Gynaecology - Outpatient Hysteroscopy

What is an outpatient hysteroscopy?

A hysteroscopy is a procedure carried out in the outpatient clinic to look and examine the inside of the uterus (womb) with a thin telescope whilst you are awake.

When is a hysteroscopy recommended?

Hysteroscopy is recommended for finding out the cause of abnormal bleeding from the womb in the following conditions:

• Heavy periods
• Irregular periods
• Bleeding after menopause, referred to as post - menopausal bleeding (PMB)
• To investigate something seen inside the uterus (womb) on an ultrasound scan, such as an endometrial polyp or fibroid

On occasions it can also be used to check the endometrial cavity in women with recurrent miscarriages and/or subfertility. The purpose is to find the cause of your problem and plan treatment as required.

Can I still have an outpatient hysteroscopy if I’m bleeding from my vagina?

It is best to keep the appointment although sometimes it can be difficult to do the procedure if there is too much bleeding.

What are the benefits of hysteroscopy?

A hysteroscopy will help to find if you have one of the following conditions:

• Polyps - a polyp is an overgrowth of the lining of your womb (endometrium) that looks like a small grape on a stalk, sometimes this can be removed in the out-patient clinic
• Fibroids - overgrown muscle of the womb
• Tissue diagnosis - a small biopsy from the lining of the womb is taken and sent to the laboratory for analysis for diagnosis of diseases related to the endometrium
• Endometrial cancer (a malignant growth) - a sample of tissue of the womb lining is taken and sent to the laboratory for analysis
• Shape of the womb - abnormally shaped womb which is sometimes associated with recurrent miscarriage or fertility problems. This is also useful to decide if you are suitable for endometrial ablation
• Intrauterine device - identification and retrieval of (lost) intrauterine contraceptive devices (coils)

What are the risks?

• Pain - most women are able to tolerate this procedure, we can offer local anaesthetic and Entonox
• Infection is uncommon
• Sometimes if the cervix is tightly closed, or if you find the procedure too uncomfortable, we may not be able to do the procedure
• The risk of uterine perforation (making a hole in the womb) is rare
• Damage to the adjoining structures is very rare

Are there alternatives to having Outpatient Hysteroscopy?

There may be other things to consider when deciding whether Outpatient Hysteroscopy is the right choice for you, such as:

• If you faint during your periods because of pain
• If you have experienced severe pain during a previous vaginal examination
• If you have experienced difficult or painful cervical smears
• If you have had any previous traumatic experience that might make the procedure difficult for you
• If you do not wish to have this examination when awake
• If you do not think that Outpatient Hysteroscopy is right for you, you can choose to have your hysteroscopy with an anaesthetic (general or regional anaesthetic), or sedation. This will be done in an operating theatre, usually as a daycase procedure
• You may still feel some pain after the procedure even when it is done with an anaesthetic, and the risks and complications are slightly higher than the outpatient procedure
• You can choose not to have a hysteroscopy at all, though this may make it more difficult for your healthcare professional to find the cause of your symptoms and to offer the right treatment for you. They may then recommend a scan and a biopsy to find out more information and/or may ask you to come back if your symptoms continue

Before attending clinic

• You must use contraception or avoid sex between your last period and your appointment
• If you have any abnormal discharge, please inform the doctors or nurses before having your hysteroscopy
• You should eat and drink normally
• You may feel pain or discomfort during the procedure, it is recommended that you take your usual painkillers for period pain 1 to 2 hours before your appointment
• Depending on your clinical history and scan result, a hysteroscopy may be carried out, therefore we advise that you take painkillers 1 to 2 hours prior to attending your appointment
• Bring a list of any medications that you are taking with you
• You may wish to bring a friend or family member with you

On arrival

You will be welcomed by a member of the staff in the outpatient department. Please take this opportunity to ask questions. The procedure must not be performed if there is any chance that you are pregnant.

A PREGNANCY TEST WILL BE PERFORMED IF YOU ARE AGED 17-50.

You may be required to change into a gown. You will then be taken to the treatment room.

The doctor or a specialist nurse will go through your history briefly and obtain your consent, which means that they will make sure that you completely understand the procedure and are happy for them to proceed.

Procedure

In the treatment room you will lie on a couch. You will be awake throughout the procedure. A member of staff will remain beside you to make sure you are comfortable. If at any time during the procedure you change your mind the procedure can be stopped at any time.

A small telescope (hysteroscope) is passed through the cervix (the neck of the womb) into the womb. During the procedure (hysteroscopy), fluid is passed through the cervix to allow the lining of the womb to be seen easily. If the clinicians have any difficulty, you may be offered a local anaesthetic (medication to numb the cervix) to enable the doctor or nurse to dilate (stretch) the cervix. The inside of the womb is examined and pictures taken to spot any abnormalities and for record keeping. If required, a sample of tissue will be taken and sent to pathology for examination. This can be done through the hysteroscope or by passing a plastic tube through the cervix (Pipelle Biopsy). The whole procedure takes approximately 15 to 20 minutes to complete.

If the doctor or nurse has been unable to carry out the procedure, they will discuss alternatives such as having the procedure done in theatre under a general anaesthetic (you will be asleep).

After the procedure

You will spend a short time in the recovery area, where tea and coffee will be offered. Once staff are reassured that you are comfortable you will be allowed to go home.

What to expect whilst recovering at home

You may experience:

• Abdominal cramping similar to period pain and may require regular painkillers. This pain should pass within a few hours and each day you should feel better than previous day
• Bleeding or spotting can last for up to a week. You may need to wear a sanitary pad, but DO NOT USE TAMPONS as it increases the risk of infection

When to return to normal activities

Most women feel able to go back to their normal activities the same day. You can return to work as soon as you feel able. You can shower as normal. Physical activity can be resumed when bleeding and discomfort has settled.

To reduce the risk of infection we advise you to refrain from:

• Sexual intercourse until your bleeding has stopped (4 to 5 days)
• Using tampons
• Swimming until your bleeding has stopped

When to seek medical advice

You must seek immediate medical advice if you have any of the following:

• Severe pain that isn’t relieved by regular painkillers
• More than usual heavy bleeding - frequently changing sanitary pads
• Passing large blood clots
• Offensive smelling vaginal discharge
• Feeling hot and shivery

Contact Numbers:

The Royal Oldham Hospital:
Gynaecology Endoscopy Suite - 0161 627 8076
Gynaecology Assessment Unit - 0161 627 8855

Fairfield General Hospital:
Gynaecology Outpatients - 0161 778 3862

Rochdale Infirmary:
Gynaecology Outpatients - 01706 906129/517100

Salford Royal Hospital:
Gynaecology outpatients - 0161 206 5224
Early Pregnancy Unit - 0161 206 1480
​​​​​​​Located in the Brook Building

Getting your results

If a biopsy is taken, the result will be sent to you and your GP.

Follow-up

In most cases a follow-up is not required. You will be advised by letter if a follow-up appointment is required.