Hysteroscopy (Diagnostic and Operative)

The uterine cavity is a small, flat space lined by the endometrium, and problems inside it, polyps, fibroids that push into the cavity, a dividing wall known as a septum, or bands of scar tissue, can cause heavy or irregular bleeding and interfere with pregnancy. Ultrasound often suggests that something is there, but hysteroscopy is the reference method for seeing the cavity directly. A slender scope, only a few millimetres wide, is guided through the cervix while sterile fluid opens the space in front of the camera. In its diagnostic form the procedure is purely a look, sometimes with a small biopsy of the lining. In its operative form, miniature instruments or an electrosurgical loop work through the same scope to remove or correct what is found. Nothing is cut from the outside: the abdomen is untouched, which is what separates hysteroscopy from laparoscopy, its keyhole counterpart for the outside of the uterus, the ovaries and the tubes.

Hysteroscopy is recommended when there is good reason to look inside the cavity or to treat something already seen there. Common triggers are abnormal uterine bleeding, heavy periods or bleeding after menopause, an ultrasound finding such as an endometrial polyp or a submucosal fibroid, a suspected uterine septum found during the evaluation of miscarriage, and adhesions after previous procedures. In fertility care it has a central place: before IVF, or after failed transfers described as recurrent implantation failure, the team may recommend hysteroscopy to confirm that the cavity is normal and to correct anything that could stop an embryo from implanting. Small polyps or a septum are treated in the same session, so diagnosis and treatment often merge into one short procedure. The gynaecologist weighs the findings, symptoms and reproductive plans before advising it, and a purely normal scan with no symptoms usually does not need one.

The procedure is done in the operating room with the patient positioned as for a routine gynaecological examination, under sedation or a short general anaesthetic; simple diagnostic checks are sometimes possible with little or no anaesthesia. The surgeon gently dilates the cervix if needed and introduces the hysteroscope, and warm sterile fluid expands the cavity so the whole lining, the openings of the tubes and any abnormality can be inspected on the screen. In operative hysteroscopy, fine scissors, graspers or a resection loop pass through a channel in the scope: polyps are detached at the base, submucosal fibroids are shaved down in slices, a septum is divided until the cavity has a normal shape, and adhesions are released under direct vision. A diagnostic check may take only about fifteen minutes, while operative work commonly takes up to an hour. There are no stitches and no dressing, and most patients are ready to go home a few hours later the same day.

Hysteroscopy suits most women who need the inside of the uterus examined or treated, and because it is so light, age and many medical conditions are rarely obstacles. It is postponed during pregnancy and active pelvic infection, and heavy bleeding on the day can occasionally make the view too poor, so scheduling usually aims at the first half of the menstrual cycle, when the lining is thin and pregnancy can be excluded. Preparation is simple: a recent ultrasound, routine blood tests, a pregnancy test where relevant, and a review of medicines, with blood thinners adjusted on medical advice. For international patients the work-up can begin from home, with recent scans and reports reviewed remotely so the team can confirm that hysteroscopy is the right procedure and whether operative treatment is likely to be needed in the same session. That way the visit can be planned tightly, often around two to three days in the treatment city.

Recovery after hysteroscopy is among the quickest in gynaecological surgery. Mild cramping, similar to period pain, and light spotting are common for a day or two and usually settle with simple pain relief. Most people are walking and eating normally within hours, back to desk work within a day or two, and back to full activity within a few days. Flying home is often possible within one to two days, once the team confirms a settled recovery, which makes hysteroscopy one of the easiest procedures to combine with a short trip abroad. Tampons, swimming and intercourse are usually paused briefly, commonly for about a week or until spotting stops, on the team's advice. Results of any biopsy are sent afterwards and can be discussed by video from home, and when hysteroscopy is part of an IVF work-up the findings flow directly into the fertility plan, with the next steps timed together with the treating team.

Hysteroscopy is considered a very safe procedure, and serious complications are uncommon. Possible issues include cramping and spotting, infection, a small risk of making a false passage or perforating the uterine wall with the instrument, which usually heals on its own but occasionally needs observation or a laparoscopy, and rare fluid-balance problems during longer operative cases, which experienced teams monitor closely. After division of a septum or removal of adhesions, scar tissue can occasionally re-form, and a follow-up check is sometimes advised. Set against these risks, the gains are concrete: polyps and submucosal fibroids are removed with immediate relief of bleeding in most cases, the cavity can be restored to a normal shape, and studies suggest that correcting such findings can improve the chance of implantation in fertility treatment, although no procedure can guarantee a pregnancy. Results are best in centres where hysteroscopic surgery is performed regularly.