Hysteroscopy is a minimally invasive gynaecological procedure that allows a specialist to examine the inside of the uterus directly.
Using a thin instrument called a hysteroscope, the uterine cavity can be carefully assessed without making an abdominal incision.
Hysteroscopy may help investigate symptoms such as abnormal uterine bleeding and can also be used to diagnose or treat certain conditions affecting the inside of the uterus.
For some patients, diagnosis and treatment can be performed during the same procedure.
Understanding why hysteroscopy is recommended and what happens during the procedure can help you feel better informed about your care.
What Is a Hysteroscopy?
A hysteroscopy is a procedure used to examine the inside of the uterus, also known as the uterine cavity.
A thin telescope called a hysteroscope is gently passed through the vagina and cervix into the uterus. The hysteroscope contains a camera that allows the doctor to view the uterine cavity on a monitor.
Because the hysteroscope reaches the uterus through the natural opening of the cervix, hysteroscopy normally requires no abdominal incisions.
This makes it an important minimally invasive technique in modern gynaecological care.
Why Might You Need a Hysteroscopy?
A hysteroscopy may be recommended when symptoms or previous investigations suggest that there could be a problem within the uterine cavity.
Common reasons include:
- Heavy menstrual bleeding
- Bleeding between periods
- Irregular or abnormal uterine bleeding
- Bleeding after menopause
- Suspected endometrial polyps
- Certain types of fibroids
- Investigation of abnormalities seen on ultrasound
- Investigation of the uterine cavity in selected fertility cases
- Removal of retained intrauterine devices in selected circumstances
Your individual symptoms and previous investigations will determine whether hysteroscopy is appropriate.
What Can Hysteroscopy Detect?
One of the main advantages of hysteroscopy is that it provides direct visualisation of the inside of the uterus.
Rather than relying solely on an imaging test, the specialist can directly inspect the uterine cavity.
Endometrial polyps
Uterine or endometrial polyps are growths arising from the lining of the uterus. They may be associated with abnormal bleeding and can often be assessed and, where appropriate, removed hysteroscopically.
Submucosal fibroids
Fibroids are benign growths that develop from the muscle of the uterus.
When a fibroid projects into the uterine cavity, it is known as a submucosal fibroid. Depending on its size and position, hysteroscopic surgery may be an appropriate treatment.
Intrauterine adhesions
Scar tissue can sometimes develop inside the uterus. Hysteroscopy can allow direct assessment of these adhesions and, in selected cases, surgical treatment.
Abnormalities of the uterine cavity
Hysteroscopy may also help evaluate certain structural abnormalities affecting the inside of the uterus.
Changes in the endometrium
When clinically indicated, hysteroscopy can be combined with an endometrial biopsy so that a tissue sample can be sent for laboratory examination.
Diagnostic vs Operative Hysteroscopy
Hysteroscopy can be broadly divided into diagnostic and operative procedures.
A diagnostic hysteroscopy is primarily performed to examine the uterine cavity and identify a possible cause of symptoms.
An operative hysteroscopy allows the specialist to treat certain abnormalities identified within the uterus.
For example, hysteroscopic surgery may be used to remove selected:
- Endometrial polyps
- Submucosal fibroids
- Intrauterine adhesions
- Retained intrauterine devices
In some situations, diagnosis and treatment may be possible during the same appointment. In others, a separate procedure may be recommended.
What Happens During a Hysteroscopy?
The exact experience depends on whether you are having an outpatient diagnostic hysteroscopy or a more extensive operative procedure.
During hysteroscopy, the hysteroscope is passed through the vagina and cervix into the uterus.
Fluid is usually introduced gently into the uterine cavity. This allows the walls of the uterus to separate slightly so that the specialist can obtain a clear view.
The camera then transmits images from inside the uterus to a monitor.
If an abnormality is identified, additional fine instruments may sometimes be passed through the hysteroscope to take a biopsy or perform treatment.
Does a Hysteroscopy Hurt?
Experiences vary considerably.
Some patients experience mild discomfort or cramping, while others may find hysteroscopy more uncomfortable.
The level of discomfort can depend on several factors, including the type and duration of the procedure and whether treatment is being performed at the same time.
Pain relief and anaesthetic options vary according to the planned procedure and individual circumstances.
If you are concerned about pain, anxiety or previous difficult gynaecological examinations, discuss this with your specialist beforehand. Your comfort should form part of the treatment plan.
Do You Need a General Anaesthetic?
Not necessarily.
Some diagnostic hysteroscopies can be performed in an outpatient setting without general anaesthesia.
More complex operative hysteroscopic procedures may be performed with anaesthesia or sedation, depending on the intervention and individual circumstances.
Your specialist should explain the recommended approach before the procedure.
Hysteroscopy and Abnormal Bleeding
Abnormal uterine bleeding is one of the common reasons for investigating the uterine cavity.
Heavy periods, irregular bleeding, bleeding between periods or postmenopausal bleeding can have several possible causes.
These include polyps, fibroids and changes affecting the endometrium.
Hysteroscopy can be particularly valuable when direct visualisation or tissue sampling is required.
However, abnormal bleeding does not automatically mean that hysteroscopy is necessary. Ultrasound, blood tests, clinical examination and other investigations may also form part of the assessment.
Hysteroscopy and Fibroids
Not every fibroid can be treated hysteroscopically.
Hysteroscopic treatment is mainly relevant to fibroids that project partly or predominantly into the uterine cavity.
Fibroids located within the uterine muscle or on the outside of the uterus may require a different approach.
This is why imaging and specialist assessment are important before deciding on treatment.
Hysteroscopy and Fertility
The uterine cavity plays an important role in implantation and pregnancy.
In selected patients experiencing fertility difficulties or recurrent pregnancy loss, assessment of the uterine cavity may form part of the investigation.
Hysteroscopy can identify certain abnormalities such as polyps, submucosal fibroids or intrauterine adhesions.
However, fertility problems have many possible causes, and hysteroscopy is not required for every patient experiencing difficulty conceiving.
The decision should be based on the patient’s history, previous investigations and individual fertility circumstances.
What Are the Benefits of Hysteroscopy?
A major advantage of hysteroscopy is direct visualisation of the uterine cavity.
Depending on the indication, potential benefits include:
- No abdominal incision
- Direct examination of the uterus
- Targeted biopsy when necessary
- Diagnosis and treatment during the same procedure in selected cases
- Treatment of certain polyps and fibroids
- Generally rapid recovery following straightforward procedures
However, hysteroscopy is not appropriate for every gynaecological condition.
It examines the inside of the uterus and therefore cannot diagnose all conditions affecting the pelvis.
What Are the Risks of Hysteroscopy?
Hysteroscopy is commonly performed, but like every medical procedure, it carries potential risks.
Possible complications can include:
- Pain or cramping
- Bleeding
- Infection
- Injury to the cervix
- Perforation of the uterus
- Complications related to the fluid used during some procedures
Serious complications are uncommon, but the specific risks depend on the type and complexity of the procedure.
Your specialist should discuss the relevant benefits and risks with you beforehand.
What Is Recovery Like After Hysteroscopy?
Recovery depends on the type of hysteroscopy performed.
After a straightforward procedure, some patients can return to normal activities relatively quickly. Mild period-like cramps and light bleeding or spotting may occur for a short period afterwards.
Recovery after operative hysteroscopy can vary depending on the treatment performed.
You should follow the specific aftercare instructions provided by your clinical team.
Seek medical advice if you develop concerning symptoms after the procedure, particularly severe or worsening pain, heavy bleeding, fever or feeling significantly unwell.
Hysteroscopy vs Ultrasound: What Is the Difference?
Ultrasound and hysteroscopy provide different types of information.
A pelvic or transvaginal ultrasound creates images of the uterus, ovaries and surrounding structures. It is an important first-line investigation for many gynaecological symptoms.
Hysteroscopy, by contrast, provides direct visualisation of the inside of the uterine cavity.
Sometimes ultrasound provides all the information required. In other situations, hysteroscopy may be recommended for further assessment or treatment.
The two investigations can therefore complement each other rather than compete with one another.
Personalised Hysteroscopy Care in Bristol
The decision to perform hysteroscopy should be based on your symptoms, medical history, previous investigations and individual treatment goals.
At Bristol EndoGyn, specialist assessment is available for women experiencing abnormal bleeding and other benign gynaecological conditions.
Where appropriate, hysteroscopy and minimally invasive gynaecological techniques can be incorporated into a personalised diagnostic and treatment plan.
The objective is not simply to perform a procedure, but to understand the cause of your symptoms and determine the most appropriate treatment for you.
To arrange a specialist consultation:
📞 0117 440 4224
🌐 bristolendogyn.com
📍 Spire Bristol Hospital, Bristol, United Kingdom
Frequently Asked Questions About Hysteroscopy
How long does a hysteroscopy take?
The duration depends on whether the procedure is diagnostic or involves treatment. A straightforward diagnostic examination can be relatively short, while operative hysteroscopy may take longer.
Can a polyp be removed during hysteroscopy?
Yes. Many endometrial polyps can be removed hysteroscopically. Whether this can be performed during the same appointment depends on the clinical setting, the polyp and the planned procedure.
Can fibroids be removed by hysteroscopy?
Certain submucosal fibroids that project into the uterine cavity can be treated hysteroscopically. Other types of fibroids require different treatment approaches.
Will I need time off work after hysteroscopy?
This depends on the procedure and how you feel afterwards. Recovery following a simple diagnostic hysteroscopy may be rapid, whereas more extensive operative treatment can require additional recovery time.
Can hysteroscopy diagnose endometriosis?
No. Hysteroscopy examines the inside of the uterine cavity, whereas endometriosis typically occurs outside the uterine cavity. Other investigations and specialist assessment are required when endometriosis is suspected.
This article is intended for general information and does not replace personalised medical advice, diagnosis or treatment.