Patient Basics: Hysteroscopy

Originally published by Harvard Health.

What is the test?

Hysteroscopy is a procedure that allows a gynecologist to look inside your uterus. The hysteroscope is a long tube, about the size of a straw, which has a built-in viewing device. Hysteroscopy is useful for diagnosing and treating some problems that cause infertility, miscarriages, and abnormal menstrual bleeding. Sometimes other procedures, such as laparoscopy, are done at the same time as hysteroscopy.

How do I prepare for the test?

The time that you schedule this test can be important. Your gynecologist is able to get the best view of the uterine lining during the week that follows your period. If you have regular cycles, it is helpful for you to anticipate the timing of your next period and plan to have the hysteroscopy done in the following week.

Tell your doctor ahead of time if you have ever had an allergic reaction to lidocaine or the numbing medicine used at the dentist’s office. Discuss different options for anesthesia with your doctor in advance.

If your doctor plans on giving you any anti-anxiety medicines before the procedure, or if you are going to have other tests done at the same time as hysteroscopy, you might be told not to eat or drink for eight hours or more before the test. Just before the test, you should empty your bladder.

What happens when the test is performed?

You lie on your back on an examination table, with your knees bent and your feet in footrests, as you would for a pelvic examination. Your vaginal area is cleaned with an antibacterial soap.

This procedure can be done with local, regional, or general anesthesia. Local anesthesia requires injections of numbing medicine into the tissue surrounding your cervix, inside your vagina. You remain awake through the procedure and may feel some cramping in your pelvis.

Regional anesthesia for hysteroscopy is done with either a spinal block or epidural block. For this type of anesthesia, a drug is injected through a needle or tube in your lower back by an anesthesiologist. You are awake for the procedure, but you do not feel pain from your pelvic region.

If you are having other procedures (such as laparoscopy) done at the same time as hysteroscopy, you might have general anesthesia, which puts you to sleep so you are unconscious during the procedure. General anesthesia is administered by an anesthesiologist, who asks you to breathe a mixture of gases through a mask. After the anesthetic takes effect, a tube may be put down your throat to help you breathe.

Once the anesthesia is working, the opening of your cervix may need to be widened. This can be done with instruments that stretch the opening. Your gynecologist inserts the hysteroscope through the vagina and cervix and into the uterus. A liquid or gas is released through the hysteroscope to expand the inside of the uterus so that your doctor has a clearer view. A light at the end of the instrument allows your doctor to see the walls of the uterus and the openings of the fallopian tubes at the top of the uterus. The doctor may also insert small surgical instruments through the hysteroscope to carry out such procedures as taking a sample of tissue (biopsy), removing a polyp or growth, removing the lining of the uterus with dilation and curettage (D&C), or treating the lining of your uterus with ablation electricity to prevent bleeding.

What risks are there from the test?

After the procedure, you may have slight vaginal bleeding and cramps for one or two days. Sometimes a small amount of the gas used to expand the uterus can float up to the top of the abdomen and remain there for a day or two before it dissolves away. This can cause some shoulder pain. Some patients experience nausea from medicines used for anesthesia or anxiety.

Some of the procedures that are done along with hysteroscopy have risks of their own. You should ask your doctor about special risks that might come along with additional procedures planned for you.

Must I do anything special after the test is over?

If you have the test done with local anesthesia, you can go home right away. If you have regional or general anesthesia, you will need to stay for a few hours to be watched by your doctor. If you have general anesthesia or anti-anxiety medication, you should not drive or drink alcohol after the test.

You should notify your doctor if you have a fever over 101° F, strong abdominal pain, or heavy bleeding from your vagina.

How long is it before the result of the test is known?

Your doctor can tell you what was seen through the hysteroscope right away. If a biopsy sample is removed, the analysis might take several days.