What is Hysteroscopy

A hysteroscopy is a procedure that allows a surgeon to have a look in the uterus (womb) by using a special telescope. The telescope (and any other instruments that are needed during the operation) is entered into the womb by passing it first through the vagina and then through the cervix, which is the entrance of the womb lying in the deep part of the vagina. A hysteroscopy is most commonly indicated for women who experience heavy bleeding during their periods; prolonged periods; bleeding between periods; or bleeding after their periods have stopped (menopause). It is also indicated in situations where a woman experiences difficulty conceiving, has had the stress of multiple miscarriages or when there is a suspicion that there is a growth (a tumour) in the womb.

When a hysteroscopy is performed to detect the cause of a problem it is called a diagnostic hysteroscopy. When the hysteroscopy includes one or more procedures that aim to clarify or solve a problem it is called an operative hysteroscopy.

What happens before the Operation

If you know that you have problems with your blood pressure, your heart, or your lungs, ask your family doctor to check that these are under control. You may be checked for past illnesses and may have special tests to make sure that you are well prepared and you can have the operation as safely as possible.

The Operation

Both a diagnostic and an operative hysteroscopy can be done as day surgery cases. This means that you can go home the same day of the operation, usually a few hours after it is completed.

A hysteroscopy is usually performed under general anaesthetic. This means that you will be asleep and unconscious and you will not feel pain during the procedure. Sometimes, simple diagnostic hysteroscopies can be tolerated where the anaesthetist gives only some sedative medication (which makes you very sleepy but not unconscious) in combination with a local anaesthetic injection that blocks the nerves that are close to the area of the operation.

Although the modern telescopes used in hysteroscopies are very thin, in most cases the surgeon will need to dilate (widen/open up) the cervix by using a special device so that the telescope or other instruments can be passed into the womb. The inside of the womb is a collapsed cavity and the surgeon will need to inflate it by using special gas or liquid so that everything can be seen properly.

In an operative hysteroscopy, following the initial observation, the surgeon will take one or more samples (biopsies) of the lining of the womb or even gently scrape and suction the lining of the womb (curettage) and send it for examination under a microscope in a laboratory so that the cause of the problem that lead to the hysteroscopy can be identified.