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An outpatient hysteroscopy(OPH) is a procedure that involves examining the inside of your uterus (womb). This is done by passing a thin telescope-like device, called a hysteroscope, that is fitted with a small camera through the neck of your womb (cervix). The healthcare doctor performing the procedure can then see whether there are any problems inside your uterus that may need further investigation or treatment.
It may be possible for a minor procedure to be done at the same visit, such as:
Endometrial biopsy – taking a sample from the lining of the uterus. This can be done through the hysteroscope or after inserting a speculum and passing a thin tube through the cervix. You may experience period-like pain during this procedure, but the pain settles fairly quickly.
Polyp removal – a polyp inside the uterus is a skin tag that looks like a small grape, sometimes on a stalk. Polyps are formed as a result of overgrowth of the lining of the uterus. They can cause irregular bleeding and are also associated with fertility problems.
Small fibroid removal – fibroids are knots in the muscle of the uterus that are non-cancerous (benign). They can sometimes bulge like a polyp into the lining of your uterus and your healthcare professional may advise removal to help with your symptoms.
Insertion of a hormone-releasing intrauterine device (for example, Mirena®).
Removal of a coil from the uterus when the threads are not visible
Reasons why you may require hysteroscopy:
How to prepare for the procedure
You should eat and drink normally. You do not need to fast before your appointment. It is recommended that you take pain relief (400 mg of ibuprofen or 1 gram of paracetamol or whatever pain relief you find useful for period pain) at least 1 hour before your appointment.
Bring a list of any medications that you are taking with you. You may wish to have a friend or family member accompanying you.
There may be other things to consider when deciding whether OPH is the right choice for you, such as:
You may choose to have your hysteroscopy with either a general or spinal anaesthetic. This will be done in an operating theatre, usually as a day case procedure. We may be able to offer this service but may have to be arranged another day.
The risks and complications are lower when hysteroscopy is done as an outpatient procedure rather than under anaesthesia. You may choose not to have a hysteroscopy at all, though this may make it more difficult to find the cause of your symptoms and to offer the right treatment for you.
You have an opportunity to discuss the procedure in detail. Please take this opportunity to ask any questions you may have. There will be two or three healthcare professionals in the room and one of them will support you throughout the procedure.
They will help you to get positioned in a special chair and will keep you as covered as possible.
The procedure
A hysteroscope is passed through the cervix to give a clear view of the inside of your uterus. No cuts are needed. Fluid (saline solution) is used to help see the inner lining of your uterus and you will feel wet as the fluid trickles back out. If no problems are found, the actual procedure will only take about 10–15 minutes. Sometimes, a biopsy (small sample) from the lining of your uterus may be taken and sent to the laboratory for examination. The biopsy can be painful, but the pain should not last long. If a fibroid or polyp is found, it can sometimes be removed at the same time by using additional instruments.
You may be offered a local anaesthetic to make you more comfortable, particularly if a wider hysteroscope is to be used and you require removal of polyp. During the OPH, we will look inside your uterus on a screen and you can also watch the screen if you choose to. Photographs of the findings inside your uterus are often taken and kept in your healthcare notes.
What are the possible risks with outpatient hysteroscopy?
Pain during or after OPH is usually mild and similar to period pain. Simple pain relief medications can help. On occasion, women may experience severe pain.
Feeling or being sick or fainting can affect a small number of women. However, these symptoms usually settle quickly.
Bleeding is usually very mild and is lighter than a period, settling within a few days. It is recommended that you use sanitary towels, not tampons. If the bleeding does not settle and gets worse, contact your healthcare professional or nearest emergency department.
Infection is uncommon (1 in 400 women). It may appear as a smelly discharge, fever or severe pain in the tummy. If you develop any of these symptoms, contact healthcare nearest to you.
Failed/unsuccessful OPH occurs if it is not possible to pass the hysteroscope inside your uterus. Usually this happens when the cervix is tightly ‘closed’ or scarred.
Damage to the wall of the uterus (uterine perforation) – rarely, a small hole is accidentally made in the wall of the uterus. This could also cause damage to nearby tissues. This happens in fewer than 1 in 1000 diagnostic hysteroscopy procedures, but is slightly more common if someone has a polyp or fibroid removed at the same time. It may mean that you have to stay in hospital overnight. Usually, nothing more needs to be done, but you may need a further operation to repair the hole which is extremely rare.
Will outpatient hysteroscopy hurt?
For most women, OPH is quick and safe, and is carried out with little pain or discomfort. OPH is often done without inserting a speculum, by using a thin telescope (called vaginoscopic OPH) as this is more comfortable.
However, everyone’s experience of pain is different and some women will find the procedure very painful. If it is too painful for you, the procedure can be stopped and option of local anaesthesia and if necessary general anaesthesia can be discussed.
If the procedure is uncomfortable or you require further treatment like polyp removal local anaesthetic can be given on the neck of the womb. This will require using a speculum to see your cervix to allow administration of local anaesthesia.
How long does the visit take?
The actual procedure may only take 10–15 minutes. However, the total visit may take up to 1–2 hours including consultation, having the procedure and recovery. If polyps or small fibroids are removed at the same time, this may take a bit longer. You can rest in the outpatient clinic’s recovery area for as long as you need (usually about 20 minutes)
How will I feel afterwards?
You may get some period-like pain for 1–2 days. You may also have some spotting or fresh (bright red) bleeding that may last up to 1 week. These symptoms usually settle very quickly. Most women feel able to go back to their normal activities on the same day. You can shower as normal. Normal physical activity and sex can be resumed when any bleeding and discomfort has settled.
If needed, you can take pain relief such as 400 mg of ibuprofen every 8 hours or 1 gram of paracetamol every 4 hours, or your usual period pain tablets.
If your pain is not controlled with the above medication, you should contact your local healthcare professional or nearest emergency department.
What happens next?
If no problems are found, you may not need any follow-up appointments. If a biopsy has been taken, you will be contacted with the results as soon as they become available.
About intimate examinations
The nature of gynaecological care means that intimate examinations are often necessary. If you feel uncomfortable, anxious or distressed at any time before, during, or after an examination, please let us know. If you find this difficult to talk about, you may communicate your feelings in writing. We are there to help and they can offer alternative options and support for you. Remember that you can always to stop the procedure anytime if it becomes too uncomfortable.
