Hysteroscopy

Overview

A hysteroscopy is a quick procedure that lets a doctor look directly inside your womb (uterus) using a thin, tube-shaped camera called a hysteroscope. The camera is about the width of a small straw. It is passed gently through your vagina and cervix (the opening of the womb), so there are usually no cuts on the outside of your body. The picture shows up on a screen, which lets your doctor see the lining of your womb clearly. A hysteroscopy can be used just to look around and find the cause of symptoms. It can also be used to fix some problems at the same time, such as removing a small growth.

Yes. Hysteroscopy is a very common and routine procedure. It is one of the main ways doctors investigate unusual bleeding and problems inside the womb.

It can be offered to anyone who has a womb. It is most often used for people in their 30s to 50s who have heavy or unusual periods, and for people after the menopause who have any vaginal bleeding. It is also used as part of fertility investigations.

Symptoms

Common symptoms

• Heavy periods, or periods that last longer than usual
• Bleeding between periods
• Bleeding during or after sex
• Any vaginal bleeding after the menopause, even a small amount
• Pelvic pain or pain during sex
• Unusual vaginal discharge
• Problems getting pregnant, or repeated miscarriages
• A coil (contraceptive device) that has gone missing or needs to be removed
• A thickened womb lining seen on an ultrasound scan

Symptoms in children

• Hysteroscopy is very rarely needed in children or young teenagers
• If it is needed, it is always done by a specialist team under a general anaesthetic
• Unusual bleeding in a child should always be checked by a doctor first

Symptoms in older adults

• Any bleeding after the menopause needs to be checked, even if it is just a spot or two
• Postmenopausal bleeding is one of the most common reasons for a hysteroscopy
• Older adults may have other health conditions, so the team will plan the procedure carefully with you

Causes

Main causes

• Polyps — small, usually harmless growths on the lining of the womb
• Fibroids — non-cancerous growths of muscle in the wall of the womb, which can bulge into the space inside
• A thickened womb lining, which can be caused by hormone changes
• Scar tissue (adhesions) inside the womb, sometimes after surgery or infection
• A small band of tissue dividing the womb (a septum), which can affect fertility
• Leftover pregnancy tissue after a miscarriage or birth
• A coil that has moved out of place or is stuck
• Less often, changes in the womb lining that need to be checked for cancer

Risk factors

• Being over 40, or having gone through the menopause
• Heavy or irregular periods
• Being overweight, which can affect hormone levels
• Polycystic ovary syndrome (PCOS)
• Some hormone treatments, such as tamoxifen
• Fertility problems or repeated miscarriages
• Previous surgery on the womb, such as a caesarean section or removal of fibroids

When to see a doctor

See a doctor urgently if:

• Any vaginal bleeding after the menopause — see your doctor promptly, even if it is light
• Bleeding between periods or after sex that has started recently
• Periods so heavy you feel tired, short of breath, or dizzy
• Severe pelvic pain
• Fever, smelly discharge, or heavy bleeding after a hysteroscopy

Book a routine appointment if:

• Periods that have become heavier or longer over several months
• Pelvic pain or pain during sex that keeps coming back
• You have been trying to get pregnant for a year without success
• You have had two or more miscarriages
• You are unsure whether a hysteroscopy is right for you and want to talk it through

Diagnosis

A hysteroscopy is itself a test. Your doctor will usually start by asking about your symptoms, your periods, and your medical history, and will examine your pelvis. An ultrasound scan often comes next. If the scan shows something that needs a closer look, or if your symptoms need explaining, a hysteroscopy is offered. Sometimes a small sample of the womb lining (a biopsy) is taken during the procedure and sent to a laboratory.

Tests that may be done

• A pelvic examination
• An ultrasound scan, often done inside the vagina (transvaginal ultrasound)
• A saline infusion ultrasound, where fluid is used to get a clearer picture of the womb
• Hysteroscopy, with or without a biopsy of the womb lining
• Swabs to check for infection
• Blood tests, such as a full blood count to check for anaemia
• Rarely, an MRI scan for fibroids or other growths

What to expect at your appointment

You will usually be asked not to eat or drink for a few hours beforehand if you are having sedation or a general anaesthetic. The procedure can be done in a clinic or an operating theatre. You may be awake with pain relief, relaxed with sedation, or asleep under a general anaesthetic. Most people go home the same day. Afterwards you may have period-like cramps and light bleeding. If you have had sedation or an anaesthetic, arrange for someone to take you home and stay with you for the rest of the day. Ask your team for clear written instructions about what to expect.

Treatment

A hysteroscopy is often both a test and a treatment. If a polyp or small fibroid is found, it can usually be removed during the same procedure. This can improve bleeding, pain, and sometimes fertility. If nothing needs treating, the hysteroscopy gives you and your doctor clear answers and a plan.

Self-care at home

• Take everyday pain relief if you have cramps, following the packet instructions or your pharmacist's advice
• Use pads rather than tampons for a few days if you are bleeding, until your team says it is fine to use tampons again
• Avoid sex for about a week, or as long as your team advises
• Rest for a day or two, then return to gentle daily activity as you feel able
• Keep the contact details of the ward or clinic handy in case you have questions
• Write down any questions before your follow-up appointment so you do not forget them

Medical treatments

Treatment depends on what is found. If infection is suspected, your doctor may prescribe antibiotics. If heavy bleeding is the main issue, hormone-based treatments or a contraceptive coil may be offered to reduce bleeding. For growths such as polyps or fibroids, removal during the hysteroscopy is often the treatment itself. Your doctor will explain the options, including the benefits and drawbacks of each, so you can choose what suits you.

When is surgery considered?

Operative hysteroscopy (surgery through the camera, with no cuts on your body) is used to remove polyps, fibroids, scar tissue, or a septum, and to take a biopsy. Occasionally, other surgery may be recommended — for example, keyhole surgery for fibroids that cannot be reached with a hysteroscope. In a small number of cases, removing the womb (hysterectomy) may be discussed if other treatments have not helped. Your specialist team will talk this through with you fully.

Living with this condition

Most people feel back to normal within a day or two. Light bleeding or spotting can last up to a week or so. You may have some period-like cramping for the first day or two. Results from any biopsy usually take one to three weeks, and you will be told how and when you will hear them.

Lifestyle tips

• Keep a simple diary of your bleeding and pain to spot patterns and to share with your doctor
• Eat iron-rich foods such as beans, lentils, leafy greens, and lean meat if your periods are heavy
• Stay gently active — short walks can help with cramps and lift your mood
• Avoid heavy lifting or intense exercise for a few days after the procedure
• Ask your pharmacist before taking any new medicines or supplements

Diet and exercise

There is no special diet needed for a hysteroscopy. Eating well and staying gently active supports recovery and helps with tiredness if you have been losing blood. If your periods are heavy, iron-rich foods can help prevent anaemia (low iron in the blood, which causes tiredness and breathlessness). Your doctor may check your iron levels with a blood test.

Mental health and emotional wellbeing

It is very normal to feel anxious before a procedure or while waiting for results. Worries about bleeding, fertility, or what might be found can affect sleep, mood, and concentration. Talking to someone you trust, writing down questions, and asking your team to explain anything unclear can all help. If low mood, worry, or panic is affecting your daily life, please speak to your doctor — good support is available. If you ever have thoughts of harming yourself, contact your local emergency number or a crisis line in your country straight away.

Prevention

You cannot really prevent needing a hysteroscopy — it is a test for symptoms, not an illness you can avoid. What you can do is get symptoms checked early, keep up with any follow-up appointments, and manage conditions such as heavy periods or polycystic ovary syndrome with your doctor's help.

Screening programmes

There is no routine screening test that checks the lining of the womb. Cervical screening (smear tests) checks the cervix, which is different from the lining of the womb. Any unusual bleeding, especially after the menopause, should be checked by a doctor rather than waiting for a screening invitation.

Complications

If left untreated

• Heavy bleeding can lead to anaemia, causing tiredness, breathlessness, and dizziness
• Growths such as polyps or fibroids may keep growing and cause more bleeding or pain
• Some causes of infertility may stay hidden and untreated
• Serious problems such as cancer of the womb lining could be found later than they needed to be

Long-term outlook

The outlook is generally very good. Hysteroscopy is a safe, well-established procedure, and serious complications are uncommon. For most people it gives clear answers, and any growths found can usually be treated at the same time. If something more serious is found, catching it early means more treatment options and better outcomes. Your care team will support you at every step.

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