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Hysteroscopy

Hysteroscopy is a medical procedure where a thin, lighted tube called an hysteroscope is used to examine the inside of your uterus (womb).

An hysteroscopy can be perfomed for diagnostic or therapeutic (treatment) purposes. In a diagnostic hysteroscopy, the aim is to explore the uterus and confirm a diagnosis, whereas during a therapeutic hysteroscopy, conditions such as polyps (small growths), fibroids (growths made of muscle and fibrous tissue) and abnormal bleeding can be treated.

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A hysteroscopy can help ascertain the cause of:

  1. Abnormal uterine bleeding: If you suffer from excessive bleeding or abnormal menstrual bleeding (heavy bleeding or bleeding between periods), an hysteroscopy can uncover the cause. Conditions you might be diagnosed with include fibroids, polyps or endometrial hyperplasia, which is an abnormal thickening of the uterine lining.
  2. Recurrent miscarriages or infertility: If you have had repeated miscarriages or are struggling with infertility, an hysteroscopy can help identify structural abnormalities in the uterus that may be impacting your ability to conceive. This can include adhesions (scarring) known as Asherman’s syndrome, where bands of scar tissue form in the uterus. These can cause changes to your menstrual cycle and impact your ability to conceive.
  3. Uterine Polyps and Fibroids: A therapeutic hysteroscopy is a useful way to remove abnormal growths such as small uterine polyps and fibroids; these can cause unusual vaginal bleeding and sometimes infertility.
  4. Pelvic pain: For those suffering with severe or mild pain in the pelvis, an hysteroscopy can help identify the cause.
  5. Postmenopausal bleeding: Post menopausal bleeding can be an indication of other health issues at play. A diagnostic hysteroscopy is a useful way to investigate symptoms and rule out conditions such as uterine cancer.

An hysteroscopy can also be used to:

  • Locate a displaced contraceptive intrauterine device (IUD)
  • Remove placental tissue that has remained in the uterus after birth

A diagnostic hysteroscopy is carried out as a day-case procedure, which means you won’t need to stay in hospital overnight. If you are having a therapeutic hysteroscopy, you should also be able to go home the same day, but you will recover in hospital for a few hours afterwards.

Before

When you come in for your initial appointment, your gynaecologist will take a detailed medical history and ask about your symptoms, including when they started, if they have been getting worse and whether they’re new or recurring. They will then conduct a physical examination and often an ultrasound scan.

At this point, your gynaecologist may recommend an hysteroscopy. This may be because further investigation is needed to confirm a diagnosis, or in order to treat issues such as polyps, fibroids or a displaced IUD.

Preparing for the procedure

If you decide to go ahead with the hysteroscopy, your gynaecologist will also refer you for some blood tests and a pregnancy test beforehand. They may recommend you take contraception as the procedure cannot go ahead if you are pregnant. If you are going to have fibroids removed, you may also be given medicine to help shrink them beforehand. If you are having a therapeutic hysteroscopy for which you will be sedated, you should stop eating 6 hours before and drinking 2 hours before your procedure.

If you are having a diagnostic hysteroscopy, for which you will have local anaesthetic or over-the-counter pain killers, you can eat and drink as normal. You should take pain killers one hour before your procedure. On the day of the procedure, it’s a good idea to wear loose, comfortable clothing and bring a small bag with things you might need during your stay. Items to remember include a toothbrush and toothpaste, your phone and a charger, any prescription medications and painkillers to take after the procedure. Once you have arrived and are settled in your room, a nurse will monitor your vital signs and confirm your medical history, medications and emergency contacts.

Your gynaecologist will then run you through the procedure once again and ask you to sign a consent form that confirms you are happy to proceed.

During

A hysteroscopy usually takes between five and 30 minutes, depending on whether it is diagnostic or therapeutic. You may find the clinical setting intimidating. If you do feel anxious, please tell a nurse or your gynaecologist and they will do their best to support you

When undergoing a diagnostic hysteroscopy, you can expect the following:

  • Firstly, you will change into a hospital gown. You will then be taken to the procedure room where you will lie on a couch with your feet in stirrups.
  • If you are having local anaesthetic, at this point your gynaecologist will numb your cervix (entrance to the uterus).
  • We are often able to perform the procedure without the need for an instrument called a speculum inserted into the vagina to hold it open. Occasionally a speculum is needed to carry out the procedure.
  • The area will be cleaned with an antiseptic solution and the hysteroscope passed into your uterus. If you have a low cervix, you may find this uncomfortable and experience some light cramping.
  • A Sterile saline solution will then be gently pumped into the uterus. This helps the uterine lining be seen more clearly.
  • The camera at the end of the hysteroscope will then send pictures of your uterus to a screen, allowing your gynaecologist to spot any abnormalities.
  • In some cases, small tissue samples may be removed for further testing. This is known as a biopsy.
  • The entire procedure should take between 5-10 minutes.

If you are having a therapeutic hysteroscopy, the same process will be followed. However, you will be given sedation before the procedure so you will be asleep. If you are having fibroids or polyps removed, fine surgical instruments will be passed along the hysteroscope and these will be used to remove any abnormal tissue. The procedure will take a little longer – around 30 minutes.

After

After the procedure, you will be taken to your own private room to recover. If you had local anaesthetic, you will be able to leave as soon as you feel ok and after your gynaecologist has explained any findings with you. You will be able to drive. If biopsies were taken, the results of these will take around one week to arrive, so make sure to book a follow-up appointment with your doctor to discuss these. This could be in-person or over the phone.

If you had sedation, a friend or family member will need to take you home as you will not be allowed to drive for 24-hours. If possible, someone should stay with you during this time as well so you can rest.

After an hysteroscopy, you may experience:

  • Cramping for a few days
  • Spotting similar to your menstrual period for one week or more

After a diagnostic hysteroscopy, most women can return to work the next day. However, if you received treatment, particularly for fibroids, you may need to take a few days off to recover.

Medically reviewed by Mr Emeka Okaro - MBBS FRCOG on 17/01/2024

How to pay for your treatment

If you’re… paying for yourself

Did you know you don’t need private medical insurance to come to St John & St Elizabeth Hospital? As a self-pay patient, you can access safe, outstanding quality health care at times to suit you.

For scans and tests, as well as to see most consultants, you’ll still need to be referred by a medical professional like your GP, but as a self-pay patient, the process is more straightforward. You won’t need authorisation from an insurance provider, and you’ll have greater choice of consultant and appointment times.

If you’re… insured

St John & St Elizabeth Hospital is approved by all major medical insurance companies. If you have a personal private health insurance policy, or your company provide it for you, you can use it to pay for your care from your initial consultation through to treatment, surgery and aftercare such as physiotherapy. Not all private health insurance plans cover the same things. It’s very important to check exactly what you are covered for with your insurance provider.