Hysteroscopy overview

  • Diagnostic hysteroscopy uses a thin lighted tube (hysteroscope) to examine the cervix and inside a woman’s uterus to evaluate for problems.
  • Operative hysteroscopy utilizes small tools to surgically correct a condition detected in the diagnostic hysteroscopy.
  • Hysteroscopy reveals the size, shape and lining of the uterus and any associated abnormalities that may affect female fertility.
  • Operative hysteroscopy can remove uterine fibroids and polyps, open blocked fallopian tubes, and perform endometrial ablation if endometriosis is present.

What are diagnostic hysteroscopy & operative hysteroscopy?

Diagnostic hysteroscopy

Diagnostic hysteroscopy allows the physician to check the size, shape and lining of a woman’s uterus to diagnose any abnormalities that may be affecting fertility or causing other gynecologic disorders.

With the patient under anesthesia, a thin viewing tool called a hysteroscope is inserted into the vagina and gently moved through the cervix into the uterus, where a liquid solution or carbon dioxide is inserted through the hysteroscope to expand the uterus. Once the uterus is expanded, a light and camera on the hysteroscope allow the doctor to see the endometrium (lining of the uterus), ovaries and fallopian tubes on a video screen.

Operative hysteroscopy

Operative hysteroscopy may be performed to correct an abnormal condition found during diagnostic hysteroscopy. Small instruments can be inserted through the hysteroscope to correct problems such as endometriosis, uterine polyps and fibroids, or adhesions.

Hysteroscopy is typically an outpatient procedure. If a doctor has any concerns, such as a patient’s reaction to anesthesia, an overnight hospital stay may be required.

When is hysteroscopy performed?

Diagnostic hysteroscopy is used to identify problems in a woman’s uterus that may be contributing to infertility. The procedure may be performed to:

  • Determine whether the uterus is abnormally shaped or contains scar tissue
  • Find potential causes of recurrent miscarriages
  • See blocked fallopian tubes
  • Find fibroids and polyps
  • Determine causes of abnormal bleeding and severe cramping.

Operative hysteroscopy is used to correct abnormal conditions that are determined during diagnostic hysteroscopy. Hysteroscopes may be used to insert small tools into the uterus to:

  • Remove uterine fibroids and polyps
  • Unblock fallopian tubes
  • Remove the endometrium using a heated tool if endometriosis is present. Endometrial ablation is not performed in women who wish to become pregnant, as it destroys much of the lining of the uterus.

Laparoscopy, another minimally invasive surgical procedure, may also be performed at the same time as a hysteroscopy to determine causes of infertility.

What are the risks of hysteroscopy?

Hysteroscopy complications are infrequent and occur in only about two out of every 100 procedures. The most common complication is perforation of the uterus, which is a small hole that typically closes spontaneously. If these perforations fail to heal, they may cause bleeding or damage to nearby organs, which could necessitate additional surgery.

Uterine adhesions or infections may develop after hysteroscopy. There may also be some risks associated with the use of anesthesia such as nausea/vomiting, dizziness, headache, and lung infection.

Severe and life-threatening complications from hysteroscopy are unusual, but could involve issues related to the fluids used to distend (expand) the uterus, including fluid in the lungs, blood clotting, fluid overload, electrolyte imbalance and severe allergic reactions. Some of these complications may prevent completion of the surgery.