Hysteroscopy: A Look Inside the Uterus
Hysteroscopy sounds intimidating, but it’s actually one of the most straightforward and useful tools we have for understanding what’s going on inside the uterus. Think of it this way: you would never buy a house based solely on listing photos. Photos are helpful, but they’re limited. You want to walk through the space, see it from different angles, and understand what’s really there.
That’s the role hysteroscopy plays in gynecology. Ultrasound and other imaging give us valuable information, but hysteroscopy allows a direct look inside the uterus, helping confirm, clarify, or treat findings that imaging can only suggest.
What a Hysteroscopy Actually Is
A hysterectomy means removing the uterus. Depending on the reason, other structures may or may not be removed. Once the uterus is gone, there will be no periods. After a hysterectomy, carrying a pregnancy is no longer possible. If you might want biological children in the future, discuss options like egg or embryo freezing before surgery.
This is where things often get confusing. What many patients, friends, or family members call a “hysterectomy” can mean something completely different from what a medical professional means. That mismatch has led to years of mixed messages, fear, and uncertainty. So, let’s demystify the terminology once and for all - so you know exactly what’s happening and how to talk about it with your doctor.
Why It’s Done
This is one of the most common procedures gynecologists perform. It can help evaluate or treat:
- Abnormal or heavy uterine bleeding
- Polyps or fibroids inside the uterine cavity
- Any abnormal tissue or structure seen on imaging
- Uterine adhesions
- Retained tissue
- Infertility or recurrent pregnancy loss
- A missing-string IUD or a device that can’t be removed easily in the office
Types of Hysteroscopy
Diagnostic hysteroscopy is done to look and gather information. Operative hysteroscopy is done to treat something that’s found. In real life, the line between these two is thin, and a procedure that starts as diagnostic often becomes operative if a treatable issue is identified.
Timing and Preparation
Hysteroscopy can be performed at any point in the menstrual cycle, but timing matters for visibility. Heavy bleeding can obscure the view, so many providers try to schedule hysteroscopy early in the cycle, often during the first week after a period ends. In some cases, hormonal medication may be prescribed beforehand to help thin the uterine lining.
What Happens During the Procedure
1. Positioning
- You’ll be positioned similarly to a pelvic exam.
2. Speculum Placement
- A speculum is placed to visualize the cervix.
3. Cervical Preparation
- The cervix may be gently stabilized with an instrument if needed. Depending on how open the cervix already is and the size of the hysteroscope being used, the cervix may be dilated to allow the camera to pass through.
4. Camera Insertion and Visualization
- The hysteroscope is passed through the cervix into the uterus. Sterile fluid is used to gently expand the uterine cavity so the walls can be seen clearly.
5. Operative Portion
- If abnormal findings are identified, small instruments can be passed through the hysteroscope to remove polyps, fibroids, or scar tissue. In some cases, a D&C (dilation and curettage, a gentle scraping of the uterine wall) is also performed to remove or sample additional uterine lining.
6. Completion
- All instruments and fluid are removed from the uterus and vagina. You’re taken to recovery and then sent home once stable.
What to Expect Before, During, and After
Before
If anesthesia is planned, you may need to fast. Your doctor will tell you what medications to adjust and whether you’ll need someone to drive you home.
During
The procedure usually takes anywhere from 15 to 45 minutes depending on what’s being done. You might feel some pressure or cramping unless you’re under sedation or general anesthesia.
After
- If you had anesthesia, expect some grogginess, nausea, dizziness, or fatigue for 24 to 48 hours.
- You may have mild cramping, spotting, or light bleeding for a few hours to a few days. For some people, it lasts longer, but if it continues beyond about a week, you should check in with your provider.
- Most people return to normal activities in 1 to 2 days. There are no strict movement restrictions.
- Your provider will often advise avoiding putting anything in the vagina, such as tampons or penetrative sex, for a few days to a couple of weeks. A safe general rule is waiting about two weeks, but follow whatever instructions your surgeon gives you.
Aftercare and Recovery
Most providers recommend avoiding anything inside the vagina for about two weeks after hysteroscopy unless instructed otherwise. Pads are preferred during this time. Most people return to normal activities within a few days.
What Happens to the Tissue That’s Removed
Anything taken from the uterus is sent to pathology, where it’s examined and checked for abnormalities or cancer. You’ll usually get results within days to a couple of weeks.
Understanding the Risks
Hysteroscopy is very safe and complications are uncommon. Typical lower-risk complications include:
- Bleeding
- Infection
- Mild cramping
- Scar tissue formation (rare)
- The need for a repeat surgery if something couldn’t be fully removed or treated the first time
- Uterine perforation:
This is when a small hole is made in the uterus accidentally with the instruments. If it happens, the procedure is usually stopped immediately. Depending on the situation, your doctor may simply observe you for a short time, or may need to perform a laparoscopy or a larger abdominal incision to evaluate and repair any damage. While serious, this complication remains rare and is estimated to occur in less than 2 percent of cases.
When to Call Your Doctor
Call your doctor for any:
- Heavy bleeding
- Severe abdominal or pelvic pain
- Fever or chills
- Foul discharge
- Dizziness or fainting
- Bleeding lasting longer than a week
- Any symptom that feels concerning or out of proportion to what you expected.
The Bottom Line
Hysteroscopy is a very common procedure with a wide range of uses. You probably know someone else who has had one, whether you’ve talked about it or not. While no procedure is zero risk, the chance of serious complications is low. Recovery is usually fast and most people return to normal life in a couple of days. And the clarity it provides often leads to relief, answers, or a clear next step.
