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Hysteroscopy

Hysteroscopic surgery; Operative hysteroscopy; Uterine endoscopy; Uteroscopy; Vaginal bleeding - hysteroscopy; Uterine bleeding - hysteroscopy; Adhesions - hysteroscopy; Birth defects - hysteroscopy

Hysteroscopy is a procedure to look at the inside of the womb (uterus). Your health care provider can look at the:

• Opening to the womb (cervix)
• Inside of the womb
• Openings of the fallopian tubes

This procedure is commonly used to diagnose bleeding problems in women, remove polyps or fibroids, or perform sterilization procedures. It may be done in a hospital, outpatient surgery center, or the provider's office.

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Description

Hysteroscopy gets its name from the thin, lighted tool used to view the womb, called a hysteroscope. This tool sends images of the inside of the womb to a video monitor.

Before the procedure, you will be given medicine to help you relax and block pain. Sometimes, medicine is given to help you fall asleep. During the procedure:

• The provider places the scope through the vagina and cervix, into the womb.
• Gas or fluid may be placed into the womb so it expands. This helps the provider see the area better.
• Pictures of the womb can be seen on the video screen.

Small tools can be placed through the scope to remove abnormal growths (fibroids or polyps) or tissue for examination.

• Certain treatments, such as ablation, can also be done through the scope. Ablation uses heat, cold, electricity, or radio waves to damage the lining of the womb.

Hysteroscopy can last from 15 minutes to more than 1 hour, depending on what is done.

Why the Procedure Is Performed

This procedure may be done to:

• Treat heavy or irregular periods
• Block the fallopian tubes to prevent pregnancy
• Identify abnormal structure of the womb
• Diagnose thickening of the lining of the womb seen on ultrasound or other imaging tests
• Find and remove abnormal growths such as polyps or fibroids
• Find the cause of repeated miscarriages or remove tissue after a pregnancy loss
• Remove an intrauterine device (IUD)
• Remove scar tissue from the womb
• Take a tissue sample (biopsy) from the cervix or womb

This procedure may also have other uses not listed here.

Risks

Risks of hysteroscopy may include:

• Hole (perforation) in the wall of the womb
• Infection of the uterus
  
• Scarring of the lining of the womb
• Damage to the cervix
• Need for surgery to repair damage
• Unusual fluid absorption during the procedure leading to low sodium levels
• Severe bleeding
• Damage to the bowels 

Risks of any pelvic surgery may include:

• Damage to nearby organs or tissues
• Blood clots, which could travel to the lungs and be deadly (rare)

Risks of anesthesia include:

• Nausea and vomiting
• Dizziness
• Headache
• Breathing problems
• Lung infection

Risks of any surgery include:

• Infection
• Bleeding

Biopsy results are usually available within 1 to 2 weeks.

Before the Procedure

Your provider may prescribe medicine to open your cervix. This makes it easier to insert the scope. You need to take this medicine about 8 to 12 hours before your procedure.

Before any surgery, tell your provider:

• About all the medicines you take. This includes vitamins, herbs, and supplements.
• If you have diabetes, heart disease, kidney disease, or other health problems.
• If you are or could be pregnant.
• If you smoke, try to stop. Ask your provider for help. Smoking can slow wound healing.

In the 2 weeks before your procedure:

• You may need to stop taking drugs that make it hard for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), naproxen (Naprosyn, Aleve), clopidogrel (Plavix), and warfarin (Coumadin). Your provider will tell you what you should or should not take.
• Ask your provider which medicines you can take on the day of your procedure.
• Tell your provider if you have a cold, flu, fever, herpes outbreak, or other sickness.
• You will be told when to arrive at the hospital. Ask if you need to arrange for someone to drive you home.

On the day of the procedure:

• You may be asked not to drink or eat anything 6 to 12 hours before your procedure.
• Take any approved drugs with a small sip of water.

After the Procedure

You may go home the same day. Rarely, you may need to stay overnight. You may have:

• Menstrual-like cramps and light vaginal bleeding for 1 to 2 days. Ask if you can take over-the-counter pain medicine for the cramping.
• A watery discharge for up to several weeks.

You can return to normal daily activities within 1 to 2 days. Do not have sex until your provider says it is OK.

Outlook (Prognosis)

Your provider will tell you the results of your procedure.

References

Grochmal SA, Watson LA, Patterson DA. Hysteroscopy. In: Fowler GC, ed. Pfenninger and Fowler's Procedures for Primary Care. 4th ed. Philadelphia, PA: Elsevier; 2020:chap 130.

Howitt BE, Quick CM, Nucci MR, Crum CP. Adenocarcinoma, carcinosarcoma, and other epithelial tumors of the endometrium. In: Crum CP, Nucci MR, Howitt BE, Granter SR, Parast MM, Boyd TK, eds. Diagnostic Gynecologic and Obstetric Pathology. 3rd ed. Philadelphia, PA: Elsevier; 2018:chap 19.

Raymond L, Lentz GM. Endoscopy in minimally invasive gynecologic surgery. In: Gershenson DM, Lentz GM, Valea FA, Lobo RA, eds. Comprehensive Gynecology. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 10.

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Review Date: 11/10/2022  

Reviewed By: John D. Jacobson, MD, Department of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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