Hysteroscopy is a way of looking directly inside the uterus with a thin telescope, usually 3–5 mm wide for a diagnostic look, passed through the vagina and cervix. Because it uses the natural opening, there is no cut on the abdomen. Ultrasound shows the uterus from outside; hysteroscopy shows the cavity itself, so a small polyp, a septum or a thin band of scar tissue can be seen clearly and, very often, treated in the same sitting.
There are two broad kinds. Diagnostic hysteroscopy is a short look, often with a targeted biopsy of the womb lining. Operative hysteroscopy uses fine instruments or an electrosurgical loop through a slightly wider telescope to remove or correct what is found. Both are usually day-care procedures, and most women are home within a few hours.
Dr. Devang Patel performs diagnostic and operative hysteroscopy at Divine Women’s Hospital, Gota, as part of his laparoscopic and hysteroscopic surgical practice. The findings are shown and explained to you in plain language, in Gujarati, Hindi or English.
What hysteroscopy shows that a scan cannot
A good transvaginal ultrasound is the first test for most uterine problems, and often all that is needed. But a scan sees shadows and thicknesses; it cannot always tell a polyp from a thick lining, show a thin adhesion, or judge exactly how deep a fibroid sits in the wall. Saline infusion sonography or 3D ultrasound can narrow this down, and hysteroscopy gives the final answer by direct vision.
The cavity is gently expanded with sterile saline so that its walls separate, and the camera image is displayed on a screen. Both tubal openings, the lining and the shape of the cavity are checked systematically.
Diagnostic, outpatient and operative hysteroscopy
A diagnostic hysteroscopy uses a very slim scope and often needs no dilatation of the cervix. Many women manage it in a procedure room with a pain-relief tablet and local anaesthetic, and are back at work the next day. If a small polyp is found, it can sometimes be removed in the same sitting with fine scissors or a grasper.
Operative hysteroscopy needs a slightly wider scope and electrosurgical or mechanical instruments, and is done in theatre under anaesthesia. Larger fibroids, a septum or dense adhesions fall into this group. The choice between the two is made in clinic from your scan, your symptoms and how comfortable you would feel awake.
Reasons hysteroscopy is advised
- Heavy, irregular or prolonged periods, or bleeding between periods or after intercourse
- Bleeding after menopause, especially with an endometrial thickness above 4 mm on scan
- Infertility or repeated IVF failure, when a scan or HSG suggests a cavity problem
- Recurrent miscarriage, to look for a septum or adhesions
- A scan showing a polyp, a submucosal fibroid or a thickened lining
- Scanty or absent periods after a D&C or a pregnancy-related infection, suggesting adhesions
- A Copper-T or other device with missing threads, or one embedded in the wall
Conditions treated by operative hysteroscopy
Most problems inside the cavity can be treated without opening the abdomen. The table summarises what is done and what it usually achieves.
| Condition | What is done | Usual benefit |
|---|---|---|
| Endometrial polyp | Removed completely at its base and sent for testing | Controls irregular bleeding; may improve fertility |
| Submucosal fibroid | Shaved away in fine slices with a loop (resection) | Lighter periods; better chance of implantation |
| Uterine septum | Wall of tissue divided to restore a single cavity | Lower miscarriage and preterm birth risk |
| Intrauterine adhesions (Asherman) | Scar bands released, sometimes in two sittings | Return of periods and of a usable cavity |
| Retained products of pregnancy | Tissue removed under direct vision | Ends bleeding with less damage to the lining than blind curettage |
| Lost or embedded IUD | Located and retrieved with grasping forceps | Avoids blind attempts and further injury |
Timing, preparation and anaesthesia
Hysteroscopy is usually planned in the week after your period finishes and before ovulation, when the lining is thin, the view is clearest, and there is no chance of an early pregnancy. If cycles are irregular, a urine pregnancy test is done on the day. Bleeding after menopause can be investigated at any time.
A short diagnostic hysteroscopy can be done with simple pain relief, with or without a local anaesthetic to the cervix. Operative procedures are usually done under a short general or spinal anaesthetic, which needs about six hours of fasting. A tablet to soften the cervix may be given a few hours beforehand, particularly in women who have never had a vaginal birth or who are past menopause.
- Bring your recent ultrasound report and any previous operation notes
- Take a pain-relief tablet about an hour before, if advised
- Diabetic and blood-thinning medicines are adjusted in advance
- Arrange for someone to take you home after an anaesthetic
Risks and how they are kept low
Hysteroscopy is a safe and common procedure. Complications are uncommon, and less frequent with a diagnostic look than with operative work. Perforation, a small hole made in the wall of the uterus, happens in fewer than 1 in 100 operative procedures and usually heals on its own; occasionally a laparoscopy is needed to check that nothing nearby has been injured.
- Infection, in about 1 in 100 to 1 in 400 women, reduced by sterile technique and antibiotics where indicated
- Bleeding, usually light and self-limiting
- Fluid absorption during long resections, prevented by measuring fluid input and output throughout
- Failure to enter the cavity, usually because of a tight cervix, reduced by cervical softening
- New adhesions after septum or adhesion surgery, which is why a follow-up look is sometimes planned
After the procedure
You will rest for an hour or two and can go home once you have eaten and passed urine. Mild cramping and light bleeding or a watery discharge for a few days are expected, and a simple pain-relief tablet is usually enough. Most women return to normal routine within one to two days.
Avoid intercourse, tampons and swimming until bleeding stops, usually about a week. Any tissue removed is sent for histopathology, and the report is discussed at a follow-up visit about one to two weeks later, together with any further treatment.
Hysteroscopy, fertility and future pregnancy
When there is a real problem in the cavity, correcting it can make a measurable difference. Removing a septum lowers the risk of miscarriage, and removing polyps and submucosal fibroids improves the chances of implantation in natural and IVF cycles. Adhesions are the hardest to treat, and the outcome depends on how much healthy lining remains.
Routine hysteroscopy in women whose scan is normal has not been shown to improve IVF success, so it is advised only when there is a reason. After a polyp removal you can usually try to conceive in the next cycle; after septum division or adhesion release, a gap of one to two cycles is common.
Hysteroscopy helps fertility when it fixes a problem that is actually there; it is not a routine add-on.
How hysteroscopy is organised at Divine Women’s Hospital
Your scan and symptoms are reviewed in clinic first, and the procedure is booked on a suitable day of your cycle. Hysteroscopy is done by Dr. Devang Patel at the NABH-accredited hospital in Gota as a day-care admission, with anaesthesia and recovery on site and 24×7 emergency cover if you have any concern after going home.
If a combined laparoscopy is needed, for example in infertility evaluation to check the tubes, both are planned together in one anaesthetic.
Your care, step by step
- Consultation and scanYour symptoms and ultrasound are reviewed to decide whether hysteroscopy will add useful information or treatment.
- SchedulingThe procedure is timed to the early part of your cycle, with the type of anaesthesia agreed in advance.
- Day-care procedureThe cavity is examined and treated, typically in 10 to 45 minutes, and you rest for an hour or two afterwards.
- ExplanationWhat was seen and done is explained before you go home, often with images from the procedure.
- Results and planThe biopsy report is reviewed at follow-up, along with fertility plans or any further treatment.
When to book a visit
- Bleeding between periods, after intercourse or after menopause
- Your scan shows a polyp, a thickened lining or a fibroid in the cavity
- You have had two or more miscarriages, or a scan suggests a septate uterus
- Your periods have become very scanty after a D&C or pregnancy
- You are preparing for IVF or have had unexplained IVF failure
- Your Copper-T threads cannot be felt or seen
Warning signs - get same-day care
- Fever above 38°C or shivering after the procedure
- Heavy bleeding, soaking more than one pad an hour
- Abdominal pain that worsens instead of easing, or does not settle with simple pain relief
- A foul-smelling vaginal discharge
- Dizziness, fainting, breathlessness or chest pain
Labour and emergency care are available 24 × 7. Call the hospital and come in directly.
Myths and facts
Myth: Hysteroscopy involves a cut on the stomach.
It is done entirely through the vagina and cervix. There is no abdominal cut unless a separate laparoscopy is planned at the same time.
Myth: A normal ultrasound means the cavity must be normal.
A scan is usually reliable, but small polyps, thin adhesions and a mild septum can be missed. Hysteroscopy is advised when symptoms persist despite a normal scan.
Myth: Every woman doing IVF needs a hysteroscopy first.
Large studies have not shown benefit when the scan is normal. It is recommended when there is a specific reason.
Myth: Hysteroscopy damages the uterus and makes it harder to conceive.
Done for the right reason, it usually improves the cavity. The lining heals within a cycle or two, and removal under direct vision is gentler than blind scraping.
Frequently asked questions
Is hysteroscopy painful?
Most women feel cramping like period pain during a diagnostic hysteroscopy, lasting a few minutes. Pain relief is given beforehand and local anaesthetic can be used. Operative hysteroscopy is done under anaesthesia, so you will not feel the procedure.
How long does it take to recover after hysteroscopy?
Most women go home the same day and return to normal activities within one to two days. Mild cramps and light spotting for a few days are common. Avoid intercourse, tampons and swimming until bleeding stops.
Can hysteroscopy improve my chances of getting pregnant?
When there is a cavity problem such as a septum, polyp, adhesions or a submucosal fibroid, correcting it can improve implantation and lower miscarriage risk. Routine hysteroscopy with a normal scan has not been shown to improve IVF results.
What is the difference between hysteroscopy and laparoscopy?
Hysteroscopy looks inside the uterus through the cervix, with no cuts. Laparoscopy looks at the outside of the uterus, tubes and ovaries through small cuts in the abdomen. The two are sometimes combined in infertility evaluation.
When can I try to conceive after hysteroscopy?
After a diagnostic hysteroscopy or polyp removal, usually in the next cycle. After septum division or adhesion release, a gap of one to two cycles is often advised, sometimes with a check of the cavity first.
Is hysteroscopy done under general anaesthesia?
Not always. A short diagnostic hysteroscopy is often done with pain relief or local anaesthetic. Operative procedures are usually done under a short general or spinal anaesthetic.
Which day of the period is hysteroscopy done?
Usually between day 6 and day 12 of the cycle, after bleeding has stopped and before ovulation. Women past menopause can have it on any day.
Is hysteroscopy the same as D&C?
No. A D&C samples the lining blindly, while hysteroscopy lets the doctor see the whole cavity and remove or biopsy exactly the abnormal area. A biopsy is often taken during hysteroscopy for this reason.
Will I bleed after hysteroscopy?
Light bleeding or a pink watery discharge for a few days, occasionally up to two weeks after operative procedures, is normal. Heavy bleeding or a foul smell should be reported.
Can hysteroscopy detect cancer of the uterus?
Yes. It allows the lining to be seen directly and any suspicious area to be biopsied, which is why it is used after postmenopausal bleeding or a thickened lining on scan. Most findings turn out to be benign, such as polyps.