Hysteroscopy allows the physician to view and operate on the uterus through the vagina. The instrument, called a hysteroscope, is a long, narrow telescope connected to a light source that illuminates the area of interest inside the uterus.
Similar to a pap smear, a speculum is placed in the vagina to visualize the cervix. The physician will inject fluid into the uterine cavity through the hysteroscope to improve the visual field. The end of the telescope is then gently passed through the cervical canal and, under direct visualization, the instrument is advanced into the uterine cavity to view and, if necessary, take a sample from areas of concern. At the end of the hysteroscope is a camera that is controlled remotely by the physician and allows the digital images to be displayed on a screen and stored electronically for future reference.
A hysteroscopy is scheduled in the window between when a patient’s period stops and ovulation occurs, or more commonly, while on active birth control pills. If a patient is not currently on birth control pills, a prescription will be provided in order to regulate her cycle. This timing ensures the uterine lining will be as thin as possible for the hysteroscopy. Patients are asked to call their nurse with the first day of their period.
One business day prior to the procedure, a nurse will call the patient to discuss allergies and provide pre-operative instructions. Patients will need to refrain from consuming food or drink starting at midnight the evening before their scheduled surgery. If they are taking regular medications, the nurse will explain which ones may be taken the morning of surgery with a small sip of water. Patients are instructed to arrive approximately one hour before surgery.
A hysteroscopy is a relatively quick procedure after which patients will spend about 30 minutes in the hysteroscopy suite. Since the procedure requires general anesthesia, the patient will need a responsible adult to drive her to and from the surgery center. It is strongly recommended that patients take the day off from work and refrain from intense activity or driving for the rest of the day.
After the procedure, there may be mild to moderate cramping for several minutes, and it may continue throughout the rest of the day. On occasion, there will be a small amount of vaginal bleeding, usually in the form of spotting. It is not unusual to have some light spotting or a watery discharge for the first 24 hours. We recommend refraining from intercourse for approximately 48 hours and the use of tampons or douching for 1-2 weeks. If cramping becomes worse instead of better over the course of the day, or if the patient develops a fever (temperature >100.4F), they should call their doctor’s office.
When the procedure is complete, the physician will be able to share the visual findings immediately and discuss options for addressing areas of concern, if there are any. If samples were taken for biopsy, those results should be reported within a week.