The direct visual examination of the interior of the uterus is a medical procedure known as hysteroscopy. This minimally invasive technique allows a gynecologist to visualize the uterine cavity, including the lining (endometrium) and the cervical canal, using a specialized instrument. Because it utilizes natural body openings, it avoids the need for external surgical incisions. By providing a clear, magnified view of the uterine interior, the procedure serves as a powerful tool for both diagnosing and treating structural abnormalities.
Defining the Hysteroscopy Process
The core instrument is the hysteroscope, a thin, lighted telescope with an attached camera. This device is inserted through the vagina and passed through the cervix into the uterine cavity. Hysteroscopes are available in various sizes, rigid or flexible, with smaller models often used in an office setting for diagnostic purposes.
For a clear view of the uterine walls, the cavity must be expanded, as the uterus is normally a collapsed, potential space. This expansion is achieved by pumping a distending medium into the uterus through the hysteroscope’s sheath. The most common fluid medium is sterile saline, an electrolyte-containing solution.
The choice of distending medium depends on whether an operative step is planned. For procedures using monopolar electrosurgical devices, non-electrolytic fluids like glycine must be used because electrolytic solutions conduct electricity and risk injury to surrounding tissues. The surgeon monitors the volume of fluid inflow and outflow, calculating the fluid deficit to prevent complications from excessive fluid absorption.
Clinical Indications for Examination
Hysteroscopy is performed to investigate and manage abnormal uterine bleeding (AUB), which includes heavy periods, bleeding between cycles, or any bleeding occurring after menopause. It is used for evaluating intrauterine pathology because it allows for direct visualization and targeted biopsy, offering a more precise diagnosis than imaging alone. The procedure confirms structural causes for bleeding, such as benign growths like endometrial polyps or submucosal fibroids.
Beyond addressing bleeding issues, hysteroscopy plays a significant role in reproductive medicine. It is used to evaluate the uterine cavity in cases of recurrent pregnancy loss or infertility. The procedure can identify intrauterine adhesions, called Asherman syndrome, which are bands of scar tissue that can interfere with embryo implantation or pregnancy progression.
Other structural anomalies, such as a uterine septum (a band of tissue dividing the cavity), can also be identified and surgically corrected during the same procedure. The hysteroscope is an effective tool for locating and retrieving a misplaced or embedded intrauterine device (IUD) whose retrieval strings are no longer visible. Operative applications also include endometrial ablation, a technique used to destroy the uterine lining to manage severe bleeding.
Patient Preparation and Procedural Steps
Preparation depends on whether the procedure is diagnostic (office setting) or operative (requiring an operating room). For menstruating women, the procedure is scheduled during the first half of the cycle, after bleeding has stopped, to ensure the uterine lining is thin for optimal visualization. Patients may take an over-the-counter pain reliever, such as ibuprofen, about an hour before the appointment to minimize cramping.
Anesthesia options range from a local anesthetic injection to numb the cervix for an office procedure, to conscious sedation, or a general anesthetic for longer or more complex operative cases. The patient is positioned with their feet in supports, similar to a standard pelvic exam. Initial steps involve inserting a speculum to visualize the cervix, though some techniques minimize the use of a speculum and tenaculum for improved patient comfort.
The hysteroscope is guided through the cervical canal, and distending fluid is introduced to expand the uterus. The surgeon examines the cavity, identifying the openings to the fallopian tubes, the fundus (top of the uterus), and the endometrial surface. If a structural abnormality is found, specialized instruments—such as graspers, scissors, or electrosurgical tools—can be passed through the working channel to remove polyps, fibroids, or scar tissue. Diagnosis and treatment are often completed in a single session, typically taking 5 to 45 minutes.
Recovery and Follow-Up Care
Recovery after hysteroscopy is quick, with most patients returning to their normal routine within one to two days. Mild to moderate cramping, similar to menstrual discomfort, is common and managed with over-the-counter pain medication. Light vaginal bleeding or watery discharge is expected and may persist for up to two weeks, depending on the extent of the procedure.
Patients should avoid placing anything into the vagina, including tampons and sexual intercourse, for seven to fourteen days to prevent infection while the cervix closes. Strenuous exercise or heavy lifting should also be avoided for about a week following an operative procedure. Patients must contact their physician if they experience a fever, heavy bleeding that soaks a pad every hour, or severe, unrelieved abdominal pain. Tissue sample results are communicated during a follow-up appointment.