10142 Hysteroscopy

Overview

A hysteroscopy is a quick procedure that lets a doctor look directly inside your womb (uterus). They use a thin, bendy tube with a tiny camera and light on the end. The tube goes in through your vagina and through the small opening at the neck of the womb (the cervix). This means there are no cuts on your tummy. Hysteroscopy can be used just to look around and find the cause of problems like unusual bleeding. Small treatments, such as removing a polyp (a small non-cancerous growth), can often be done at the same time.

Yes. Hysteroscopy is very common. It is one of the standard tests used for unusual bleeding and for checking the womb before fertility treatment. Thousands are done every year in the UK and around the world.

It is done for people who have a womb. Most people who have one are between their 30s and 60s, but it can be done at any age when there is a good reason. It may also be used for children or teenagers in special situations, such as unusual bleeding or development concerns, always with extra care and specialist support.

Symptoms

Common symptoms

• Periods that are very heavy or last a long time
• Bleeding between periods
• Bleeding during or after sex
• Any bleeding after the menopause (when periods have stopped for a year or more)
• Unusual vaginal discharge
• Pain in the lower tummy or during periods
• Trouble getting pregnant, or repeated miscarriages
• A scan that showed a possible polyp, fibroid (a non-cancerous growth in the muscle of the womb), or a thick womb lining
• A coil (contraception device) that needs to be found or removed

Symptoms in children

• Hysteroscopy is rarely needed in children. If it is, it is done by a specialist children's team.
• Signs that might lead to a specialist referral include unusual bleeding, bleeding that starts very early, or concerns about how the womb has developed.
• Children and young people should be offered extra support, clear explanations and pain relief suited to their age.

Symptoms in older adults

• Any bleeding after the menopause should always be checked by a doctor. It is not something to wait and see about.
• Hysteroscopy is safe in later life, but the team will check your general health first, including heart and lung health.
• Tell the team about any medicines that thin the blood, as these may need planning around the procedure.
• Bring a list of your medicines and ask for extra time to talk things through if you need it.

Causes

Main causes

• Polyps: small, usually harmless growths of the womb lining that can cause bleeding
• Fibroids: non-cancerous growths in the muscle of the womb, especially ones that sit just under the lining
• A thicker than expected womb lining, which can cause heavy or irregular bleeding
• Scar tissue (adhesions) inside the womb, sometimes after surgery or infection
• A septum: a small band of tissue dividing the womb, which some people are born with
• Leftover tissue after a miscarriage or birth
• Changes linked to the menopause or to hormone treatments
• In some cases, changes in the lining of the womb that need to be checked, including early cancer or pre-cancer

Risk factors

• Irregular or heavy periods, or bleeding between periods
• Bleeding after the menopause
• Previous surgery on the womb, such as a caesarean or removal of fibroids
• Fertility problems or repeated miscarriages
• Being overweight, which can raise levels of the hormone oestrogen and thicken the womb lining
• Polycystic ovary syndrome (a common hormone condition)
• Long-term use of some hormone treatments, such as tamoxifen, which your doctor will discuss with you
• A family history of womb or bowel cancer, which may mean extra checks are needed

When to see a doctor

See a doctor urgently if:

• Any bleeding after the menopause, even a small amount or just once
• Bleeding between periods that keeps happening
• Bleeding after sex that keeps happening
• Periods so heavy that you feel tired, breathless, or dizzy
• Bleeding with severe pain or a smelly discharge

Book a routine appointment if:

• Periods that have changed and stay different for three months or more
• Pain during periods that is getting worse
• Trouble getting pregnant after a year of trying (or six months if you are over 35)
• Repeated miscarriages
• A scan has shown something in the womb and you have been advised to have it checked

Diagnosis

Hysteroscopy is itself a test, so your doctor will usually talk with you about your symptoms and periods, check your general health, and may examine your tummy or pelvis first. They may also arrange a scan before deciding whether a hysteroscopy is needed. The hysteroscopy then lets the doctor see the womb lining directly and take a small sample if needed.

Tests that may be done

• A pelvic ultrasound scan: a painless scan that shows the shape of the womb and the thickness of its lining
• Hysteroscopy: a camera looks inside the womb
• Endometrial biopsy: a tiny sample of the womb lining, often taken during the hysteroscopy, sent to a lab
• Vaginal swabs if there are signs of infection
• Blood tests, such as a full blood count to check for anaemia (low iron) if you have heavy bleeding
• A pregnancy test before the procedure, as a routine safety check

What to expect at your appointment

Most hysteroscopies are booked for the days after your period, when the womb lining is thinner and easier to see. You may be asked to eat and drink normally, but this depends on the type of pain relief you choose, so follow the instructions you are given. You will usually lie on a couch with your legs supported, a little like a smear test. A speculum is gently put in to hold the vagina open. The camera tube is then passed through the cervix. Warm salty water is used to gently open the womb so the doctor can see. You may feel period-like cramps or a warm feeling. If a sample or small growth is removed, you may feel a brief tug. The team will tell you what they saw, and you can usually go home soon afterwards. Lab results usually come back within one to three weeks.

Treatment

Hysteroscopy can be a test, a treatment, or both at once. If the doctor finds a polyp, a small fibroid, scar tissue, or a septum, they can often remove or correct it during the same procedure. If they find a thickened lining, they may take a sample instead, because the lab needs to check the cells. What happens next depends on what is found and on your own wishes about your periods and fertility.

Self-care at home

• Arrange for someone to take you home if you have sedation or a general anaesthetic, and plan a quiet rest for the rest of the day
• Use simple pain relief that you would normally take for period pain if you have cramps, following the label
• Use pads rather than tampons for about a week, or as your team advises
• Avoid sex, swimming, and baths for about a week, or as advised, to lower the risk of infection. Showers are fine
• Keep an eye on your bleeding and how you feel, and know who to contact if something worries you
• Drink plenty of water and eat iron-rich foods if you have been losing blood

Medical treatments

Treatment depends on what is found. Sometimes no treatment is needed beyond the test itself. If the lining is thickened or bleeding is troublesome, doctors may suggest hormone-based treatments, such as a hormone-releasing coil or tablets, to control bleeding and protect the womb lining. If an infection is found, antibiotics may be prescribed. Your doctor or pharmacist will explain the options, the benefits and possible side effects, so you can choose what suits you. No treatment is started until you have discussed it and given your consent.

When is surgery considered?

Surgery may be suggested if a polyp, fibroid, scar tissue, or a septum is found that could be causing your symptoms or affecting fertility. These are usually removed during a hysteroscopy under a general or spinal anaesthetic. Surgery may also be advised if the womb lining needs to be removed for medical reasons, or if tests show changes that need treatment. Your specialist team will explain the risks, benefits, and alternatives with you before you decide.

Living with this condition

Most people feel back to normal within a day or two. Light bleeding or spotting and mild period-like cramps for a few days are common and usually settle on their own. You can usually eat and drink normally straight after, and return to work the next day unless you were advised otherwise. If you have cramps, rest, a warm heat pack on your tummy, and simple pain relief can help.

Lifestyle tips

• Take gentle walks to help your circulation and mood, but avoid heavy lifting or hard exercise for a few days
• Follow your team's advice about swimming, baths, and sex, usually about a week
• Keep a simple note of your bleeding pattern and any pain, so you can tell your doctor if needed
• Go to follow-up appointments, especially if you are waiting for test results
• Ask your pharmacist to check any medicines you buy, including herbal ones

Diet and exercise

There is no special diet needed for recovery, but eating well helps you heal and keeps your energy up. If you have heavy periods or have been losing blood, try foods rich in iron, such as beans, lentils, dark green vegetables, eggs, and lean meat or fortified cereals, and pair them with vitamin C from fruit to help your body absorb the iron. Gentle movement like walking is fine once you feel ready. Wait a few days to a week before going back to gym workouts, swimming, or heavy lifting.

Mental health and emotional wellbeing

It is very common to feel worried before or after a hysteroscopy, especially while waiting for results. Some people also feel low if bleeding has affected their work, sex life, or plans for a family. These feelings are normal and worth talking about. Tell your doctor or nurse how you feel, because support is available and you don't have to manage alone. If your low mood lasts for more than two weeks or affects your daily life, please reach out for help.

Prevention

You cannot always prevent needing a hysteroscopy, because some causes, like polyps or early changes in the womb lining, are simply not something you can control. What you can do is pay attention to changes in your periods, get unusual bleeding checked early, keep to a healthy weight, and manage conditions like high blood pressure and diabetes if you have them. Getting checked early often means simpler treatment and less worry.

Screening programmes

There is no routine screening test for womb problems in the UK. Cervical screening (the smear test) checks the neck of the womb, not the womb itself, so it is not a substitute. The best safeguard is to see your doctor promptly if you notice any bleeding between periods, bleeding after sex, or any bleeding after the menopause. If you have a family history of womb or bowel cancer, or take long-term hormone treatments, ask your GP whether extra checks are recommended for you.

Complications

If left untreated

• The cause of your bleeding may stay unknown and continue to affect your daily life
• Polyps or fibroids may keep causing heavy or irregular bleeding, which can lead to low iron (anaemia) and tiredness
• Thickened womb lining or early pre-cancer changes may go unnoticed, when they are usually much easier to treat when found early
• Scar tissue or a septum could keep affecting fertility or cause recurring miscarriages
• You may keep worrying about symptoms without the reassurance of clear answers

Long-term outlook

The outlook after hysteroscopy is good. Most people recover quickly and are back to normal within a day or two. If a small growth or scar tissue was found, removing it often improves bleeding and can help with fertility. The most common finding is something harmless and easy to treat. If the result shows that more care is needed, your team will explain the next steps clearly and support you through them. Getting checked is a positive step, and you deserve clear answers and good support.

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