Hysteroscopy lets a gynecologist look directly inside the uterus. A hysteroscope, a thin lighted telescope with a camera, is passed through the vagina and cervix, and the uterine cavity is gently filled with fluid so its walls can be seen clearly on a screen. No incision is made anywhere on the body.
The procedure does two jobs. As a diagnostic test, it shows exactly what is causing a problem that an ultrasound can only suggest, such as a polyp, a fibroid bulging into the cavity, scar tissue or a misplaced IUD. As a treatment, small instruments passed through the same scope can remove what is found, often during the same procedure. For many women that means one visit instead of a separate test and a later operation.
At NYMD Center our gynecologists perform many hysteroscopies in the office, reserving the operating room for larger or more complex cases. The goal is the least invasive setting that can safely do the job.
Who needs a hysteroscopy
The most common reason is abnormal uterine bleeding: periods that are much heavier or longer than normal, bleeding between periods or after sex, or any bleeding after menopause. Ultrasound often points toward a cause, and hysteroscopy confirms it and allows a targeted biopsy of the uterine lining instead of a blind sample.
Endometrial polyps are soft overgrowths of the lining and are a frequent finding. Submucosal fibroids, the type that grow into the uterine cavity, can cause heavy bleeding and affect fertility even when they are small. Hysteroscopy is also used to find and remove an IUD whose strings cannot be seen, to identify scar tissue inside the uterus (adhesions), and to evaluate a uterine septum, a band of tissue some women are born with. Women going through a fertility evaluation or who have had repeated pregnancy losses may have a hysteroscopy to make sure the cavity is normal.
How we evaluate it at NYMD Center
A hysteroscopy is rarely the first test. We start with your history and a pelvic exam, a pregnancy test, and blood work including a complete blood count when bleeding has been heavy. A pelvic ultrasound, and sometimes a saline-infusion sonogram in which a small amount of fluid outlines the cavity, usually tells us whether something is inside the uterus and roughly how large it is. That information decides whether hysteroscopy is needed and, if so, whether the office or the operating room is the right setting.
The ultrasound also tells us where fibroids sit. A fibroid inside the cavity is well suited to hysteroscopic removal. Fibroids within the muscle wall or on the outer surface of the uterus cannot be reached through the scope, and for those women uterine fibroid embolization, performed by our interventional radiology team without surgery, may be the better option. More on fibroid treatment is available at 1Fibroid.
Treatment options, least invasive first
Hysteroscopy comes in two forms, and the difference is mostly about what needs to be done and how much anesthesia that requires.
Office hysteroscopy
Office hysteroscopy uses a very narrow scope and usually requires little or no dilation of the cervix. It is done with local anesthetic, sometimes with oral pain medication or light sedation beforehand, and typically takes only a few minutes. It is well suited to diagnosis, directed biopsies, removal of small polyps and retrieval of a lost IUD. You go home shortly afterward and most women return to normal activities the next day. The trade-off is that cramping during the procedure can be uncomfortable, and larger lesions cannot always be removed in this setting.
Operative hysteroscopy in the operating room
Larger polyps, submucosal fibroids, significant adhesions and a uterine septum usually need a larger scope and instruments that cut or shave tissue, which means more cervical dilation and anesthesia. These cases are done in an operating room, typically as outpatient surgery with no hospital stay. You spend a short time in recovery while the anesthesia wears off and go home the same day. Recovery is usually one to two days.
When hysteroscopy is not the right tool
If the problem is a fibroid within the uterine wall, adenomyosis, or bleeding that is hormonal rather than structural, hysteroscopy may not help. Medical treatment, a hormonal IUD, or fibroid embolization may address the cause with less intervention, and we will tell you when that is the case rather than scheduling a procedure that will not solve the problem.
Risks and recovery
Hysteroscopy is a low-risk procedure. Mild cramping and light spotting or watery discharge for a few days afterward are normal, and over-the-counter pain relievers usually handle the discomfort. Uncommon complications include infection, heavier bleeding, and a reaction to the fluid used to expand the uterus. Rarely, the instrument can pass through the wall of the uterus (perforation), which may require further evaluation. Most women can return to work the next day after an office procedure and within a day or two after operative hysteroscopy. We will tell you when you can resume intercourse, tampon use and exercise based on what was done.
What to expect at your visit
Hysteroscopy is best scheduled after your period ends and before ovulation, when the lining is thin and the view is clearest. Bleeding is not an absolute barrier, but heavy bleeding can obscure the view. We may ask you to take a medication beforehand to soften the cervix, and to take an anti-inflammatory pain reliever an hour before an office procedure. Tell us if you might be pregnant, take blood thinners, or have had a reaction to anesthesia. For an operating-room case you will be told when to stop eating and should arrange for someone to take you home.
During the procedure you lie on the exam table as you would for a pelvic exam. Many women choose to watch the screen, and your gynecologist will explain what is seen as it happens. Any tissue removed is sent to pathology, and we review the results with you, usually within about a week, along with any next steps. If bleeding problems are related to the menopausal transition, our perimenopause and irregular menstrual cycle pages explain the broader treatment picture.
When to seek care urgently
After a hysteroscopy, call the office right away if you develop a fever or chills, bleeding heavier than a normal period, severe or worsening abdominal pain, or foul-smelling discharge. Heavy bleeding with dizziness or fainting, or pain with shortness of breath, is a reason to go to an emergency room.
Questions patients ask
Does a hysteroscopy hurt?
Most women feel cramping similar to a strong period during an office hysteroscopy, which usually lasts only a few minutes. Local anesthetic and a pain reliever taken beforehand make it more comfortable, and light sedation is available for some patients. Operative hysteroscopy in the operating room is done under anesthesia, so you do not feel the procedure itself.
How long does recovery take after hysteroscopy?
Recovery is usually quick. After an office hysteroscopy most women return to normal activities the next day. After operative hysteroscopy, recovery is typically one to two days. Mild cramping and light spotting for a few days are normal. We will advise you about when to resume exercise, intercourse and tampon use based on what was done.
When should a hysteroscopy be scheduled?
The best time is in the days after your period ends and before ovulation, when the uterine lining is thin and the view is clearest. Postmenopausal women can be scheduled at any time. Tell us if there is any chance you could be pregnant, because hysteroscopy is not done during pregnancy.
Can hysteroscopy remove fibroids?
It can remove submucosal fibroids, the type that grow into the uterine cavity, which are a common cause of heavy bleeding. Fibroids inside the muscle wall or on the outside of the uterus cannot be reached through the scope. For those, uterine fibroid embolization or other treatments may be more appropriate, and we will review the options with you.
What is the difference between office and operative hysteroscopy?
Office hysteroscopy uses a very thin scope with local anesthetic and is used for diagnosis, biopsies, small polyps and lost IUDs. Operative hysteroscopy uses larger instruments under anesthesia in an operating room to remove bigger polyps, fibroids, scar tissue or a septum. Both are usually same-day procedures without a hospital stay.