Hysteroscopy

What is a hysteroscopy?

A hysteroscopy is a procedure where a doctor or nurse looks inside your uterus (womb) and cervix (the neck of the womb) using a thin tube with a light and camera on the end, called a hysteroscope. It can be used to find the cause of a problem, to treat one, or both at the same time.

Why might I need one?

Your doctor may suggest a hysteroscopy if you have heavy or long periods; bleeding between periods or after the menopause; or any unexplained new bleeding. It's also used to investigate fertility problems or repeated miscarriage, or to look further into something unusual seen on an ultrasound scan, such as a polyp or fibroid.

It can also be used to remove a coil (IUD) when the threads can't be seen, or to look further into abnormal cells found on a smear test.

A hysteroscopy can help your doctor find things such as:

• the cause of abnormal bleeding
• fibroids, polyps or adhesions (scar tissue) in the womb
• an unusual size or shape of the womb
• a blockage at the opening of a fallopian tube.

If a problem is found, your doctor may be able to treat it during the same appointment, for example by removing a polyp, a small fibroid, or scar tissue, or by fitting or removing a coil.

What are the benefits of having it?

A hysteroscopy lets your doctor look directly inside your womb, which can give a clearer picture than a scan alone. In many cases, they can treat a problem, such as removing a polyp, during the same appointment as the diagnosis, so you may not need a separate procedure.

The test doesn't involve any cuts. It is often done as an outpatient day procedure, without a general anaesthetic, so recovery is usually quick, and most women go home and back to their normal activities the same day.

Are there different types of test?

There are two main types, based on why you're having the test:

• Diagnostic hysteroscopy: This is done to find the cause of a problem, such as unusual bleeding
• Operative hysteroscopy: This is done to treat a problem at the same time, such as removing polyps, fibroids or scar tissue.

Many women have it while awake in an outpatient clinic, often without any anaesthetic or with just a local anaesthetic injection into the cervix. Others may need to have it done under general or regional anaesthetic, or sedation, in an operating theatre, usually as a day case.

How do I prepare for the test?

If you have regular periods, the best time for a hysteroscopy is usually in the week after your period ends. If your period starts unexpectedly close to your appointment, tell your care team, as you may need to reschedule.

You'll usually need to avoid sex, or use contraception, between your last period and your appointment, to avoid the small chance of being pregnant during the test. You may be offered a urine pregnancy test when you arrive.

Before your test, tell your care team about:

• any medications you're taking, and check whether you need to stop any of them beforehand
• any chance you could be pregnant
• a pelvic infection, or symptoms of one
• other health conditions, such as heart problems or a tendency to bleed easily.

You don't usually need to fast beforehand, and you can eat and drink normally, unless you're having a general anaesthetic, in which case you may need to avoid food and drink for 6 to 12 hours before. Avoid using tampons, vaginal medicines, or a douche (a method of washing inside the vagina) for 24 hours before and after your test.

It helps to take a painkiller such as paracetamol or ibuprofen about an hour before your appointment. You may want to bring a friend or family member with you, along with a list of any medications you take.

What happens during the test?

1. You'll be asked to undress from the waist down and put on a gown in a private area.
2. You may be asked for a urine sample to check you're not pregnant, then helped into position on a special chair or couch, with your legs supported.
3. If you're having any anaesthetic, sedation or pain relief, this is given now; it might be a local anaesthetic injection into the cervix, gas that you breathe in, or a general anaesthetic if you're having the test in an operating theatre.
4. Your doctor or nurse may use an instrument called a speculum to hold your vagina open so they can see your cervix, although some hospitals do this without one, to help with comfort.
5. The hysteroscope is passed through your cervix and into your womb.
6. Fluid or gas is passed through the hysteroscope to gently open up your womb, so the inside can be seen clearly on a screen; you may feel wet as the fluid trickles out.
7. If needed, a biopsy (a small tissue sample) is taken, or growths such as polyps or small fibroids are removed, using tools passed through the hysteroscope.
8. Once the examination is finished, the hysteroscope is removed.

The examination itself often takes around 5 to 10 minutes, and can take up to an hour if you're having treatment at the same time. Your whole appointment, including recovery, may last up to 2 hours.

What happens after the test?

Most women feel able to go back to their normal activities on the same day. You may have some cramping or lower abdominal pain for a few hours afterwards, though for some people this lasts a few days. Simple pain relief like paracetamol or ibuprofen can help with that generally.

You may also have some spotting or light bleeding for up to a week. You might also notice some bloating and shoulder discomfort caused by the gas or fluid used during the test, and possibly feel a little sick.

You're generally advised to avoid tampons, douching, or penetrative sex until your bleeding and any pain has settled – for up to 2 weeks. You can shower as normal.

If you had sedation or an anaesthetic, you'll need someone to take you home, and you shouldn't drive yourself.

If a biopsy was taken, you'll be contacted with the results when they're ready. If no problems were found, you may not need a follow-up appointment. Contact your care team urgently, or go to your nearest emergency department, if you get a fever, severe abdominal pain, or heavy vaginal bleeding.

What are the risks or side effects?

A hysteroscopy is generally very safe, and most side effects are mild.

• Pain during or after the test: Most women have some pain, but it's severe for only some
• Feeling faint or sick: Which affects around 1 in 200 women having the test without an anaesthetic, or with only a local anaesthetic – this usually settles quickly
• Infection of the womb: This is uncommon (fewer than 3 in 100 women) – it can cause a smelly discharge, fever or heavy bleeding, and is usually treated with a short course of antibiotics
• Not being able to complete the test: For example if your cervix is tightly closed or scarred
• Uterine perforation: This is a small hole made in the wall of the womb – this happens in fewer than 1 in 200 diagnostic procedures, is slightly more likely if a polyp or fibroid is removed at the same time, and may need an overnight hospital stay or a further operation to repair
• Heavier bleeding during or after the test: This very rarely may need further treatment or, extremely rarely, removal of the womb.