Diagnostic hysteroscopy

A guide to understanding the procedure and its indications

Diagnostic hysteroscopy allows direct examination of the inside of the uterus when symptoms, medical history or the results of other investigations indicate that a more detailed assessment of the uterine cavity and endometrium is needed. One of its main advantages is that, in addition to visualising possible abnormalities, it allows targeted tissue samples to be taken from areas requiring further investigation.

When might diagnostic hysteroscopy be recommended?

The procedure may be indicated for abnormal uterine bleeding, very heavy periods, bleeding between periods or bleeding after menopause. It may also be recommended when an ultrasound scan shows endometrial thickening, a polyp, a fibroid or another possible abnormality within the uterus.

Hysteroscopy may also form part of investigations into certain fertility problems or recurrent miscarriage and can be used to locate an intrauterine device when its threads are not visible.

The indication is always established individually, taking into account the patient’s symptoms, medical history and information obtained from other investigations.

Ultrasound and hysteroscopy: what does each examination offer?

Gynaecological ultrasound allows assessment of the uterus, endometrium and ovaries and is one of the main tools used during the initial evaluation. However, in certain circumstances, direct visualisation of the uterine cavity may be necessary to characterise a finding more accurately.

Hysteroscopy provides a magnified view of the endometrial surface and the shape of the uterine cavity. It can therefore help confirm or further characterise abnormalities previously identified by ultrasound, including polyps, fibroids protruding into the uterine cavity, adhesions and certain malformations.

The two investigations are complementary, and their use depends on the condition being assessed.

Why might a targeted biopsy be useful?

When an area requiring further investigation is identified during the examination, small instruments can be passed through the hysteroscope to obtain a tissue sample.

Direct visualisation allows the biopsy to be taken from the specific area requiring investigation. The sample is then sent to the laboratory for analysis, and the results are interpreted alongside the hysteroscopy findings and the patient’s other clinical information.

Not every hysteroscopy requires a biopsy. The decision depends on the reason for the examination and the findings observed during the procedure.

What happens if a polyp or another abnormality is found?

Diagnostic hysteroscopy can identify polyps, certain fibroids, adhesions and other abnormalities within the uterine cavity.

In some cases, minor procedures can be performed during the same examination, such as removing certain small lesions or an intrauterine device. Whether this is possible depends on the type and size of the abnormality, the patient’s individual circumstances and the conditions under which the examination is being performed.

When the lesion requires a more complex intervention, treatment is planned through a separate operative hysteroscopy.

Learn more about operative hysteroscopy

Preparation and management of discomfort

Before hysteroscopy, the medical team explains what the examination involves and the options available to manage any discomfort. Many diagnostic hysteroscopies can be performed in an outpatient setting, but the experience can vary considerably from one patient to another.

Depending on the patient’s individual characteristics, medical history, the reason for the examination and any planned procedures, hysteroscopy may be performed without anaesthesia, under local anaesthesia, with sedation or in an operating theatre. The most appropriate option should be selected individually and agreed with the patient beforehand.

For women who are still menstruating, the timing of the examination may be planned around the menstrual cycle to facilitate clear visualisation of the uterine cavity. The possibility of pregnancy must also be ruled out before performing the procedure.

After diagnostic hysteroscopy

Following the examination, patients may experience period-like cramps and light vaginal bleeding. In most cases, when the procedure is performed on an outpatient basis without sedation, patients can return home shortly afterwards and gradually resume their normal activities.

The severity and duration of discomfort may vary depending on each patient’s sensitivity and whether a biopsy or another minor procedure was performed during the examination.

The medical team provides the necessary aftercare instructions and explains which symptoms require medical attention, particularly severe or persistent pain, significant bleeding, fever or other signs that do not correspond to the expected recovery.

Further information

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