Test Overview

A hysteroscopy is a way for your doctor to look at the lining of your
uterus. He or she uses a thin viewing tool called a
hysteroscope. The tip of the hysteroscope is put into your
vagina and gently moved through the
cervix into the uterus. The hysteroscope has a light
and camera hooked to it so your doctor can see the lining (endometrium) on a video screen.

A
hysteroscopy may be done to find the cause of abnormal bleeding or bleeding
that occurs after a woman has passed
menopause. It also may be done to see if a problem in
your uterus is preventing you from becoming pregnant (infertility). A
hysteroscopy can be used to remove growths in the uterus, such as
fibroids or
polyps.

Your doctor may take a small
sample of tissue (biopsy). The sample is looked at under
a microscope for problems. Another surgery, called a
laparoscopy, may also be done at the same time as a
hysteroscopy if infertility is a problem.

Why It Is Done

A hysteroscopy may be done to:

  • Find the cause of severe cramping or abnormal bleeding. Your
    doctor can pass heated tools through the hysteroscope to stop the
    bleeding.
  • See whether a problem in the shape or size of the uterus
    or if scar tissue in the uterus is the cause of infertility.
  • Look
    at the uterine openings to the
    fallopian tubes. If the tubes are blocked, your doctor
    may be able to open the tubes with special tools passed through the
    hysteroscope.
  • Find the possible cause of repeated
    miscarriages. Other tests may also be
    done.
  • Find and remove a misplaced
    intrauterine device (IUD).
  • Find and remove
    small fibroids or polyps.
  • Check for
    endometrial cancer.
  • Use heated tools to remove problem areas
    in the lining of the uterus (endometrial ablation).
  • Place a contraceptive implant (such as Essure)
    into the opening of the fallopian tubes as a method of permanent
    sterilization.

How To Prepare

Tell your doctor if you:

  • Are or might be pregnant.
  • Are
    taking any medicines.
  • Are allergic to any
    medicines.
  • Take a blood thinner, or if you have had bleeding problems.
  • Have been treated for a vaginal,
    cervical, or pelvic infection in the past 6 weeks.
  • Have any heart
    or lung problems.

It is best to have a hysteroscopy done when you are not
having your menstrual period. If there is a chance that you could become
pregnant, the hysteroscopy should be done before you are ovulating so your
doctor is sure you are not pregnant.

Do not douche, use tampons,
or use vaginal medicines for 24 hours before the hysteroscopy.

You may be
given a medicine (sedative) to relax you for the test, or
general, regional, or local anesthesia can be used.
Your doctor will discuss this with you.

If you are going to have
general anesthesia, you will need to stop eating and drinking before the test. Follow the instructions exactly
about when to stop eating and drinking, or your surgery may be canceled. If
your doctor has instructed you to take your medicines on the day of surgery, do so using only a sip of water.

Arrange to have someone drive
you home the day of the test in case you are given a sedative.

You will be asked to sign a consent form that says you understand the risks of the test and agree to have it done.

Talk to your doctor about
any concerns you have regarding the need for the test, its risks, how it will
be done, or what the results will mean. To help you understand the importance
of this test, fill out the
medical test information form (What is a PDF document?).

The hospital or surgery center may
send you instructions on how to get ready for your surgery, or a nurse may call
you with instructions before your surgery.

How It Is Done

A hysteroscopy is usually done by your
gynecologist in the operating room of a hospital or
surgery center. Most women go home the same day. In some cases, the
hysteroscopy can be done in your doctor’s office.

You may be given
medicine (anesthesia) to help you relax, to numb the area, or to help you sleep.

You will take off all of your
clothes and wear a gown for the test. You will empty your bladder before the
test. You will then lie on your back on an examination table with your feet
raised and supported by footrests (stirrups).

Your doctor will insert a lubricated tool called a speculum into your vagina. The
speculum gently spreads apart the vaginal walls so your doctor can see inside
the vagina and the cervix. Your vagina will be cleaned with a special
soap.

The hysteroscope will be placed at the entrance to your
vagina and gently moved through the cervix into your uterus. A gas or liquid
will be put through the hysteroscope into your uterus to help your doctor see
the lining clearly. Your doctor looks through the hysteroscope at a magnified
view of the lining of your uterus. Your doctor can also see the uterine
openings of the fallopian tubes. A video screen may be used during the
test.

If a biopsy or other procedure is done, your doctor will use
small tools through the hysteroscope. A hysteroscopy takes about 30 minutes,
unless other procedures are being done.

How It Feels

If you are given a sedative or a local or
regional anesthesia, you may have some cramping during the test. If you have
general anesthesia, you may have a tickling, dry throat, slight hoarseness, or
a mild sore throat after the test; these symptoms may last several days. Throat
lozenges and warm saltwater gargles can help relieve the throat
symptoms.

Some women feel dizzy and sick to their stomachs. This
is called a
vasovagal reaction. This feeling will go away after a
few minutes.

You may need to avoid sexual intercourse, using
tampons, or playing sports for a while after hysteroscopy. Talk to your doctor
about when you can resume normal activities.

Risks

If a fluid is used during the test to help your
doctor see the uterine lining clearly, you may absorb some fluid and feel bloated. It
may also change the level of sodium in your blood. If gas is used, you have a
small risk for an air bubble (air embolism) in a blood vessel, though this is
very rare.

A hysteroscopy can cause injury to the uterus or
cervix, an infection, or bleeding. In rare cases, the uterus, bladder, or bowel
can be punctured during the test, requiring surgical repair. If general
anesthesia is used, there is a small risk of problems from the
anesthesia.

After the test

Right after the test, you will be
taken to a recovery area where nurses will care for and observe you. Usually
you will stay in the recovery area for 1 to 4 hours, and then you will be moved
to a hospital room or you will go home. In addition to any special instructions
from your doctor, your nurse will explain information to help you in your
recovery. You will likely go home with a sheet of care instructions and who to
call if you have any problems.

It is normal to have a small amount
of vaginal bleeding for a day or so after a hysteroscopy. You also may have
some mild belly pain if a gas was used during the test. This should go away in
24 hours. Ask your doctor if you can take acetaminophen (such as Tylenol) to relieve the
pain. Be safe with medicines. Read and follow all instructions on the label.

Follow any instructions your doctor gave you. Call your
doctor if you have:

  • Heavy vaginal bleeding or discharge (more
    than a normal menstrual period).
  • A fever.
  • Severe belly
    or pelvic pain or cramping.
  • Problems
    urinating.
  • Shortness of breath.
  • Vomiting.

Results

A
hysteroscopy is a way for your doctor to look at the
lining of your
uterus. He or she uses a thin viewing tool called a
hysteroscope. Your doctor will talk to you about what he or she sees at the
time of the hysteroscopy.

Hysteroscopy
Normal:

The inside of the uterus looks normal in size and shape.

No
polyps,
fibroids, or other growths are present.

Openings to the
fallopian tubes look normal.

Abnormal:

The size or shape of the inside of the uterus does not
look normal.

Scar tissue is present in the uterus.

Uterine polyps, fibroids, or other growths are
present.

A misplaced
intrauterine device (IUD) is found and
removed.

The uterine openings to one or both fallopian tubes are
closed.

What Affects the Test

Reasons you may not be able to
have the hysteroscopy or why the results may not be helpful include:

  • Having your menstrual period. Your doctor will
    not be able to see the lining clearly.
  • Being pregnant. A
    hysteroscopy will not be done if you are pregnant because of the risk to your
    developing
    baby (fetus).
  • If a vaginal or cervical
    infection is present.

If you are not sexually active, a hysteroscopy can be done
anytime. But it is best to have a hysteroscopy when you are not having your
menstrual period.

If you are past
menopause, a hysteroscopy can be done anytime.

What To Think About

References

Other Works Consulted

  • Chernecky CC, Berger BJ (2008). Laboratory Tests and Diagnostic Procedures, 5th ed. St. Louis: Saunders.
  • Pagana KD, Pagana TJ (2010). Mosby’s Manual of Diagnostic and Laboratory Tests, 4th ed. St. Louis: Mosby.

Credits

ByHealthwise Staff
Primary Medical Reviewer Sarah Marshall, MD – Family Medicine
Adam Husney, MD – Family Medicine
Martin J. Gabica, MD – Family Medicine
E. Gregory Thompson, MD – Internal Medicine
Specialist Medical Reviewer Femi Olatunbosun, MB, FRCSC – Obstetrics and Gynecology

Current as ofOctober 6, 2017