What Happens During a Hysteroscopy?

Procedure, Risks, Cost, and Recovery

Nurse holding a woman's hand before a hysteroscopy procedure
It's normal to feel anxious during a hysteroscopy. Don't be afraid to ask your doctor what to expect. Phil Boorman / Getty Images

Hysteroscopy is a procedure that allows your doctor to see inside the uterus and opening of the fallopian tubes.

If you’re having trouble getting pregnant, or if you have had two or more miscarriages, your doctor may order a hysteroscopy as part of fertility testing.

As with all fertility testing, it’s normal to be nervous before the procedure. You likely have a lot of questions.

What happens during a hysteroscopy?

Will it hurt? What do the results mean? Are there any risks?

The answers to these questions and more are below! As always, talk to your doctor before any fertility test or treatment.

Diagnostic vs. Surgical Hysteroscopy

There are two kinds of hysteroscopy: diagnostic and surgical.

A diagnostic hysteroscopy may be conducted in your doctor’s office. It is usually done with local anesthetic and possibly medication to help you relax.

The primary goal is to look at the inside of the uterus and at the fallopian tube openings, to see if there are any abnormalities.

Your doctor may suggest a hysteroscopy if...

Unrelated to fertility testing, if an IUD became misplaced (or “lost”) in the uterus, a diagnostic hysteroscopy may be performed to find and remove it.

Surgical hysteroscopy (also known as operative hysteroscopy) may be used to treat uterine problems found during a diagnostic exam.

Sometimes, a doctor may perform both a diagnostic and surgical hysteroscopy at the same time.

Surgical hysteroscopy usually takes place in the hospital under general anesthesia.

While it’s considered to be a surgical procedure, it’s minimally invasive. Everything is done via the cervical opening. There aren’t incisions made.

As long as everything goes smoothly, you won’t stay overnight. It’s an outpatient procedure.

Sometimes, a surgical hysteroscopy is scheduled along with a diagnostic laparoscopy. If you’re having a laparoscopy, you will have a small incision. But, this is also an outpatient procedure and doesn’t require an overnight hospital stay.

During a surgical hysteroscopy, your doctor may be able to...

Unrelated to fertility testing, surgical hysteroscopy may also be used to perform endometrial ablation. This procedure involves removing a thin layer of endometrium (or uterine lining.)

Endometrial ablation may be done if you have abnormally heavy bleeding during menstruation.

However, endometrial ablation should not be done if you plan on having more children.

If you’re having a hysteroscopy to diagnose or treat heavy uterine bleeding, make sure your doctor knows if you plan on having children now or in the future.

What Is a Hysteroscope?

A hysteroscopy is done with a medical instrument known as a hysteroscope – a thin, tube-like device that has many channels, or passageways, within the tube.

The hysteroscope is equipped with:

  • a light
  • a camera
  • a channel that delivers gas or fluid
  • a channel through which surgical instruments can be passed

All of that, and a hysteroscopy is just 3 to 5 millimeters in width! That’s slightly thinner than a typical pencil.

Preparing for a Hysteroscopy

As always, follow your doctor’s directions for preparation. If you’re unsure or forget, call up your doctor and clarify what you need to do.

The hysteroscopy will be scheduled to occur just after your period. This is when the endometrium is naturally thinner, and it’s easier for your doctor to visualize problems.

This timing is also to avoid accidentally doing the procedure if you’re pregnant.

If there is any possibility that you may be pregnant, tell your doctor before the procedure.

Preparation will partially depend on whether you’re having a diagnostic or surgical hysteroscopy.

Whether you’re having a diagnostic or surgical procedure, you may be asked to:

  • stop taking certain medications in advance if they increase your risk of bleeding. (Do not stop any medication without talking to your doctor first!)
  • avoid putting anything in your vagina the day before the procedure (like tampons, vaginal deodorants or douches, vaginal yeast infection suppositories.)
  • take antibiotics for a few days before to avoid infection (not always needed)
  • have someone accompany you to the doctor’s office or hospital,
  • have someone drive you home after the procedure

If you’re going under general anesthesia (if it’s a surgical hysteroscopy), you may be asked to:

  • shower in the morning or night before at home
  • not eat or drink anything after midnight the night before
  • have someone who can stay with you at home the day of the procedure, as you recover

If your procedure is not first thing in the morning and later in the day, talk to your doctor about the cut-off time for food and drink.

If there are medications you usually take every morning, talk to your doctor about what to do on the day of the procedure.

Procedure: What Happens During a Hysteroscopy

If you’re having a surgical hysteroscopy, the hospital will prepare you for general anesthesia.

An anesthesiologist will talk to your beforehand. Then, after being rolled into the operating room, an anesthesiologist will administer medications via an I.V. and/or a gas mask. 

Rather quickly, you will feel really sleepy. Once the medications are started, it may be only minutes before you are unconscious.

With general anesthesia, you will be unconscious throughout the procedure. You won’t remember it.

If you’re having a diagnostic hysteroscopy, your doctor may give you a sedative to help you relax. You will most likely be awake during the procedure and remember it.

This is what typically happens during a hysteroscopy:

1. Your doctor will use a speculum (this is a metal device used during regular gynecological exams) to gently open the vagina, so he can visualize the cervical opening.

2. Next, he may administer a local anesthetic to reduce pain. This is an injection and will cause cramping. (Not every doctor gives a local anesthetic.)

3. Your doctor will then gently dilate the cervical opening just enough to fit through the hysteroscope. You will feel cramping and pressure.

4. Then, through the hysteroscope, your doctor will either administer liquid or gas into the uterus. This is so the uterine walls will move apart for visualization and to clear away any mucus or blood that may block your doctor’s view.

5. Your doctor will see on a video screen the inside of the uterus. If you’re awake and the monitor is facing your direction, you may also be able to see it.

6. Your doctor will look to see that the fallopian tubes openings are clear. He will also look to see if there are any signs of uterine problems or abnormalities. He may also take a biopsy of the endometrium. This shouldn’t take more than a few minutes.

7. If it’s a diagnostic hysteroscopy only, your doctor will remove the hysteroscope. The procedure is over! You may feel lightheaded. This is common. If you do, tell your doctor.

8. If you’re having a surgical hysteroscopy, your doctor will pass instruments through a special canal in the hysteroscope. He will use these instruments to repair or remove problem growths or structures.  A surgical hysteroscopy can take an hour or more to perform.

Will It Hurt?

Hysteroscopy is a painful procedure for most women. About 1 in 3 women report having mild or no pain. The rest have moderate to severe pain during the procedure.

You may experience intense cramping when the cervix is dilated and the hysteroscope is inside the cervical opening.

You’re more likely to experience moderate pain if you’ve never given birth vaginally before.

The good news is that the procedure is rather quick. If you’re awake for the procedure, it should take no more than a few minutes to complete.

Some doctors offer a sedative, a local anesthetic, or both. Some doctors offer no pain medications or sedatives unless you ask.

Make sure you talk to your doctor about your options before procedure day.

If you’re going under general anesthesia, you won’t feel anything during the procedure because you will be unconscious.

Afterward, when you wake up, you may have a sore throat and mild pelvic cramping.

How Will I Feel After?

Some women may have what’s known as a vasovagal response to the procedure.

If this happens to you, you may feel lightheaded, dizzy, or nauseated.

Not every woman will have this experience.

But, if you tend to get dizzy, or you feel very anxious, tell your doctor. It’s better if you don’t get up right after the procedure in that case.

A vasovagal response is scary, but it’s not dangerous (as long as you don’t fall from dizziness.)

If gas was used during the procedure, you may feel shoulder pain.

You may have pelvic cramps for the next few days. They should be mild.

You may also have some light spotting.

Contact your doctor if you experience:

  • severe pelvic pain
  • heavy bleeding
  • feeling faint
  • fever

What Is Recovery Like After a Hysteroscopy?

If you went under general anesthesia, you will not be able to drive for at least 24 hours after the procedure. You should not expect to return to work that day.

If you didn’t go under general anesthesia, you may feel ready to go back to work later that same day.

However, it’s probably best to take off the entire day. Just in case you don’t feel well.

You may have mild cramping and spotting for up to a week. This is normal.

Your doctor may ask you to refrain from sexual intercourse for a week or until the spotting stops. This is to reduce the risk of infection.

Some doctors prescribe antibiotics for after the procedure, but this isn’t common.

Your doctor may order estrogen for a few weeks post surgery.

What Are the Risks of Hysteroscopy?

Complications occur in two out of every 100 procedures. The most serious complications are very rare.

Possible risks of hysteroscopy include:

  • accidental puncture of the uterine wall
  • infection
  • bleeding
  • adhesions or scaring post-procedure
  • damage to the cervix
  • needing further surgery to repair damage caused by the procedure
  • damage to nearby organs
  • blood clots, which can be deadly (rare)
  • fluids in the lungs
  • fluid overload or an electrolyte imbalance
  • allergic reaction

General anesthesia has its own risks.

What Happens After a Hysteroscopy?

If the results are normal, your doctor may order additional fertility testing or proceed to develop a fertility treatment plan.

If the results are not normal, your doctor may suggest surgery to correct the problems found, if possible.

Receiving the results can cause anxiety and even sadness. Be sure to take good care of yourself.

Also, don’t be afraid to ask your doctor questions, especially if you’re unsure of what the results mean.

Things you may want to ask include:

  • What do the results mean for our chances of getting pregnant?
  • Can the problem be repaired?
  • Will I be able to conceive on my own after surgical repair?
  • What are the risks of surgical treatment? What are the risks of not having surgery to repair the problem?
  • What do you recommend we do next?

What Are the Costs of Hysteroscopy?

Hysteroscopy may or may not be covered by your health insurance. In some cases, it depends on the reason given for the procedure.

It is more likely they will cover diagnostic hysteroscopy than surgical hysteroscopy intended for fertility treatment.

Coverage and cost will also depend on whether it’ll be done in an office or surgically in the hospital.

The full cost of a hysteroscopy, without insurance, ranges from approximately $1,300 to $5,000.

Out of pocket expenses will depend on your co-pay policies, deductible, and how much of the procedure is covered (if any.)

You may pay nothing, or you pay anywhere from $100 to thousands of dollars out of pocket.

Talk to your fertility clinic’s financial advisor and your insurance provider, so you’re not caught by surprise.

Sources:

Hysteroscopy. MedlinePlus. Accessed April 25, 2016. https://www.nlm.nih.gov/medlineplus/ency/article/007571.htm

Hysteroscopy: Treatment and Procedures. Cleveland Clinic. Accessed April 25, 2016.https://my.clevelandclinic.org/health/treatments_and_procedures/hic-what-is-hysteroscopy

Hysteroscopy. The American College of Obstetricians and Gynecologists (ACOG). Accessed April 25, 2016. http://www.acog.org/Patients/FAQs/Hysteroscopy

Hysteroscopy – Recovery. NHS Choices. Accessed April 25, 2016. http://www.nhs.uk/Conditions/Hysteroscopy/Pages/afterwardspage.aspx

Laparoscopy and Hysteroscopy: A Guide for Patients. American Society for Reproductive Medicine. Accessed April 25, 2016. http://www.reproductivefacts.org/uploadedFiles/ASRM_Content/Resources/Patient_Resources/Fact_Sheets_and_Info_Booklets/laparoscopy.pdf

 

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