A hysteroscopy is a procedure doctors use to diagnose and treat conditions involving the uterus and cervix, such as abnormal uterine bleeding, abnormal endometrial thickening, bleeding after menopause, and infertility.
During a hysteroscopy, your doctor inserts a hysteroscope – a thin tube with a light on the end – into your vagina, through your cervix, and into your uterus. They'll be able to see into your cervix and inside your uterus. They can take a sample for later testing if they find anything abnormal.
A diagnostic hysteroscopy allows a doctor to check for causes of abnormal uterine bleeding. Doctors may use a this procedure to diagnose conditions including:
- Abnormal endometrial thickening
- Postmenopausal bleeding
- Blocked fallopian tubes
- Endometrial cancer
- Intrauterine adhesions (IUAs), or scar tissue in the uterus
An operative hysteroscopy is surgery that puts a hysteroscope through the cervix into the uterus. It's used to treat abnormalities in the uterus. A doctor may recommend an operative hysteroscopy for conditions like:
- Abnormal uterine bleeding
- Other disorders of the uterus
A doctor may use an operative hysteroscopy for surgeries to treat conditions affecting the vagina, cervix, and uterus. These surgeries include:
- Endometrial ablation, to destroy the uterine lining
- Septum resection, to treat a vaginal septum, or wall of tissue dividing the vagina
- Myomectomy, to remove fibroids without removing the uterus
- Polypectomy, to remove any abnormal growth in the uterus
A doctor may do a diagnostic and operative hysteroscopy in the same procedure so that you won’t have to have another surgery to treat any issue they found.
Why Would I Need a Hysteroscopy?
The most common reasons for a hysteroscopy are periods that are longer or heavier than normal or bleeding between periods. You might need the procedure in these situations:
- Your Pap test results are abnormal.
- You’ve been bleeding after menopause.
- There are fibroids, polyps, adhesions, or scarring on your uterus.
- You’ve had more than one miscarriage.
- You've had problems with infertility.
- Your doctor needs a small tissue sample (biopsy) of the lining of your uterus. You might have a hysteroscopy with a biopsy before you get a dilation and curettage (D&C) procedure to remove more tissue from the uterine lining.
- Your IUD has come out of place.
- To confirm the results of an ultrasound, hysterosalpingography (HSG), or other tests looking at the cervix and uterus
- To open blocked fallopian tubes
- To place birth control implants that close off the fallopian tubes
- For surgery to treat fibroids, polyps, scarring, and more
- Together with a laparoscopy, which allows your doctor to see the outside of your uterus as well as other organs in your pelvis
- At times, a hysteroscopy might be done along with an endometrial biopsy before a full D&C procedure.
You can have a hysteroscopy in a hospital or at your doctor’s office. During the procedure, you may be awake under local or regional anesthesia or asleep under general anesthesia. If you're having general anesthesia, your doctor may ask you not to eat or drink anything for 6 to 12 hours. If you’re awake, your doctor will give you medicine to help you relax. They'll also use medication or tools called dilators to help open your cervix.
Your doctor will likely use a tool called a speculum to keep your vagina open. If you’ve ever had a Pap test, your doctor probably used one during that procedure, too.
They'll gently insert the hysteroscope through the cervix into your uterus and push gas or a liquid-like saline through the hysteroscope into your uterus to expand it. This will give them a clear view of its lining and the opening of your fallopian tubes.
They’ll then see the insides of your uterus with the images that appear on a video monitor.
If the hysteroscopy is to treat conditions like polyps or fibroids, your doctor will insert the devices for removing the abnormal tissue through the hysteroscope.
The best time to do a hysteroscopy if you have regular periods is the first week after your period ends. You may have a hysteroscopy at any time if you're past menopause. A doctor will not do a hysteroscopy if you:
- Are on your period
- Are pregnant
- Have a pelvic infection
- Have genital herpes or signs that you might have it
- Have cervical or endometrial cancer
A doctor might also not recommend a hysteroscopy if you have heart disease or tend to bleed easily. Speak with your doctor about any health conditions you might have before a hysteroscopy.
Tell your doctor if you unexpectedly get your period on the week of the procedure. They may need to reschedule it. Also, don’t use vaginal medicines, a douche, or a tampon 24 hours before your procedure.
How long does a hysteroscopy take?
A hysteroscopy usually takes 5 to 30 minutes. In some cases, it can take about an hour. How long the procedure lasts depends on whether you’re having a diagnostic hysteroscopy, an operative hysteroscopy, a diagnostic and operative hysteroscopy, or another surgery with the hysteroscopy.
Is a hysteroscopy painful?
A hysteroscopy can be painful. Pain can sometimes keep a doctor from completing the procedure. But it might also be painless or cause only mild pain. Your pain level depends on whether you were anxious before the procedure, how long it takes, if you’ve ever given birth, and more.
Speak with your doctor about the procedure, your anesthesia options, and medications that may help you feel calm.
You’ll probably be able to go home and eat and drink soon after. But if you received local or general anesthesia, you’ll need someone to drive you.
You must avoid sex, inserting anything into your vagina, or douching for at least 2 weeks after the procedure. Your doctor may also tell you to avoid hot tubs, baths, and swimming during recovery. Before you’re sent home, your doctor will tell you more about how to care for yourself after surgery.
Hysteroscopy Side Effects
You may have mild cramping or bleeding for a few days after the procedure. You might also have gas that can last for about 24 hours. Your doctor may give you medicine to help with any pain. You might also have other side effects like:
- Stomach pain
- Lightheadedness or dizziness
- Shoulder pain
- Mild nausea
As with any medical procedure, you could have some complications from a hysteroscopy, such as:
- Problems from the anesthesia
- Bleeding too much
- Tearing or damage to your cervix, though this is rare
- Problems with gas or fluid from the uterus
- Damage to nearby organs like the bladder, bowel, or ovaries
- Pelvic inflammatory disease
Call your doctor right away or go to the emergency room if you have symptoms like a fever, serious stomach pain, or heavy bleeding after a hysteroscopy.
The cost for a hysteroscopy can vary widely, depending what other procedures you have done with it and where you get it done. It averages between about $1,600 and $5,000.
You'll probably pay less for a diagnostic hysteroscopy than an operative hysteroscopy. A hysteroscopy at an ambulatory surgical center may cost less than one at a hospital outpatient department. Likewise, you may pay less if you have the procedure at the doctor’s office than if you have it in an operating room. You may also pay more if you have a hysteroscopy with general anesthesia and other surgeries.
Most health insurance providers will cover your hysteroscopy if it's done to diagnose and treat a health condition. But they may ask that your doctor confirm the reason for the procedure. How much your health insurance will cover will depend on your plan. Speak with your health insurance provider to learn more about what your plan covers.
A doctor may recommend a hysteroscopy to diagnose and treat conditions related to your reproductive organs, such as infertility, uterine fibroids, and more. This procedure takes no more than an hour and usually doesn’t cause any serious side effects or health problems. Talk to your doctor if you have concerns about the procedure and how to care for yourself during recovery.
Is a hysteroscopy done with or without anesthesia?
A hysteroscopy may be done with or without anesthesia, depending on what’s best for you. Anesthesia will make your procedure painless. Speak with your doctor about it.
Is a hysteroscopy the same as a D&C?
Although both procedures are used to diagnose and treat a condition affecting your uterus, a hysteroscopy is not the same as a D&C. A D&C is a surgery that involves dilating the cervix with small instruments or a medication, then scraping the uterine lining with a spoon-shaped or sharp object to remove abnormal tissue from your uterus.