Dr. Peter KrugerUrogynecology & Surgery
Diagnostic Procedures

Hysteroscopy

Direct visualization of the uterine cavity using a small camera to diagnose and treat abnormal bleeding, polyps, fibroids, and other intrauterine conditions.

Overview

Hysteroscopy is a procedure that allows direct visualization of the inside of the uterus using a thin, lighted telescope (hysteroscope) passed through the vagina and cervix. It can be performed for diagnostic purposes or to treat conditions within the uterine cavity. Many hysteroscopic procedures can be done in the office without general anesthesia.

When Is It Considered?

Hysteroscopy may be recommended for:

  • Abnormal uterine bleeding (heavy, prolonged, or irregular periods)
  • Postmenopausal bleeding
  • Suspected uterine polyps or fibroids
  • Evaluation of abnormal findings on ultrasound
  • Recurrent pregnancy loss
  • Retained intrauterine device (IUD) removal
  • Uterine adhesions (Asherman syndrome)
  • Abnormal uterine cavity findings on imaging

Types of Hysteroscopy

Diagnostic Hysteroscopy

  • Used to examine the uterine cavity and identify abnormalities
  • Often performed in the office setting with local anesthesia or no anesthesia
  • The vaginoscopic ("no-touch") technique avoids the need for a speculum or tenaculum, reducing discomfort

Operative Hysteroscopy

  • Performed to treat identified pathology within the uterine cavity
  • May involve removal of polyps, fibroids, adhesions, or uterine septa
  • Typically performed in an operating room under general or regional anesthesia, though some procedures can be done in-office

The Procedure

  • A thin hysteroscope is passed through the cervix into the uterine cavity
  • The uterus is gently distended with saline to allow clear visualization
  • Instruments can be passed through the hysteroscope to biopsy, remove, or treat abnormalities
  • Diagnostic hysteroscopy typically takes 10-15 minutes; operative procedures may take 30-60 minutes depending on the complexity
  • Ideally performed in the follicular phase (after menstruation) in premenopausal women

What to Expect After

  • Mild cramping similar to menstrual pain is common and usually resolves within a few hours
  • Light vaginal bleeding or spotting may occur for several days
  • Most patients return to normal activities within 24-48 hours
  • Avoid intercourse, tampons, and douching for approximately two weeks following operative procedures
  • A follow-up appointment will be arranged to review findings and discuss any pathology results

Risks and Success Rates

Hysteroscopy is a very safe procedure with high patient satisfaction. Diagnostic hysteroscopy has a complication rate of approximately 0.1%, and operative hysteroscopy approximately 1%. Over 95% of patients tolerate the procedure well. Potential risks include:

  • Uterine perforation — the most common surgical complication, occurring in approximately 1% of cases; usually managed conservatively
  • Bleeding — uncommon, occasionally requiring further intervention
  • Infection — rare
  • Fluid overload — a rare risk with operative procedures involving uterine distension media
  • Incomplete procedure — occasionally cervical stenosis or poor visualization may limit the examination