Hysteroscopy: what it is, why it is done and what to expect

The NHS says a hysteroscopy is a test to look inside a womb, using a thin tube with a small camera inside it. During it, a thin tube with a camera is inserted into the vagina, passed through the cervix and into the womb. Salt water (saline solution) is injected through the tube to make it easier to see inside the womb. The camera sends images to a screen, and you can watch the screen if you want to.

University College London Hospitals NHS Foundation Trust describes it as a minor surgical procedure that allows examination and sampling of the lining of the womb, which can be performed by doctors or specially trained nurse hysteroscopists. Cambridge University Hospitals describes outpatient hysteroscopy as a procedure carried out in the outpatient clinic that involves examination of the inside of the womb with a thin telescope.

The NHS says a hysteroscopy can be done to find out why you are having certain symptoms such as unexplained vaginal bleeding, and can help diagnose or treat many health issues. Sometimes a sample of tissue (biopsy) is taken, or fibroids and polyps are removed.

• Very heavy periods or bleeding between periods.

• Bleeding after the menopause.

• Fibroids or small growths (polyps).

• Problems getting pregnant or repeated miscarriages.

• Removal of a coil (IUS or IUD) if the threads are missing.

The NHS says a hysteroscopy can be uncomfortable and may feel like period pain, but that for many people it can be very painful. Taking ibuprofen or paracetamol 1 hour before can help. It says to talk to staff before the day if you are worried about pain, and to tell them if you have painful periods that make you faint, have had painful vaginal examinations or cervical smears, or have experienced sexual violence, which could make the procedure difficult.

If you are in a lot of discomfort during the procedure, the NHS says you may be offered gas and air or a local anaesthetic, or you can ask to stop at any time and may be able to have it later with local or general anaesthetic or intravenous sedation. Not all hospitals offer general anaesthetic or sedation, so you may need referring to one that does.

University College London Hospitals says some women experience no pain at all, but most experience strong period-like cramping, and for some it is very intense and the procedure is stopped. It stresses that you are in control and that if you ask the team to stop, they will.

A GP or hospital doctor can refer you for a hysteroscopy. The NHS says you will get printed information including pain relief options, and that you can bring a friend or family member; there will also be a chaperone with you during the test.

Cambridge University Hospitals says you do not need to fast and recommends a light breakfast or lunch because it reduces the chance of feeling faint, and that it is best to keep the appointment even if you are bleeding, though heavy bleeding can make it difficult. University College London Hospitals says to tell the team if you take blood thinning medicines, and that if you are on your period on the day they may not be able to carry out the procedure because bleeding can interfere with the view.

The NHS says not to have a hysteroscopy if you could be pregnant: use contraception or avoid sex between your last period and the procedure, and you may be given a pregnancy test on the day.

The NHS says you will meet the healthcare professional who will do the procedure (the hysteroscopist), who explains what will happen including pain relief and asks you to sign a consent form. You may feel sick or faint during the procedure.

The NHS says a hysteroscopy usually takes 10 to 15 minutes but can take longer if samples are taken or a fibroid or small growth is removed. Cambridge University Hospitals says the procedure itself usually takes 5 to 10 minutes but that it can take longer to set up the equipment especially with additional procedures, while University College London Hospitals gives 10 to 30 minutes. Afterwards you will go to a recovery area until you feel ready to go home.

If you have a general anaesthetic or intravenous sedation, the NHS says a friend or family member will need to collect you afterwards and you should not drive yourself; with a general anaesthetic you may need to stay overnight.

The NHS says it is normal to have pain similar to period pain for a couple of days afterwards, which paracetamol, ibuprofen or your usual period pain medicine should help. You may also have some bleeding or spotting for up to a week. Use pads, not tampons, and avoid exercise or sex until the pain and bleeding have stopped.

The NHS says most hysteroscopies are quick and safe, but rarely there is a risk of developing an infection afterwards, which can be treated with antibiotics, and of making a small hole in the wall of the womb when removing a polyp. If that happens you may need to stay in hospital overnight; it often gets better on its own but sometimes an operation is needed to repair it. Cambridge University Hospitals says the risk of uterine perforation is lower in outpatient hysteroscopy than under general anaesthetic.

The NHS says to contact the hospital or clinic where you had the procedure urgently if you have bleeding that gets worse or does not stop after a few days, tummy pain that gets worse and is not helped by painkillers, a high temperature, or smelly vaginal discharge. You can also call 111 or get help from 111 online.

The camera lets the hysteroscopist see inside the womb straight away, so you may be told what was seen. Where a biopsy has been taken, the sample goes to a laboratory and results follow later. Your clinic will tell you how and when you will hear. If something is found, such as a polyp or fibroid, it may be removed at the same visit or planned for another.

On the NHS, a GP or hospital doctor refers you for a hysteroscopy, often in an outpatient one-stop clinic. The NHS notes not all hospitals offer general anaesthetic or sedation, so you may be referred elsewhere if you want it.

Private gynaecology units also offer hysteroscopy. If you are choosing, ask what pain relief is available, whether samples or removals can be done in the same visit, and how results will be shared with your GP.