YOUR HYSTEROSCOPY

What to expect and how to prepare.

This leaflet contains important information to help you prepare for your hysteroscopy - please read it carefully.

Patient Information Leaflet

Airedale Hospital Gynaecology Outpatient Department

What is hysteroscopy?

Hysteroscopy is the examination of inside the uterus (womb). ‘Hyster’ refers to the womb and ‘scopy’ means to look at. This is done using a hysteroscope, a narrow fibreoptic telescope, thinner than a pencil. The hysteroscope is passed, very gently, through the vagina and cervix (neck of the womb), and into the womb itself. The hysteroscopist (doctor or specialist nurse) can see if there are any problems inside your womb that may need further investigation or treatment. The procedure usually takes less than 10 minutes.

Sometimes, treatment can be done at the time using miniature surgical tools inserted through the hysteroscope. This means that you would not need to come back for treatment another time. However, this will not always be possible.

Why do I need a hysteroscopy?

There are several reasons why your doctor may want to see inside yourwomb. Common conditions that may require hysteroscopy include:

  • Heavy periods
  • Bleeding in between periods
  • Irregular bleeding whilst taking hormonal treatment
  • Any bleeding after the menopause (‘The Change’)
  • If an ultrasound scan suggests the possibility of a polyp in the womb cavity
  • Difficulty becoming pregnant
  • Problems after a miscarriage or recurrent miscarriage
  • Lost contraceptive or hormonal coil.

Hysteroscopy allows us to examine the lining of the womb (endometrium). We can check and see whether it looks healthy or if there are any swellings (polyp/fibroids) or extra tissue present.

Endometrial polyps are swellings of the lining of the womb. If we find polyps, we may ask you if you would like us to remove them during your procedure. Otherwise, you may need another hysteroscopy, or you can ask for this to be done under general/spinal anaesthetic. Polyps are removed by passing a small device down the hysteroscope that nibbles away the extra tissue.

Fibroids are firm muscle-swellings that may stick out from the wall of the womb. They can make periods heavier or interfere with pregnancy by causing a miscarriage. Small fibroids can be removed just like polyps, and we may ask if you would like us to remove them during your procedure. Large fibroids take longer to remove so it is better if you areunder general/spinal anaesthetic.

Where will I have the hysteroscopy done?

Hysteroscopy is usually done in the outpatient clinic while you are awake. However, if you prefer you are able to have it done as a day patient with a general anaesthetic (when you are asleep), or a spinal anaesthetic, or possibly by controlled intravenous sedation (an injection to make you sleepy). If you do not want an outpatient procedure this will be discussed with you when you attend your appointment.

Will it hurt?

For 9 out of 10 women hysteroscopy in the outpatient clinic is quick and safe and carried out without any, or with little pain or discomfort. However, everyone is different and women’s experiences vary widely. Many women find it is helpful to take painkillers, such as paracetamol and ibuprofen, at least one hour before their appointment to reduce any crampy pains after the procedure.

About 1 in 10 women experience more severe pain. If you find the procedure too painful please tell us and we will stop immediately. You may prefer to have this procedure under a general or spinal anaesthetic. The following list may help you decide in advance whether you do not want an outpatient hysteroscopy:

  • have found a previous hysteroscopy very painful
  • find cervical smears very difficult or painful
  • faint due to period pain
  • have had severe pain during a previous vaginal examination
  • do not wish to have such an examination when awake.

We often need to place a speculum in your vagina to see the cervix (neck of your womb);thispart is similar to a smear test. To reduce any pain or discomfort we can place numbing gel into the vagina beforehand. We are also able to inject local anaesthetic into your cervix if itis sensitive.

Our clinic offers nitrous oxide gas (Entonox, ‘Gas and Air’) that may make the procedure easier for you as it reduces anxiety and is also a painkiller. The gas works for only a short time and you remain fully conscious, but you may feel a little ‘groggy’ for a few minutes.

What complications can happen?

Hysteroscopy is a safe, routine procedure, but there are some risks. These are generally lower for an outpatient than an inpatient hysteroscopy. Complications can include the following:

  1. Severe pain, feeling or being sick or fainting can affect up to 1 in 10 women. However, these feelings usually go away quickly.
  2. Heavy vaginal bleeding is uncommon but can affect up to 1 in 400 women.
  3. Infection is uncommon but can affect up to 1 in 400 women. It may appear as a smelly discharge, a high temperature or severe abdominal pain. See below for what to do if this happens.
  4. Perforation of the uterus. Very rarely, a small hole is made in the wall of the womb. This could damage nearby tissue. This happens in less than 1 in 1000 procedures, but is slightly more common if someone has a polyp or fibroid removed. It is apparent at the time and may mean that you have to stay in hospital overnight and have antibiotics. Usually, nothing more needs to be done, but rarely you may need a further operation to repair the hole.

Are there any alternatives?

The alternatives are an ultrasound scan but it may not give us all the information we need. This procedure is also done under general/spinal anaesthetic but there are extra risks associated with this.

What to expect on the day?

You will be seen by the hysteroscopist who will take a short history about your symptoms, including the dates of any recent vaginal bleeding.They will also explain the procedure and this is an opportunity to ask any questions.

You will be asked to undress from the waist down. A nurse will stay with you throughout the procedure to support you. You will be asked to get into position on the examination couch with your legs resting on supports. The nurse can help you with this.

The hysteroscopist will then place a speculum in the vagina and pass the hysteroscope through the neck of the womb into the cavity.The front and back walls of the womb lie flat against each other and so saline (a safe fluid of salt water) is used to separate the walls so that the inside of the womb can be seen. You will feel wet as the fluid trickles out of the vagina.

You can watch the procedure on the screen if you wish and the operator can explain the findings.

It is often necessary to take a small sample of the lining of the womb (a biopsy). This will either be done through the hysteroscope or after inserting the speculum and passing a thin sampler through the cervix. The sample may help explain why you are experiencing problems. Unfortunately, this can be uncomfortable, like severe period cramps, but should not last long.If it is too uncomfortable please tell us and we will stop immediately.

For around 1 in 10 women it is not possible to complete the outpatient hysteroscopy. This might be because it isn’t possible to open your cervix, or you find the procedure too painful, or it makes you feel sick or faint. In this case wewill arrange for you to have another hysteroscopy as soon as possible under general or spinal anaesthetic. We will discuss the options with you.

Please eat normally on the day of your appointment (so that you are less likely to feel faint). As you may feel dizzy or shaky after the procedure, please arrange to have the day free to rest at home if necessary.

What happens after hysteroscopy?

Following the procedure you will have another chance to speak to the hysteroscopist and discuss findings as well as follow up.

You can rest in the outpatient clinic’s recovery area for as long as you need (usually about 20 minutes). It is a good idea to bring someone to drive or take you home. If you have driven yourself and had Entonox (‘gas and air’), you will need to be prepared to stay for a little longer.

We can offer further pain relief depending on what you have taken prior to your procedure.

How long does it take?

The visit may take up to an hour. This includes time spent talking to the person who will do the procedure, having it done and resting afterwards. The actual hysteroscopy should take no longer than 10 minutes. If we find polyps or small fibroids you may decide to have them removed at the same appointment, this takes about another 10 to 20 minutes.

When will I know the results?

Your hysteroscopist will tell you at the time what was found during the procedure. If you need any treatment they will also discuss this with you. If we have taken a biopsy or removed a polyp it will be sent for examination. We will write to you with the result as soon as possible, but please note that this may take up to three weeks.

What to expect in the days following hysteroscopy and other advice.

You may experience period-like pain, which can last for one or two days. If you need more pain relief you may have paracetamol, co-codamol, codeine or ibuprofen depending upon what you have already taken and when.

It is not unusual to have some watery bleeding afterwards. This is a small amount of blood mixed in with the water used for the procedure. It usually settles in one to two days. You may shower or bath as usual.

Most women are able to return to their normal activities, including working the next day. If your recovery takes longer see below for what to do next.

To minimise the risk of infection you will be asked to avoid intercourse, refrain from swimming and not to use tampons for a week.

What do I do if I have problems afterwards at home?

Please contact us if it is within 48 hours of your procedure. Otherwise, contact your GP and ask for an urgent appointment, explaining that you have just had a hysteroscopy. If you are not able to get an urgent appointment, go to your nearest accident and emergency (A&E) department instead.

What symptoms would require me to seek help?

  • You have pain in your tummy that is not settling with simple pain killers.
  • You have heavy bleeding with clots (unless a normal period).
  • You have a smelly discharge
  • You are feeling feverish and/or unwell.
  • You have a coil fitted and cannot feel the threads.

Do I still need to attend if I’m having a period?

We will try to arrange your appointment for when you are not having a period, as it is difficult to do the test if you are bleeding heavily. If this occurs on the day of the appointment please call and speak to a nurse. We will want you to attend if you have experienced any bleeding after the menopause, or if you have some bleeding most days, even if you are bleeding at the time.

Do I need to use contraception?

We will not do the test if you might be pregnant. A urinary pregnancy test may be done when you attend. If you are under 55 years of age please do not have sexual intercourse without using contraception from the first day of your last period to the time of your appointment.

If you have suggestions, concerns or complaints

While you arewith us we will do our best to look after you and keep you safe and as comfortable as possible. However, we know that sometimes things do not always go according to plan. If this is the case we will discuss with you what could or needs to be done instead.

If you would like to discuss a concern or complaint you can ask to speak to the clinic manager who may be able to help straight away or contact our Patient Advice and Liaison Service(PALS) Team – Tel: 01535294019Wetake your concerns seriously and will reply to you directly. We also welcome feedback both good and bad so we can continue to improve our services.

Who to contact if you have any questions

If you need any further information, please do not hesitate to contact.

  • Gynaecology Specialist Nurse: 01535 295097 or 01535 652511
  • Gynaecology Assessment and Treatment Unit: 01535 295095

Please bring the following with you to your appointment:

  • A list of any medications that you are taking
  • The date of your last menstrual period, or when you went through the menopause.
  • A friend or family member who can stay with you during the procedure (if that would be helpful) and who can take you home afterwards.

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