This leaflet answers common questions about a hysteroscopy. If you would like further information, or have any particular worries, please do not hesitate to ask your nurse or doctor.

In all cases, a doctor will explain the procedure to you and answer any questions you may have.

In most cases it will be possible for a friend or relative to accompany you for all or part of the procedure. Please ask your nurse or doctor.

What is a hysteroscopy?

A hysteroscopy is an examination of the inside of the uterus (womb) using a fine telescope (Diameter ranges between 2.9 – 5 mm).

The telescope is inserted via the vagina and through the opening of the uterus (cervix). The inside of the uterus can then be seen and assessed in terms of its shape, the lining (endometrium) and for focal lesions (polyps, fibroids, septa, adhesions). This can help identify the cause of the symptoms you are experiencing.

A small biopsy (removal of some cells from the endometrium - lining of the uterus) is often done at the end of the procedure to allow further analysis under a microscope. We can sometimes remove polyps / fibroids / septums / other pathology as well during the procedure.

If a hysteroscopy has been recommended, we normally discuss how this can be performed in an outpatient setting or under a sedation/general anaesthetic (GA) in an operating theatre setting. 

We may not recommend an outpatient hysteroscopy if you find vaginal examinations painful and will assist you in making the best decision about which setting would be best suited to you.

Most patients can tolerate an outpatient hysteroscopy and describe the pain as a 5/10 (like a painful period).  However approximately 30% of patients experience more severe pain (more than 7/10).  It is hard to predict how a patient may react to a Hysteroscopy if they have never had similar procedures in the past. 

Patients may still get pain after a hysteroscopy however, irrespective if performed in the outpatients or under a GA. Prior to having an outpatient hysteroscopy, we recommend that patients take one gram of Paracetamol and 400 mgs of ibuprofen one hour before the procedure (if not allergic to them). 

Alternatively, an equivalent analgesic can be taken (something that you might normally take when experiencing pain or discomfort). This will help to make the procedure more comfortable for you.

Some women benefit from local anaesthetic injections into the cervix to numb the area.  This is usually performed in an outpatient setting to help open the cervix if there is narrowing (stenosis) but most patients do not need this and often the injections can add to the discomfort. 

Why is a hysteroscopy performed?

Women who are experiencing certain gynaecological symptoms relating to their womb (uterus) are often recommended to undergo a hysteroscopy. Some of the more common complaints include:

  • Heavy or irregular periods.
  • Bleeding between periods or after the menopause.
  • Fibroids (non-cancerous growths).
  • Unusual vaginal discharge.
  • Repeated miscarriages.
  • Problems with fertility.
  • To insert or remove coils.

Risks and side effects

A hysteroscopy is a safe procedure with a low risk of complications. The most common side effects are pain (like period pain for most, but some experience more severe pain – see above), feeling faint and bleeding. You should contact your GP or emergency department (A&E) if following the procedure if you develop:

  • A temperature.
  • Increased pain, not relieved with your usual painkillers.
  • Increased discharge which is smelly and unpleasant.
  • Heavy bleeding.

Before your hysteroscopy

No preparation is needed before an outpatient hysteroscopy. You can eat and drink normally before your procedure. It is advisable to take pain relief 1 hour before your appointment (as discussed above).

If you are of childbearing age (up to 55-years-old), you will be asked to provide a urine sample for a pregnancy test (so please do not empty your bladder prior to your appointment). If there is any chance you may be pregnant, please tell a member of the team immediately. We will not be able to perform a hysteroscopy if you are pregnant. Please avoid unprotected sex (use a condom) between your last period and your appointment.

Hysteroscopies can be performed during a period, however, please call for advice prior to your appointment on the contact number below.

What happens during a hysteroscopy?

You will always be awake. You will be asked to remove the bottom half of your clothing and lie on a couch with your legs in leg supports. The hysteroscope will then be inserted into your vagina to locate your cervix. To guide the hysteroscope, we use sterile saline. 

Once your cervix has been located, the doctor will gently advance the hysteroscope into your uterus to examine the area. If at any point you find the procedure too uncomfortable or if the doctor sees you are in discomfort, the procedure can be abandoned. 

If inadequate information is obtained from the procedure, then it will be rescheduled but under a general anaesthetic (GA).  This will not be done on the same day, and you will need to be assessed beforehand. The team will arrange this for you and give you all the details.

If a local anaesthetic is recommended to dilate your cervix (if stenotic) a speculum (a smooth, tube-shaped tool) will be inserted into your vagina so the doctor can locate your cervix and inject the anaesthetic. You may feel some discomfort from the injection.

The local anaesthetic can also cause an increase in heart rate and shaky legs. These side effects will ease within a couple of minutes.  In general, a speculum isn’t used for the hysteroscopy procedure unless otherwise indicated.

The local anaesthetic only numbs the cervix, so you might still feel pain when the uterus is filled with saline.

If the doctor finds a polyp, they will stop the procedure and explain the finding. They will ask you if you wish to have the polyp removed that day or if you wish to have it done under general anaesthetic. If you wish to have it done on the day, the hysteroscope will need to be changed to a larger one (the difference between scopes is roughly 2 – 3 mm).

You are more than welcome to watch the procedure on the screen. Straightforward procedures normally last about three minutes but can take up to 15-20 minutes if you require a local anaesthetic and removal of a polyp.

After your hysteroscopy

We will ask you to stay in the waiting area until you feel ready to leave. You may get period like cramps during or after the procedure, but many women only feel a little discomfort. Occasionally, some women can feel a little faint or nauseated. If this happens to you, you will be able to lie down until you feel better.

It is usual to have some light bleeding after a hysteroscopy and you might need to wear a sanitary towel for a few days. There is no reason you should not drive home, but you may prefer to take things easy for the day. You should be able to return to work the following day.

It is best to avoid using tampons, swimming, taking baths (stick to showers) and having sexual intercourse for seven days.

When will I find out my results?

We will discuss the findings on the day of your hysteroscopy, and you will find out the results of the biopsy and implications either by letter or a follow-up appointment.

If you require any additional investigations or surgery, we will arrange this for you. The results of any biopsies can take up to four weeks and then we will write to you and your GP with the outcome.