Hysteroscopy

If you have been told you need a hysteroscopy, you probably have two competing thoughts: relief that there is a clear next step, and anxiety about what the procedure actually involves. Both are normal. Hysteroscopy is commonly used to look inside the uterus, and in many cases it can diagnose and treat the problem in the same visit. It is considered a minimally invasive approach because it uses a thin camera rather than abdominal incisions.

This guide explains hysteroscopy in plain language: why it’s recommended, what happens during the procedure, what recovery feels like, how results are interpreted, and when to call your clinician.

What is hysteroscopy?

Hysteroscopy is a minimally invasive procedure used to examine the inside of the uterus with a thin, lighted camera.

Doctors use hysteroscopy to diagnose and treat conditions like abnormal bleeding, uterine polyps, fibroids, or infertility issues. The procedure involves inserting a hysteroscope through the vagina and cervix into the uterus, avoiding any external incisions. It allows for both diagnostic observation and surgical treatment in one session.

Recovery is usually quick, and many patients return to normal activities within a day. Hysteroscopy provides a clear view of the uterine lining, making it a valuable tool in gynecological care. Early diagnosis through hysteroscopy can improve treatment outcomes and fertility success.

Why is it performed?

A hysteroscopy is a minimally invasive procedure used to examine the inside of the cervix and uterus. Doctors perform it using a thin, lighted tube called a hysteroscope, which is inserted through the vagina. Because it enters through natural pathways, no incisions or cuts are required. It is commonly used to investigate abnormal bleeding, diagnose causes of infertility, or locate displaced IUDs. Beyond diagnosis, it can also treat issues immediately; surgeons can remove polyps, small fibroids, or scar tissue (Asherman’s syndrome) during the same session. It is typically a day-case procedure with a quick recovery time.

Types of hysteroscopy

• Diagnostic hysteroscopy: looks for causes of symptoms; often done in the office.

• Operative hysteroscopy: treats problems in the same session using tiny instruments or energy devices.

Hysteroscopy symptoms

Hysteroscopy has many indications. These are listed below.

• diagnosis and treatment of abnormal uterine bleeding (diagnostic hysteroscopy procedure)
• endometrial polyps
• intracavitary fibroids
• intrauterine adhesions caused by infections or previous surgical procedures
• diagnosis and/or treatment of uterine anomalies (eg, uterine septum, arcuate uterus)
• retained intrauterine devices or other foreign bodies
• insertion of intrauterine tubal contraceptive devices
• endocervical lesions

Why do people get a hysteroscopy?

The most common reason is abnormal uterine bleeding. That can mean heavy periods, bleeding between periods, bleeding after sex, or bleeding after menopause. Imaging tests can be helpful, but hysteroscopy gives something different: direct visibility. It can identify a polyp, a submucosal fibroid, unusual endometrial changes, adhesions, or retained tissue that a scan might not fully clarify.

Hysteroscopy is also used in fertility care and recurrent pregnancy loss evaluations when the uterine cavity needs closer assessment. A small abnormality inside the uterus can interfere with implantation or contribute to bleeding patterns, so clinicians often want a clear look when symptoms or prior tests point in that direction.

It can also be recommended when there is difficulty accessing the uterine cavity for another necessary procedure. Sometimes the cervix is tight or the anatomy makes blind procedures more challenging, and hysteroscopy offers a controlled way to visualize and guide what is happening.

Hysteroscopy surgery

Hysteroscopy surgery is a procedure used to diagnose and treat problems within the uterus. It is a minimally invasive technique. We use a thin, lighted instrument called a hysteroscope. This tool is inserted through the vagina and cervix directly into the uterus.

No incisions are made on the skin. The camera on the hysteroscope sends images to a monitor. This allows to see the uterine lining clearly. This method is used to find causes of abnormal bleeding. It is also used to remove polyps, fibroids, or scar tissue.

How long does a hysteroscopy take?

Most hysteroscopies take 5–45 minutes, depending on whether it’s diagnostic (quick look) or operative (diagnose and treat).

Diagnostic (office) hysteroscopy: The camera exam itself usually lasts 5–15 minutes. With check-in, consent, and recovery, plan for a 30–60 minute visit. Many people have mild cramps and light spotting afterward and return to normal activity the same day.

Operative hysteroscopy (polyp/fibroid removal, adhesions): Procedure time typically ranges 15–45 minutes.

What happens during the procedure?

The details depend on where and how it’s performed, but the basic sequence is similar. You change into a gown and lie back as you would for a pelvic exam. A speculum is placed so the cervix can be seen. The hysteroscope is inserted carefully through the cervical opening. The uterus is then distended with fluid so the lining can be inspected.

If a biopsy is planned, a small sample of the lining may be taken. If treatment is planned, instruments can be used to remove a polyp, trim a fibroid that bulges into the cavity, divide adhesions, or remove retained material. When operative work is done, the procedure can take longer and may involve different anesthesia options. Many diagnostic cases are brief, sometimes just minutes. Operative cases can take longer depending on complexity.

Does hysteroscopy affect fertility?

Hysteroscopy can improve fertility when it fixes problems inside the uterus, and when performed expertly it rarely harms fertility.

Hysteroscopy lets your doctor see the uterine cavity directly and treat issues that block implantation or trigger miscarriage.

Why it helps: Cavity irregularities distort blood flow, inflame the lining, and interfere with embryo attachment. A brief, targeted hysteroscopic procedure normalizes the cavity, reduces inflammation, and improves the endometrium’s ability to accept an embryo.

What is the role of hysteroscopy during endometriosis surgery?

Hysteroscopy complements endometriosis surgery by optimizing the uterine cavity while laparoscopy treats disease in the pelvis, boosting fertility and improving bleeding and pain control.

During the same anesthesia, your surgeon can perform a quick diagnostic hysteroscopy to inspect the endometrial cavity. If they find a problem, they can switch to operative hysteroscopy and fix it immediately.

According to our unpublished data, out of 941 patients who had endometriosis surgery with us and a hysteroscopy, 645 (68%) had some kind of uterine abnormality including uterine structure abnormalities such as cornual funneling, midline prominence, arcuate uterus, fibroids, septum, etc, and 38% of these abnormalities were arcuate uteruses.

Recovery after hysteroscopy

Most patients experience postoperative cramping or light bleeding and some complaints of vaginal discomfort, which mostly ease in 15 minutes. Paracetamol or nonsteroidal anti-inflammatory drugs like Advil, Tylenol, or Brufen are usually adequate for postoperative pain control, if necessary.

Patients can resume their daily activities within 24 hours. At Seckin Endometriosis Center, we see patients for a follow-up visit seven to ten days after the operation to assess any further complications and review results.

Hysteroscopy recovery time

Hysteroscopy recovery time is generally very short. Most patients can return to their normal activities within one or two days. For a simple diagnostic hysteroscopy, you may even feel fine by the next day. You might experience some mild cramping or light spotting. This is normal and usually resolves quickly. If you had an operative procedure, like polyp removal, recovery might take slightly longer. Your doctor will give you specific instructions.

Risks and complications

Complications from hysteroscopy are rare but could be serious if not managed by an experienced doctor. They include:

• uterine injury
• anesthesia-related complications
• infections
• excessive fluid absorption due to the uterine distention media
• hemorrhage

Infertility

Uterine abnormalities may prevent implantation of the embryo to the endometrial cavity. All abnormalities should be evaluated for a patient who desires fertility. The uterine anomalies that are most common during hysteroscopy that may prevent implantation are adhesions, septa, polyps, cavitary fibroids, anomalies of the cervical canal, and lesions of the tubal cornual channels. According to literature, most of the patients with cavitary lesions profit from hysteroscopic treatments, and almost 65% achieve pregnancy.

Risks and possible side effects of hysteroscopy

While hysteroscopy is generally safe, there are some risks and possible side effects. These include mild cramping, spotting, or vaginal discharge, which are usually temporary. In rare cases, there can be an infection, injury to the uterus, or damage to surrounding organs.

There is also a small risk of scarring or adhesions inside the uterus, which could affect fertility. More serious complications, such as heavy bleeding or a reaction to anesthesia, are uncommon.

When will you het the results of a hysteroscopy?

The results of a hysteroscopy are typically available right after the procedure if no biopsies are taken. If the doctor performs any treatments, such as removing polyps or fibroids, they can explain the findings immediately. However, if a biopsy was taken, it may take a few days to a week to get the results from the lab.

What Is Hysteroscopy D&C?

D&C (dilation and curettage) involves gently widening the cervix and removing tissue from the uterine lining. When performed together, they provide accurate diagnosis and allow treatment in the same procedure.

When Is It Performed Hysteroscopy D&C?

• Abnormal or heavy menstrual bleeding
• Suspected uterine polyps or fibroids
• Thickened endometrium
• Recurrent miscarriage evaluation
• Therapeutic uterine cleaning

How is Performed Hysteroscopy D&C?

Hysteroscopy D&C is performed by inserting a thin camera into the uterus and gently removing uterine lining tissue.

First, the cervix is carefully dilated to allow access to the uterine cavity. A hysteroscope is then inserted to visually examine the uterus for polyps, fibroids, or abnormal tissue. After inspection, dilation and curettage (D&C) is performed using a small surgical instrument or suction device to remove targeted tissue. The procedure usually takes 15 to 30 minutes and is done under local or general anesthesia.

Hysteroscopy FAQs

Our approach

At Seckin Endometriosis Center, our specialist surgeons use hysteroscopy to inspect the uterine cavity.  Instead of using the old-fashioned blind procedure of D&C, hysteroscopy is a minimally invasive visual approach for the diagnosis and treatment of common gynecologic problems such as abnormal uterine bleeding, uterine abnormalities to treat fibrosis, polyps, adenomyosis, endometrial hyperplasia, and heavy menstruation with clots. Hysteroscopic evaluation of the uterine cavity is the gold standard in the investigation of miscarriages, early pregnancy loss, and evaluation of infertility.

Endometriosis surgery should always start with an evaluation of the endometrial cavity by hysteroscopy. D&C is a touch-and-feel blind procedure. Hysteroscopy has largely replaced this procedure as the current standard of accepted practice

The best time to perform hysteroscopy is immediately after your period, or in the early follicular phase. The increased endometrial thickness would impair visualization other times during the cycle. Office hysteroscopy should always take place at the early follicular phase to obtain optimal visualization. Diagnostic hysteroscopy may be combined with laparoscopy and therefore take place in the luteal phase of the menstrual cycle, but care must be taken to avoid abrading the endometrium during the procedure, causing unnecessary trauma.

Our best approach is the “see and treat” technique in an advanced operative room with general anesthesia unless the patient prefers otherwise.