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Hysteroscopy

Published by Bupa's health information team, December 2006.

This factsheet is for women who are having or thinking of having a hysteroscopy. Your care may differ from what is described here because it is adapted to meet your individual needs, so it's important to follow your doctor's advice.

A hysteroscopy is a test that allows your doctor to look inside your womb using a narrow tube-like telescope called a hysteroscope. This instrument is very slim (about three to five millimetres in diameter). It's carefully passed through the vagina and cervix, and into your womb.

Why have a hysteroscopy?

A hysteroscopy can help find out what is causing symptoms such as unusual vaginal bleeding, or as a check-up for certain gynaecological conditions such as fibroids, heavy periods or early signs of womb cancer, and can also be used to deliver treatment.

During the procedure your doctor may take a biopsy (a small sample of tissue) for examination in a laboratory, and/or treat the inside of your womb. It's also possible to remove polyps (small lumps of tissue) that may be found on the womb lining, as well as scar tissue and intra-uterine contraceptive devices (IUCDs) or "coils" that have become lost or stuck.

What are the alternatives?

Depending on your symptoms and circumstances, it may be possible to examine your womb using ultrasound (an imaging technique using sound waves). For some women, a simpler procedure called endometrial aspiration may be an alternative to a hysteroscopy. This involves passing a narrow tube through the cervix and into your womb, and using suction to remove samples of the womb lining.

For most women, however, a hysteroscopy is the best option to help diagnose or treat the problem. Unlike other tests, it enables your doctor to see directly into your womb.

Preparing for the procedure

Hysteroscopy is routinely performed as an out-patient or day case

Hysteroscopy can be performed with or without a local anaesthetic, especially if it's only being used for a check-up (a diagnostic hysteroscopy). Sometimes, it's done under general anaesthesia (an operative hysteroscopy). This means you will be asleep during the procedure. For more information on anaesthesia, please see the separate Bupa health factsheets, General anaesthesia and Local anaesthesia or sedation.

If the procedure is planned under general anaesthesia, your hospital may send you a pre-admission questionnaire. Your answers help hospital staff to plan your care by taking into account your medical history and any previous experience of hospital treatment. You will be asked to fill in this questionnaire and return it to your hospital.

If you are having the procedure under a local anaesthetic, you will be asked some questions -about your health, experience of surgery, allergies and the medicines you are taking - when you arrive for your examination.

If you normally take medication (eg tablets for blood pressure), continue to take this as usual, unless your doctor specifically tells you not to. If you are unsure about taking your medication, please contact the hospital.

Before you come for your examination, you will be asked to follow some instructions.

• Have a bath or shower at home.
• Remove any make-up, nail varnish and jewellery.
• Bring some sanitary towels with you.

You must follow the fasting instructions in your admission letter. These will vary depending on the type of anaesthesia you are having. Typically, if you are having a local anaesthetic there is no need to go without food or drink. If you are having general anaesthesia you must not eat or drink for six hours before the procedure.

About the procedure

Your doctor may use a speculum to gently open your cervix (similar to having a smear test). The vagina and cervix are cleaned with an antiseptic solution. Your doctor will then pass the hysteroscope through the cervix and into your womb.

Gas or fluid is then usually pumped into your womb to make it expand and the womb lining easier to see.

A camera lens at the end of the hysteroscope sends pictures from the inside of your womb to a video screen. Your doctor will look at these images and if necessary take a biopsy, remove polyps, and/or deliver treatment. This is done using special instruments passed inside the hysteroscope, and is quick and painless.

When the examination is finished, the hysteroscope is gently taken out. The procedure usually takes about 10 to 20 minutes to complete.

Where a hysteroscope is passed

What to expect afterwards

If you have a biopsy or polyps removed, you may need to wear a sanitary towel to absorb any vaginal bleeding.

If the procedure is done under a local anaesthetic, you will usually be able to go home after a short rest.

If you have general anaesthesia, you will need to rest on your bed until the effects of the anaesthetic have passed. You will need to arrange for someone to drive you home and stay with you for the first 24 hours.

General anaesthesia can temporarily affect your co-ordination and reasoning skills, so you should not drive, drink alcohol, operate machinery or sign legal documents for 48 hours afterwards. If you are in any doubt about driving, please contact your motor insurer so that you are aware of their recommendations, and always follow your doctor's advice.

As the anaesthetic wears off, you may have period-like cramps, and may need painkillers.

Results

If you have a biopsy or polyps removed, the results will be ready several days later and will usually be sent in a report to the doctor who recommended your test. Other findings may be discussed before you leave the hospital. If you have general anaesthesia, it's a good idea to have someone with you if the results are being discussed immediately after the procedure, as you may not remember the details clearly.

After you return home

If you need them, continue taking painkillers as advised by your doctor.

It's important to take it easy for the rest of the day. Some women feel ready to return to normal activities and work the day after the procedure; others may need to take two or three days off. Follow your doctor's advice about contraception, and starting to exercise again and having sexual intercourse.

Most women experience no problems after the procedure. However, please contact your doctor if you develop any of the following symptoms:

• prolonged heavy bleeding
• vaginal discharge that is dark or smells unpleasant
• severe pain
• pain that lasts for more than 48 hours
• high temperature

You shouldn't use tampons for at least one month after your hysteroscopy to help reduce the risk of infection.

You may find that your first period following the hysteroscopy is heavier or more prolonged than usual and that your periods are irregular for a couple of months.

Deciding to have a hysteroscopy

Hysteroscopy is a commonly performed and generally safe procedure. For most women, the benefits in terms of having a clear diagnosis, or quick and effective treatment, are much greater than any disadvantages. However, as with all medical procedures, a hysteroscopy carries an element of risk. In order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications.

Side-effects are the unwanted but mostly temporary effects of a successful procedure. After having a hysteroscopy you may:

• have slight period-like cramps and may need painkillers
• feel some pain in the tip of your shoulders caused by the gas or fluid used to inflate the womb but this should clear-up within 48 hours
• have some vaginal bleeding for a few days - in some cases bleeding and discharge continue for up to a month

Complications are unexpected problems that can occur during or after the procedure. Most women are not affected. The possible complications of any surgery include bleeding during or very soon after the procedure, infection and an unexpected reaction to the anaesthetic. It's also possible to develop a blood clot in a vein in one of the legs (deep vein thrombosis or DVT). For more information on blood clots, please see the separate Bupa health factsheet, Deep vein thrombosis.

Specific complications of hysteroscopy are uncommon but it's possible to:

• develop a pelvic infection afterwards, needing treatment with antibiotics
• damage or perforate the womb during the procedure - this can lead to bleeding and infection, which may require further surgery or, in very rare cases, a hysterectomy

Your doctor will be experienced at performing hysteroscopies, but even so a few are not successfully completed and may need to be repeated.

Ask your doctor to explain how these risks apply to you. The exact risks will differ for every woman. This is one of the reasons why we have not included statistics here.

Further information

• Royal College of Obstetrics and Gynaecologists
  020 7772 6200
  www.rcog.org.uk

Sources

• Petrozza JC, Sikking E. Hysteroscopy
  www.eMedicine.com
  24 May 2005
• Diagnostic hysteroscopy under general anaesthesia.
  Royal College of Obstetrics and Gynaecologists.
  www.rcog.org.uk
  October 2004
• Zuber TJ Endometrial biopsy.
  Am Family Physician 2001; 63:1131-1141

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