So, your OB/GYN or fertility doctor has recommended a hysteroscopy — now what? More importantly, what exactly is a hysteroscopy?
A hysteroscopy is a versatile procedure used in gynecologic practice. It can determine a variety of diagnoses, as well as serve as treatment. Specifically, operative hysteroscopy can treat instances of intrauterine pathology like endometrial polyps or fibroids.
What happens during a hysteroscopy?
The procedure itself consists of looking directly inside the uterus with a tool called a hysteroscope — a thin, lighted telescope-like tube your provider inserts through the vagina and cervix. During the process, explains Callum Potts, MBBS, a board-certified OB/GYN and practice director at CCRM Fertility of Miami, a small amount of sterile fluid (usually saline) is used to distend the uterine cavity enough to get an accurate picture of the endometrium (aka the lining of the uterus) and the entrance to the fallopian tubes.
There are numerous reasons why your provider may recommend a hysteroscopy: “Diagnostic hysteroscopy is the gold-standard test for evaluating the uterine cavity prior to an embryo transfer or to diagnose intrauterine pathologies like endometrial polyps, fibroids, adhesions, or retained pregnancy tissue,” says Dr. Potts. A hysteroscopy can also help diagnose the causes of abnormal uterine bleeding.
An operative hysteroscopy — the type used for treatment — is similar to diagnostic hysteroscopy, but it consists of using “a larger, rigid camera in order to pass instruments into the uterine cavity,” explains Dr. Potts. “Under direct visualization, we can use these instruments to treat any pathology identified, remove it from the uterus, and normalize the endometrial cavity.”
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If you have a regular menstrual cycle, the hysteroscopy will likely be scheduled for “the follicular phase of the cycle after menstruation has ended,” says Dr. Potts. This is because the endometrial lining is thinner, and it’s easier for your doctor to detect subtle abnormalities. “In women without regular cycles, or so long as pregnancy can be reasonably excluded, hysteroscopy can be performed at any time.”
The diagnostic hysteroscopy process
Suppose you’re scheduled for a diagnostic hysteroscopy. In that case, the procedure is usually performed in your provider’s office, because “the hysteroscope and camera are narrow (as small as a couple of millimeters!) and often flexible to reduce discomfort,” explains Dr. Potts.
Dr. Potts does recommend, however, taking an NSAID like ibuprofen prior to the procedure to help reduce any pain.
The hysteroscopy begins with the doctor placing a speculum inside the vagina. Then, the cervix is cleaned to reduce the risk of infection. “The hysteroscope is gently passed through the vaginal entrance of the cervix,” says Dr. Potts. “The hysteroscope has a channel that allows sterile fluid to mildly distend the uterine cavity so that the camera at the end of the scope can clearly visualize all surfaces of the endometrium and the entrances to the fallopian tubes.” The provider will use the hysteroscope to take pictures, and then remove the hysteroscope and speculum. Barring any complications, the procedure “should only take a couple of minutes from start to finish.”
The operative hysteroscopy process
Although the procedure itself is analogous to a diagnostic hysteroscopy, Dr. Potts explains that “operative hysteroscopies are a little more involved.” While they can be conducted in the provider’s office, these kinds of hysteroscopies can also take place in a hospital operating room and may require sedation depending on the case. Other differences include a larger hysteroscope, which may require cervix dilation to accommodate it. “The larger scope allows us to pass a variety of instruments into the uterine cavity to complete the surgery,” says Dr. Potts.
After the hysteroscopy: What to expect
Be sure to take it easy for a few days following a hysteroscopy, as the procedure can trigger uterine cramps similar to menstrual cramping. These cramps can be treated with NSAIDs or Tylenol, says Dr. Potts. He also mentions that it’s common to experience spotting or light bleeding for a few days post-procedure — especially following an operative hysteroscopy. “This should decrease daily and stop after 1-2 weeks.”
While complications are rare, Dr. Potts recommends immediately contacting your doctor’s office if you’re experiencing fever/chills, severe pain not relieved by NSAIDs, bleeding that saturates a pad in less than one hour, or abnormal discharge.
What happens to my period after hysteroscopy?
“The safest approach is to expect the period following a hysteroscopy to be a little different,” warns Dr. Potts. You certainly may menstruate normally, but your period after a hysteroscopy could also be “lighter or heavier, earlier or later, or may even be skipped until the next period.”
Rest assured, all of these potential menstrual outcomes are normal, but Dr. Potts suggests contacting your provider should you have any post-hysteroscopy concerns.
Sarene Leeds holds an M.S. in Professional Writing from NYU, and is a seasoned journalist, having written and reported on subjects ranging from TV and pop culture to health, wellness, and parenting over the course of her career. Her work has appeared in Rolling Stone, The Wall Street Journal, Vulture, SheKnows, and numerous other outlets. A staunch mental health advocate, Sarene also hosts the podcast “Emotional Abuse Is Real.” Visit her website here, or follow her on Instagram or Twitter.