Hysteroscopy

Before your hysteroscopy

Be sure your healthcare team knows if you:

• Take any medicines. This includes vitamins, herbs, and supplements.
• Have allergies to any medicines.
• Get your menstrual period before the test. A hysteroscopy is not usually done while you are on your period.

Do not have this test if you are pregnant. If there is any chance that you may be pregnant, tell your healthcare team. You might be given a pregnancy test before your hysteroscopy.

You might be asked to stop taking certain medicines. To lower your risk of bleeding, you might need to stop taking aspirin or other blood-thinning medicines for several days before the test. Your healthcare team might also ask you to adjust or stop other medicines, such as those for diabetes.

If you normally take prescription medicines in the morning, ask your healthcare team how to manage them on the day of your test.

You may be asked not to eat or drink anything for at least several hours before the test. You will get specific instructions. Follow them carefully and ask questions if you don’t understand something.

Making a transportation plan

If you get a sedative to help keep you more comfortable during the test, you will need to arrange for a ride home after the test.

You might be sleepy or dizzy and need someone to help you get safely into your home, so a cab or rideshare service might not be a good option. Some centers will not let you use a cab or rideshare after this test.

If transportation or help getting home is a problem, talk with your healthcare team. There might be other resources available, depending on the situation.

During your hysteroscopy

Hysteroscopy is usually done as an outpatient, meaning you do not need to stay overnight in a hospital. It can be done in a clinic or an operating room.

Most diagnostic hysteroscopies take about 15 to 30 minutes. If polyps or fibroids are being removed, it can take longer.

Depending on the reason for the test, hysteroscopy may be done with:

• A sedative put into a vein (IV) to help you relax
• Local or regional anesthesia to numb the area but not make you sleepy
• General anesthesia to put you into a deep sleep in the operating room (less common)

Your doctor will review the procedure with you and ask you to sign a consent form.

For this test, you’ll change into a hospital gown. You may be asked to empty your bladder. You will lie on your back and place your legs in stirrups at the end of the bed. Your blood pressure, heart rate, and breathing will be monitored.

The doctor will insert a speculum into your vagina to widen and spread the vaginal wall. They will use an antiseptic to clean the vagina and cervix.

After your cervix is cleaned, the doctor will often widen (dilate) it. The cervix is the opening of the uterus. Widening it makes it easier to pass the hysteroscope through. Sometimes, your cervix is widened with medicine. This is taken by mouth or placed in your vagina a few hours before the test.

Once your cervix is widened, the hysteroscope is inserted into your vagina, through your cervix, and into your uterus. The doctor fills your uterus with sterile salt water (saline) or gas so that the lining can be more easily seen. Depending on the reason for the test, tools may be inserted through the hysteroscope to take samples or treat problems.

When the test is finished, the hysteroscope and any tools are removed.

After your hysteroscopy

After the test, you will be watched closely for any problems. If you had a sedative or general anesthesia, you might be groggy or confused for a few hours as it wears off.

You might have mild cramping, spotting, or light vaginal bleeding for a few days after the test.

If you had the test as an outpatient, you should be able to go home after a few hours. If you were given a sedative, someone will need to drive you home and stay with you until it wears off. Your doctor or nurse should give you specific instructions on what you can and can’t do in the hours after the test.

Your doctor may recommend avoiding tampons, douching, or vaginal sex for several days before and after the test to help lower the risk of infection.

If biopsies were taken, test results are usually ready within a few days, although some might take longer. You will need to follow up with your healthcare team after the test to get your results.

Possible risks of hysteroscopy

Hysteroscopy is usually safe, but there is a small risk of certain complications.

Bleeding: If a biopsy is done, a small amount of bleeding could happen where the tissue samples were removed. Heavy bleeding is uncommon.

Perforation of the uterus: Rarely, the hysteroscope can make a small hole in the wall of the uterus. Most heal on their own, but some may need treatment or surgery.

Damage to nearby organs, nerves, and blood vessels: Rarely, instruments used during the test can injure nearby organs such as the bowel or bladder.

Infection: In rare cases, an infection can develop in the uterus or pelvis. This may require antibiotics.

Fluid overload: In rare cases, your body can absorb too much of the fluid used to expand the uterus during the test. This is uncommon, because your care team will limit the amount of fluid used.

Gas embolism: This is very rare, because most hysteroscopies today use fluid (saline) instead of gas to inflate the uterus. But it can happen if gas is used and it accidentally enters a blood vessel. This can keep oxygen from reaching parts of your body, such as the brain, heart, or lungs.

Tumor spread: In very rare cases, cancer cells may move to nearby areas during the test, such as the fallopian tubes or abdomen. Research has not shown that this increases the risk of the cancer spreading or lowers survival in people with endometrial cancer.

Vasovagal syncope: Some people may feel dizzy, sweaty, sick to their stomach, or faint during or after the test. This happens when your heart rate and blood pressure drop. The risk is low, and it only lasts for a short time and gets better with rest.

Drug reactions: The medicine used to help you relax and stay comfortable during the test can sometimes cause changes in blood pressure, confusion, dizziness, trouble breathing on your own, or an allergic reaction. You will be watched closely for any of these side effects. They will be treated if needed.

When to call your care team

Before you go home, your doctor or nurse should give you specific instructions on when to call about problems.

In general, call your care team if you have:

• Bleeding that becomes heavier instead of lighter
• Bleeding that lasts longer than your doctor told you to expect
• Bad-smelling vaginal discharge
• Fever or chills
• Severe belly or pelvic pain
• Vomiting
• Inability to pee

Call 911 or go to the emergency room if you have:

• Chest pain or pressure that is increasing
• Trouble breathing (new)
• Heavy vaginal bleeding, soaking through one pad an hour or faster

Be sure you understand what to watch out for, when to call for problems, and the possible timing of when these problems might happen.