Hysteroscopy

A hysteroscopy is generally very safe but, like any procedure, there is a small risk of complication. The risk is higher for women who have treatment during the procedure.

A hysteroscopy will only be carried out if the benefits are thought to outweigh the associated risks including:

• Accidental damage to the womb. This is uncommon but may require treatment with antibiotics in hospital or, in rare cases another operation to repair it.
• Accidental damage to the cervix. This is rare and can usually be repaired easily.
• Excessive bleeding during or after surgery. This can occur if you have treatment under general anaesthetic. It can be treated with medication or another procedure, and very rarely, it may be necessary to remove the womb (hysterectomy).
• Infection of the womb. This can cause smelly vaginal discharge, a fever and heavy bleeding but it can usually be treated with a short course of antibiotics from your GP.
• Feeling faint. This affects 1 in every 200 women who have the procedure carried out without an anaesthetic or just a local anaesthetic.

A specialist can also examine your womb using:

• Pelvic ultrasound, where a small probe is inserted in the vagina and uses sound waves to produce an image of the inside of your womb.
• Endometrial biopsy, when a narrow tube is passed through your cervix into your womb, with suction used to remove a sample of your womb’s lining.

These alternatives may be performed alongside a hysteroscopy, but do not provide as much information and cannot be used to treat problems in the same way as a hysteroscopy.

Prior to a hysteroscopy, you may be advised to:

• Have tests to check whether you can have the procedure, such as a blood test or ECG.
• Use contraception, as a hysteroscopy cannot be carried out if you are pregnant.
• Stop smoking. If you are due to have a general anaesthetic, stopping in the lead-up to the procedure can help reduce your risk of complications.
• Some women feel none or only mild pain during a hysteroscopy, but for others it can be severe. Taking painkillers such as ibuprofen or paracetamol about an hour beforehand can help reduce discomfort after the procedure.
• If you are going to have fibroids removed, you may be given a drug to help shrink them beforehand. You will be given an injection in your stomach a month beforehand during an outpatient appointment.

A hysteroscopy is carried out as an outpatient in our procedure room and can take up to 30 minutes, although it may only last around 5 to 10 minutes if is just being done to diagnose a condition or investigate symptoms.

During the procedure:

• It may not be necessary to use any anaesthetic for the procedure, although local anaesthetic (where medication is used to numb your cervix) can be used.
• Longer or more complicated procedures, such as the removal of fibroids, may be done under general anaesthetic.
• You lie on a couch with your legs held in supports, and a sheet is used to cover your lower body.
• An instrument called a speculum (the same as used for a smear test) may be inserted into your vagina to hold it open, although this is not always needed.
• A hysteroscope (long, thin tube containing a light and camera) is passed into your womb. You may experience some cramping and discomfort as it passes through your cervix.
• Fluid is gently pumped into the womb to make it easier for your doctor to see inside.
• The camera sends pictures to a monitor so your consultant can spot any abnormalities.
• In some cases, a small sample of tissue from the womb lining may be removed for further testing. This is known as an endometrial biopsy.
• If you are having a hysteroscopy to treat a condition such as fibroids or polyps, fine surgical instruments can be passed along the hysteroscope. These are used to cut or burn away the abnormal tissue.

If at any point you are finding the procedure too uncomfortable, tell the doctor or nurse. They can stop at any time.

Your doctor or nurse will let you know straight away whether they found anything unusual during your hysteroscopy or discuss how any treatment.

If a small sample of tissue (biopsy) was removed from the womb, it can take several weeks to get your results. These will be sent through the post to your home address and to your doctor’s surgery.

Most women feel they can return to normal activities, including work, two to three days after the procedure. However, you may wish to have a few days off to rest, particularly if you had treatment such as fibroid removal under a general anaesthetic.

You may have a sore throat or feel sick from the anaesthetic.

If you have had a general anaesthetic, someone should stay with you for at least 24 hours until it has worn off. Do not drive or drink alcohol during this time.

Paracetamol and ibuprofen are generally recommended for a couple of days, with codeine (if appropriate) supplied by the hospital for break through pain only. Do not exceed the recommended maximum daily dose.

Your consultant can advise you about any activities you need to avoid while you recover, but generally speaking:

• You can eat and drink as normal straight away. If you feel a bit sick after a general anaesthetic, try eating small, light meals initially.
• You can have a shower the same day and a bath the next, unless your doctor advises you otherwise.
• You should avoid having sex for a week, or until any bleeding stops. This will help reduce the risk of infection.

While you recover, you may experience:

• Cramping similar to period pain. This should pass in a few days, and you can take regular painkillers.
• Spotting or bleeding for up to a week or more. Use sanitary towels rather than tampons until your next period to help reduce the risk of your womb or cervix becoming infected.

These side effects are normal and nothing to worry about, but you should seek medical advice if they are severe. Contact your consultant or GP if you:

• Have severe pain that is not relieved by regular painkillers.
• Have heavy bleeding that means you must change sanitary pads frequently.
• Pass bright red blood or large clots.
• Have foul-smelling vaginal discharge.
• Feel hot and shivery.

These symptoms could be a sign of a problem, such as an infection.