Hysteroscopy

Our Hysteroscopy Services provide minimally invasive diagnosis and treatment of conditions affecting the inside of the uterus. Using a thin camera inserted through the cervix, we can directly visualise and treat abnormalities without the need for abdominal incisions.

What Is Hysteroscopy?

Hysteroscopy is a procedure that allows your doctor to look inside your uterus using a hysteroscope — a thin, lighted telescope-like instrument. The hysteroscope is passed through the vagina and cervix into the uterus, providing a clear view of the uterine cavity on a monitor.

Types of Hysteroscopy

Benefits of Hysteroscopy

• No incisions — Performed through the natural opening of the cervix
• Direct visualisation — Clear view of the uterine cavity
• Accurate diagnosis — Can see abnormalities that scans may miss
• Same-time treatment — Many conditions can be treated during the same procedure
• Quick recovery — Most women return to normal activities within 1-2 days
• Outpatient procedure — Often performed as a day case

Diagnostic Hysteroscopy

What Is It?

Diagnostic hysteroscopy is performed to investigate symptoms or abnormal findings on ultrasound. It allows direct visualisation of the uterine cavity to identify the cause of problems.

When Is It Recommended?

Abnormal bleeding:

• Heavy menstrual bleeding
• Bleeding between periods
• Postmenopausal bleeding
• Irregular periods

Fertility investigations:

• Recurrent miscarriage
• Unexplained infertility
• Before IVF treatment
• Assessment of uterine cavity

Abnormal scan findings:

• Suspected polyps
• Suspected fibroids
• Thickened endometrium
• Uterine abnormalities

Other indications:

• Lost intrauterine device (IUD)
• Follow-up after treatment
• Investigation of abnormal cells on smear

The Procedure

Outpatient (office) hysteroscopy:

1. Preparation — You may be advised to take pain relief before the procedure
2. Positioning — You lie on an examination couch with legs supported
3. Speculum — Inserted to visualise the cervix
4. Hysteroscope insertion — The thin camera is gently passed through the cervix
5. Uterine distension — Fluid or gas is used to expand the uterus for better visualisation
6. Examination — The uterine cavity is carefully examined
7. Biopsy — Samples may be taken if needed
8. Completion — The hysteroscope is removed; procedure takes 5-15 minutes

What you may feel:

• Mild cramping similar to period pain
• Pressure sensation
• Brief discomfort as the hysteroscope passes through the cervix

After the procedure:

• You can usually go home immediately
• Mild cramping may continue for a few hours
• Light spotting for a few days is normal
• Results discussed immediately or at follow-up

Operative Hysteroscopy

What Is It?

Operative hysteroscopy uses the hysteroscope along with specialised instruments to treat conditions found within the uterus. It combines diagnosis and treatment in one procedure.

Conditions Treated

Endometrial polyps:

• Benign growths from the uterine lining
• Common cause of abnormal bleeding
• Can affect fertility
• Removed using hysteroscopic polypectomy

Submucosal fibroids:

• Fibroids that protrude into the uterine cavity
• Cause heavy bleeding and fertility problems
• Removed using hysteroscopic myomectomy
• Preserves the uterus

Uterine adhesions (Asherman’s syndrome):

• Scar tissue inside the uterus
• Can cause absent or light periods
• May cause infertility or recurrent miscarriage
• Divided using hysteroscopic adhesiolysis

Uterine septum:

• A wall of tissue dividing the uterus
• Congenital abnormality
• Associated with miscarriage and preterm birth
• Corrected using hysteroscopic septoplasty

Endometrial ablation:

• Destruction of the uterine lining
• Treatment for heavy menstrual bleeding
• Alternative to hysterectomy
• Not suitable if future pregnancy desired

Retained products of conception:

• Tissue remaining after miscarriage or delivery
• Causes bleeding and infection risk
• Removed under direct vision

Lost IUD removal:

• When IUD strings are not visible
• Safe removal under direct visualisation

Procedures Explained

Hysteroscopic Polypectomy

What is it? Removal of endometrial polyps using instruments passed through the hysteroscope.

Techniques:

• Mechanical removal (grasping forceps, scissors)
• Electrosurgical resection
• Morcellation (for larger polyps)

Benefits:

• Relieves abnormal bleeding
• Improves fertility outcomes
• Provides tissue for analysis
• Preserves the uterus

Recovery:

• Usually day-case procedure
• Light bleeding for a few days
• Return to normal activities: 1-2 days

Hysteroscopic Myomectomy

What is it? Removal of submucosal fibroids (fibroids protruding into the uterine cavity) using the hysteroscope.

Suitable for:

• Type 0 fibroids (entirely within the cavity)
• Type 1 fibroids (>50% within the cavity)
• Type 2 fibroids (<50% within the cavity) — may require staged procedure

Techniques:

• Resectoscope with electrosurgical loop
• Hysteroscopic morcellation
• May require more than one procedure for large fibroids

Benefits:

• No abdominal incisions
• Preserves the uterus
• Improves heavy bleeding
• Improves fertility outcomes
• Shorter recovery than abdominal surgery

Recovery:

• Hospital stay: Day-case or overnight
• Return to work: 2-5 days
• Avoid intercourse: 2 weeks
• Full recovery: 1-2 weeks

Hysteroscopic Adhesiolysis

What is it? Division of intrauterine adhesions (scar tissue) to restore the normal uterine cavity.

Causes of adhesions:

• Previous uterine surgery (D&C, myomectomy, caesarean)
• Infection
• Radiation therapy

Symptoms:

• Absent or very light periods
• Infertility
• Recurrent miscarriage
• Pelvic pain

Procedure:

• Adhesions are carefully divided using scissors or electrosurgery
• Cavity is restored to normal shape
• Oestrogen therapy may be given after to promote healing
• Balloon or IUD may be placed temporarily to prevent re-adhesion
• Follow-up hysteroscopy may be needed

Success rates:

• Menstruation restored in most cases
• Pregnancy rates improve significantly
• Severe adhesions may require multiple procedures

Hysteroscopic Septoplasty

What is it? Removal of a uterine septum — a congenital wall of tissue that divides the uterine cavity.

Why treat it?

• Septum is associated with:
  • Recurrent miscarriage (up to 60% risk)
  • Preterm birth
  • Abnormal fetal presentation
  • Infertility

Procedure:

• Septum is divided using scissors or electrosurgery
• Procedure is guided by ultrasound or laparoscopy
• Creates a single unified uterine cavity

Outcomes:

• Miscarriage rate significantly reduced
• Improved pregnancy outcomes
• Better fetal positioning

Recovery:

• Day-case procedure
• Light bleeding for a few days
• Can try to conceive after 1-2 months

Endometrial Ablation

What is it? Destruction of the uterine lining (endometrium) to reduce or stop menstrual bleeding.

Who is it suitable for?

• Women with heavy menstrual bleeding
• Women who have completed their family
• Women who want to avoid hysterectomy
• Not suitable if future pregnancy is desired

Techniques:

• Thermal balloon ablation
• Radiofrequency ablation (NovaSure)
• Microwave ablation
• Resectoscopic ablation

Expected outcomes:

• 90% of women have reduced bleeding
• 40-50% have no periods after treatment
• Some women may still need hysterectomy later

Important considerations:

• Contraception still required (pregnancy dangerous after ablation)
• Permanent procedure — cannot be reversed
• May make future investigation of uterus difficult

Recovery:

• Day-case procedure
• Cramping and watery discharge for 2-4 weeks
• Return to normal activities: 1-3 days

Before Your Hysteroscopy

Preparation

Timing:

• Diagnostic: Best performed in first half of cycle (after period, before ovulation)
• Operative: May be scheduled based on procedure type

Pre-procedure instructions:

• Eat normally (unless general anaesthetic planned)
• Take recommended pain relief 1 hour before
• Bring someone to accompany you home (if sedation used)
• Empty bladder before procedure

What to bring:

• Sanitary pads (not tampons)
• Comfortable clothing
• List of medications
• Insurance/ID documents

Anaesthesia Options

After Your Hysteroscopy

Immediately After

• Rest in recovery area until ready to leave
• Light refreshments offered
• Post-procedure instructions provided
• Results discussed (or at follow-up)

At Home

Normal experiences:

• Mild cramping (like period pain) for 1-2 days
• Light vaginal bleeding or spotting for up to 2 weeks
• Watery or blood-tinged discharge
• Feeling tired

What to avoid:

• Tampons — use pads only for 2 weeks
• Sexual intercourse — wait 1-2 weeks (or as advised)
• Swimming/baths — showers only for 1 week
• Heavy lifting — for 1-2 weeks after operative procedures

When to contact us:

• Heavy bleeding (soaking more than 1 pad per hour)
• Fever (temperature >38°C)
• Severe abdominal pain not relieved by painkillers
• Foul-smelling discharge
• Unable to pass urine

Recovery Timeline

Risks and Complications

Hysteroscopy is generally very safe, but like any procedure, carries some risks:

Common (temporary):

• Cramping
• Light bleeding
• Feeling faint during procedure

Uncommon:

• Infection (treated with antibiotics)
• Failure to complete procedure
• Need for repeat procedure

Rare:

• Uterine perforation (small hole in uterus) — usually heals on its own
• Heavy bleeding requiring treatment
• Damage to cervix
• Fluid overload (with operative procedures)

Risk factors for complications:

• Previous cervical surgery
• Postmenopausal status (narrower cervix)
• Large fibroids or complex anatomy
• Longer operative procedures

Overall complication rate is less than 1% for diagnostic hysteroscopy and around 2% for operative procedures.

Hysteroscopy and Fertility

Hysteroscopy plays an important role in fertility treatment:

Before IVF

• Identifies and treats polyps, fibroids, adhesions
• Corrects uterine abnormalities
• May improve implantation rates
• Often recommended after failed IVF cycles

Recurrent Miscarriage

• Diagnoses uterine abnormalities
• Treats septum, adhesions, polyps
• Improves chances of successful pregnancy

Unexplained Infertility

• Evaluates uterine cavity when other tests normal
• May find subtle abnormalities missed on ultrasound
• “Scratch” procedure may improve implantation (endometrial scratching)

Frequently Asked Questions

Is hysteroscopy painful? Most women experience mild discomfort similar to period cramps. Outpatient procedures are well-tolerated with simple pain relief. More complex procedures are done under sedation or general anaesthesia.

How long does hysteroscopy take? Diagnostic hysteroscopy takes 5-15 minutes. Operative procedures take 15-60 minutes depending on complexity.

Can I drive home after hysteroscopy? If you have no anaesthesia or only local anaesthesia, you can usually drive. If you have sedation or general anaesthesia, you will need someone to take you home.

When can I try to conceive after hysteroscopy? For diagnostic procedures, you can try immediately. After operative procedures, we usually recommend waiting 1-2 months to allow healing.

Will hysteroscopy affect my fertility? Hysteroscopy is designed to improve fertility by treating conditions that may be preventing pregnancy. When performed correctly, it does not damage fertility.

Is hysteroscopy better than D&C? Yes, in most cases. Hysteroscopy allows direct visualisation and targeted treatment, whereas D&C is a blind procedure. Hysteroscopy has lower complication rates and better outcomes.

Book a Consultation

If you’ve been advised to have a hysteroscopy or would like to discuss whether it might help your symptoms, our team is here to help. Contact us at info@salamivf.com or call +973 1725 5095 to schedule an appointment.