroscopy
- During the visual inspection of your uterus, the doctor will note any abnormality.
- If tissue samples or cultures are taken, specimen containers may be sent to several different laboratories for examination. Your doctor will review the results for any evidence of any abnormality.
- This test usually results in a definitive diagnosis. Your doctor will recommend an appropriate course of medical or surgical treatment, depending on the specific problem.
The Johns Hopkins Consumer Guide to Medical Tests
Simeon Margolis, M.D., Ph.D., Medical Editor
Updated by Remedy Health Media