Hysteroscopy

Overview

What is a hysteroscopy?

Hysteroscopy is a procedure that can be used to both diagnose and treat causes of abnormal bleeding. The procedure allows your doctor to look inside your uterus with a tool called a hysteroscope. This is a thin, lighted tube that is inserted into the vagina to examine the cervix and inside of the uterus. Hysteroscopy can be a part of the diagnosis process or an operative procedure.

What is diagnostic hysteroscopy?

Diagnostic hysteroscopy is used to diagnose problems of the uterus. Diagnostic hysteroscopy is also used to confirm results of other tests, such as hysterosalpingography (HSG). HSG is an X-ray dye test used to check the uterus and fallopian tubes. Diagnostic hysteroscopy can often be done in an office setting.

Additionally, hysteroscopy can be used with other procedures, such as laparoscopy, or before procedures such as dilation and curettage (D&C). In laparoscopy, your doctor will insert an endoscope (a slender tube fitted with a fiber optic camera) into your abdomen to view the outside of your uterus, ovaries and fallopian tubes. The endoscope is inserted through an incision made through or below your navel.

What is operative hysteroscopy?

Operative hysteroscopy is used to correct an abnormal condition that has been detected during a diagnostic hysteroscopy. If an abnormal condition was detected during the diagnostic hysteroscopy, an operative hysteroscopy can be performed at the same time, avoiding the need for a second surgery. During operative hysteroscopy, small instruments used to correct the condition are inserted through the hysteroscope.

When is operative hysteroscopy used?

Your doctor may perform hysteroscopy to correct the following uterine conditions:

  • Polyps and fibroids: Hysteroscopy is used to remove these non-cancerous growths found in the uterus.
  • Adhesions: Also known as Asherman’s Syndrome, uterine adhesions are bands of scar tissue that can form in the uterus and may lead to changes in menstrual flow as well as infertility. Hysteroscopy can help your doctor locate and remove the adhesions.
  • Septums: Hysteroscopy can help determine whether you have a uterine septum, a malformation (defect) of the uterus that is present from birth.
  • Abnormal bleeding: Hysteroscopy can help identify the cause of heavy or lengthy menstrual flow, as well as bleeding between periods or after menopause. Endometrial ablation is one procedure in which the hysteroscope, along with other instruments, is used to destroy the uterine lining in order to treat some causes of heavy bleeding.

When should hysteroscopy be performed?

Your doctor may recommend scheduling the hysteroscopy for the first week after your menstrual period. This timing will provide the doctor with the best view of the inside of your uterus. Hysteroscopy is also performed to determine the cause of unexplained bleeding or spotting in postmenopausal women.

Who is a candidate for hysteroscopy?

Although there are many benefits associated with hysteroscopy, it may not be appropriate for some patients. A doctor who specializes in this procedure will consult with your primary care physician to determine whether it is appropriate for you.

Procedure Details

How is hysteroscopy performed?

Prior to the procedure, your doctor may prescribe a sedative to help you relax. You will then be prepared for anesthesia. The procedure itself takes place in the following order:

  • The doctor will dilate (widen) your cervix to allow the hysteroscope to be inserted.
  • The hysteroscope is inserted through your vagina and cervix into the uterus.
  • Carbon dioxide gas or a liquid solution is then inserted into the uterus, through the hysteroscope, to expand it and to clear away any blood or mucus.
  • Next, a light shone through the hysteroscope allows your doctor to see your uterus and the openings of the fallopian tubes into the uterine cavity.
  • Finally, if surgery needs to be performed, small instruments are inserted into the uterus through the hysteroscope.

The time it takes to perform hysteroscopy can range from less than five minutes to more than an hour. The length of the procedure depends on whether it is diagnostic or operative and whether an additional procedure, such as laparoscopy, is done at the same time. In general, however, diagnostic hysteroscopy takes less time than operative.

Risks / Benefits

What are the benefits of hysteroscopy?

Compared with other, more invasive procedures, hysteroscopy may provide the following advantages:

  • Shorter hospital stay.
  • Shorter recovery time.
  • Less pain medication needed after surgery.
  • Avoidance of hysterectomy.
  • Possible avoidance of "open" abdominal surgery.

How safe is hysteroscopy?

Hysteroscopy is a relatively safe procedure. However, as with any type of surgery, complications are possible. With hysteroscopy, complications occur in less than 1% of cases and can include:

  • Risks associated with anesthesia.
  • Infection.
  • Heavy bleeding.
  • Injury to the cervix, uterus, bowel or bladder.
  • Intrauterine scarring.
  • Reaction to the substance used to expand the uterus.

Recovery and Outlook

What can I expect after hysteroscopy?

If regional or general anesthesia is used during your hysteroscopy, you may have to be observed for several hours before going home. After the procedure, you may have some cramping or slight vaginal bleeding for one to two days. In addition, you may feel shoulder pain if gas was used during your hysteroscopy. It is also not unusual to feel somewhat faint or sick. However, if you experience any of the following symptoms, be sure to contact your doctor:

  • Fever.
  • Severe abdominal pain.
  • Heavy vaginal bleeding or discharge.

Will I have to stay in the hospital overnight after hysteroscopy?

Hysteroscopy is considered minor surgery and usually does not require an overnight stay in the hospital. However, in certain circumstances, such as if your doctor is concerned about your reaction to anesthesia, an overnight stay may be required.

Additional Details

What type of anesthesia is used for hysteroscopy?

Anesthesia for hysteroscopy may be local, regional or general:

  • Local anesthesia: The numbing of only a part of the body for a short time.
  • Regional anesthesia: The numbing of a larger portion of the body for a few hours.
  • General anesthesia: The numbing of the entire body for the entire time of the surgery.

The type of anesthesia used is determined by where the hysteroscopy is to be performed (hospital or doctor’s office) and whether other procedures will be done at the same time. If you are having general anesthesia, you will be told not to eat or drink for a certain amount of time before the hysteroscopy.

Last reviewed by a Cleveland Clinic medical professional on 07/18/2018.

References

  • American College of Obstetricians and Gynecologists. . Accessed 7/19/2018.FAQ: Hysteroscopy (https://www.acog.org/Patients/FAQs/Hysteroscopy)
  • American Society for Reproductive Medicine. . Accessed 7/19/2018.Hysteroscopy (https://www.asrm.org/topics/topics-index/hysteroscopy/)
  • Cain J, ElMasri WM, Gregory T, Kohn EC. Chapter 41. Gynecology. In: Brunicardi FC, Andersen DK, Billiar TR, Dunn DL, Hunter JG, Matthews JB, Pollock RE, eds. . 9th ed. New York: McGraw-Hill; 2010. Accessed 7/19/2018.Schwartz's Principles of Surgery (https://accessmedicine.mhmedical.com/Book.aspx?bookid=2576)

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy