Hysteroscopy
Hysteroscopy is one of the most reliable methods for the direct assessment of the uterine cavity. It enables both diagnosis and therapeutic management of pathological findings without an incision.
It is an essential diagnostic and therapeutic tool in gynecology, as it is used both to investigate abnormal bleeding and to assess infertility or recurrent miscarriages. In many cases, it allows the problem to be treated immediately during the same procedure.
What is hysteroscopy?
Hysteroscopy is a minimally invasive procedure in which a thin hysteroscope is inserted through the cervix into the uterus, without an incision. The uterine cavity is distended with a special fluid to allow clear visualization of its walls.
The examination may be:
- Diagnostic, when the goal is to evaluate the uterine cavity.
- Operative (surgical), when pathological findings are removed or corrected at the same time.
Hysteroscopy is performed either in the doctor’s office or in an organized day clinic, depending on the type of procedure.
How is hysteroscopy performed?
Hysteroscopy is performed by inserting a thin optical instrument (hysteroscope) through the cervix into the uterus, without requiring an incision. The uterine cavity is distended with a special fluid to achieve clear and complete visualization of the endometrium.
The procedure usually lasts only a few minutes when it is a diagnostic hysteroscopy. In the case of an operative procedure, the duration may be longer, depending on the finding and the complexity of the intervention.
Diagnostic hysteroscopy is often performed in the doctor’s office, without general anesthesia. In operative cases, local anesthesia or, less commonly, general anesthesia may be required in an organized day clinic.
The appropriate approach is determined by the patient’s history and the reason for performing the examination.
When is hysteroscopy performed?
Hysteroscopy is usually scheduled immediately after the end of menstruation and before ovulation, when the endometrium is thin and allows better visualization of the cavity.
It is indicated in cases of:
- infertility or unsuccessful attempts to conceive
- recurrent miscarriages
- abnormal or prolonged bleeding
- suspicious ultrasound findings
- postmenopausal bleeding
Diagnosis of Chronic Endometritis
Assessment of the endometrium for the presence of chronic endometritis and/or collection of a sample for microbiome testing.
As part of fertility investigation, hysteroscopy may precede assisted reproduction cycles when detailed assessment of the uterine cavity is required.
Therapeutic applications
Beyond its diagnostic value, hysteroscopy offers the possibility of immediate treatment of pathological findings in the uterus, with minimal invasiveness and high precision.
Removal of endometrial polyps
Polyps are usually benign formations of the endometrium that may cause cycle irregularities or affect fertility. Their hysteroscopic removal is performed under direct visualization, allowing complete and targeted excision.
Removal of submucosal fibroids
Submucosal fibroids protrude into the uterine cavity and may be associated with increased bleeding or difficulty conceiving. Hysteroscopy allows their removal without an external incision.
Surgical adhesiolysis (Asherman syndrome)
Intrauterine adhesions, which often occur after inflammation or surgical procedures, can disrupt the menstrual cycle or lead to infertility. Hysteroscopic adhesiolysis restores the normal morphology of the cavity.
Improvement of implantation (implantation cuts)
In selected cases of repeated implantation failure, small cuts may be made in the endometrium with the aim of improving its receptivity, according to medical indications.
Removal of a displaced intrauterine device
When the intrauterine device has shifted or its strings are not visible, hysteroscopy allows its safe and controlled removal.
Preparation for hysteroscopy
Preparation for hysteroscopy depends on the type of procedure.
For diagnostic hysteroscopy, which is usually performed in the doctor’s office, no special preparation is required. The examination is scheduled after the end of menstruation, and the doctor provides the necessary instructions.
In the case of operative hysteroscopy, fasting from food and fluids for a few hours before the procedure or preoperative testing may be requested, depending on the medical history.
Recovery after hysteroscopy
Recovery after hysteroscopy is usually quick, especially when it is a diagnostic procedure. Most women return to their daily activities on the same or the following day.
Mild cramping or light spotting may occur for a few days, symptoms that are considered normal and resolve on their own.
After operative hysteroscopy, recovery may take slightly longer, depending on the type of intervention. In case of severe pain, fever, or increased bleeding, immediate contact with the doctor is recommended.
Frequently Asked Questions (FAQ)
Hysteroscopy is considered a safe procedure with a low complication rate. Rarely, infection, increased bleeding, or injury to the uterus may occur. Proper technique and the doctor’s experience significantly reduce these risks.
Mild spotting or light bleeding may occur for a few days after the procedure, especially if an operative procedure has been performed. It usually resolves on its own within 2–5 days.
Mild bloating or cramping low in the abdomen may occur temporarily after the examination. The symptoms are usually mild and subside quickly.
In most cases, intercourse is allowed after a few days, once spotting has stopped and there is no discomfort. The doctor will provide individualized instructions depending on the type of procedure.
The timing depends on the type of intervention. After diagnostic hysteroscopy, an IVF cycle can often be scheduled in the next cycle. After an operative procedure, the doctor will determine the appropriate healing interval before treatment begins.
In most cases, the cycle continues normally. Menstruation appears at the expected time, although a slight change may occur in the first cycle after the procedure.
A slight delay may be observed, especially after an operative procedure. If the delay is significant, contacting the doctor is recommended.
In our clinic, we have observed numerous natural pregnancies after hysteroscopy. Correction of pathological findings (such as polyps or adhesions), tubal flushing, gentle endometrial scratching, and similar interventions may improve the intrauterine environment and therefore the chances of conception.
The cost of hysteroscopy depends on whether it is a diagnostic or operative procedure, as well as on the facility where it is performed. The doctor will determine the appropriate plan and provide detailed information about the cost, depending on the case.
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