In which situations is it used?
- Both investigating and treating abnormal and excessive bleeding from the womb
- Removing a polyp inside the womb or fibroids growing into the cavity of the womb
- Correcting structural abnormalities found in infertility and recurrent pregnancy loss
- Dividing adhesions inside the womb
- Cutting a septum inside the womb
- Removing an intrauterine device (coil) whose threads cannot be seen or have been lost
- Removing pregnancy tissue remaining in the womb after a birth or a miscarriage
For assessment of the inside of the womb for diagnostic purposes, pain management and your rights as a patient, you can see the Diagnostic Curettage page.
How is each procedure done?
Removing a polyp
The current guideline recommends that mechanical tissue-removal systems be preferred to small electrical tips for removing polyps inside the womb (the highest level of evidence). The reason is clear: in a comparative study the mechanical system was found to be less painful, faster and to have a higher success rate.
Removing a fibroid
Fibroids growing into the cavity of the womb are cut out with hysteroscopy when they cause bleeding and infertility. In people with a history of recurrent miscarriage who have a fibroid distorting the cavity of the womb, removing these fibroids is reported as possibly helpful in reducing the risk of pregnancy loss.
Dividing adhesions
Adhesions inside the womb are divided with hysteroscopy. What is critical here is the second step: protective measures must be taken to prevent the adhesion re-forming — such as barrier gels containing hyaluronic acid, absorbable medical membranes or the placing of an intrauterine device.
The reason is this: surgery on the womb is itself a cause of adhesions. For this reason treatment must cover not only dividing the existing adhesion but also preventing a new one from forming.
Cutting the septum
A congenital septum inside the womb is cut with hysteroscopy. Here too the guideline states a preference: mechanical mini-scissors that use no electricity are preferred to electrical tips — because they are significantly less painful and the procedure times are similar.
In people who have experienced recurrent pregnancy loss, surgical correction of the septum is reported to reduce the rates of pregnancy loss markedly.
Are antibiotics needed?
No — routine preventive antibiotics are not recommended. This is something people often ask about. In a large randomised study, no significant difference was found in the infection rate between those given antibiotics before the procedure and those not given them (1.0% versus 1.3%).
There are exceptions to this:
- If there is suspicion of an active pelvic infection before the procedure, it is postponed, a sample is taken and targeted treatment is started.
- If a collection of pus is found inside the womb during the procedure, intravenous antibiotics are started immediately to prevent the risk of spread and severe infection; a full course by mouth is then continued.
Risks and possible complications
- Perforation of the wall of the womb: rare but serious (reported rate 0.002–1.7%). In a diagnostic procedure it is less than one in a thousand; it is a little more frequent when a polyp or fibroid is removed. Factors that increase the risk: the need to dilate the cervix by more than 6 mm, narrowing of the cervix, a tortuous canal and an excessively angled womb. If perforation occurs there is a risk of injury to the bowel, bladder or a blood vessel, and further surgery may be needed for repair.
- Fainting, nausea, dizziness: 1.1% in a diagnostic procedure; 5.8–12% in treatment procedures such as polyp and fibroid removal. Using salt water instead of carbon dioxide to distend the inside of the womb reduces this reaction significantly.
- Bleeding: bleeding for a few days after the procedure that is lighter than a period is normal. Serious bleeding is rare.
- Infection: the rate is low (1.15–3.6%). It shows itself with fever, severe abdominal pain or foul-smelling discharge.
- Fluid overload: excessive absorption into the blood vessels of the fluid used to distend the inside of the womb. Using salt water keeps this risk to a minimum.
- Pain: generally similar to period pain.
Before and after the procedure
- The procedure generally takes 10–15 minutes; it may take longer if an additional procedure is carried out.
- Taking a painkiller 1–2 hours before the appointment is recommended.
- Afterwards you should use a pad, not a tampon.
- You should be given verbal and written information together with telephone numbers you can reach — including an out-of-hours number.
Seek help without delay in the following situations: abdominal pain that does not settle with a simple painkiller, bleeding heavier than a period, or signs of infection such as fever, shivering and foul-smelling discharge.
The procedure can be stopped at any moment. If pain or discomfort becomes unbearable, telling the team is enough; the procedure is stopped immediately.
With any surgical procedure, results vary from person to person. You are advised to discuss the procedure with your doctor in detail beforehand.
Frequently Asked Questions
Is hysteroscopy done only to look?
No. It is direct visualisation of the inside of the womb with a fine telescope, but treatment can also be carried out in the same session — this is called the "see and treat" approach. Removing polyps and fibroids, dividing adhesions, cutting a septum, removing a lost coil and removing pregnancy tissue remaining in the womb can all be done this way.
Which method is better for removing a polyp?
The guideline prefers mechanical tissue-removal systems to small electrical tips, and recommends this at the highest level of evidence. In a comparative study the mechanical system was found to be less painful, faster and to have a higher success rate.
Do adhesions come back after they are divided?
This is a real risk, because surgery on the womb is itself a cause of adhesions. For this reason treatment does not end with dividing the existing adhesion; protective measures such as barrier gels containing hyaluronic acid, absorbable medical membranes or an intrauterine device must be used to prevent a new one from forming.
Does an operation for a uterine septum reduce my risk of miscarriage?
In people who have experienced recurrent pregnancy loss, correction of the septum with hysteroscopy is reported to reduce the rates of pregnancy loss markedly. Mechanical mini-scissors that use no electricity are preferred in the procedure; they are significantly less painful than electrical tips.
Do I need to take an antibiotic before the procedure?
No, routine preventive antibiotics are not recommended. In a large randomised study no significant difference was found in the infection rate between those given antibiotics and those not given them (1.0% versus 1.3%). The exception: if an active infection is suspected before the procedure it is postponed and treated; if pus is found in the womb during the procedure, intravenous antibiotics are started immediately.
Can my womb be perforated?
It is rare but serious; the reported rate is between 0.002% and 1.7%. In a diagnostic procedure it is less than one in a thousand, and a little more frequent when a polyp or fibroid is removed. Factors that increase the risk: the need to dilate the cervix by more than 6 mm, narrowing of the cervix, a tortuous canal and an excessively angled womb.
Will I faint during the procedure?
Fainting, nausea and dizziness can occur: reported at 1.1% in a diagnostic procedure and at 5.8–12% in treatment procedures such as polyp and fibroid removal. Using salt water instead of carbon dioxide to distend the inside of the womb reduces this reaction significantly.
How long does it take and what should I do afterwards?
It generally takes 10–15 minutes; it may take longer if an additional procedure is carried out. Taking a painkiller 1–2 hours before the appointment is recommended. Afterwards use a pad, not a tampon. Bleeding for a few days that is lighter than a period is normal.
When should I seek help without delay?
If you have abdominal pain that does not settle with a simple painkiller, bleeding heavier than a period, or signs of infection such as fever, shivering and foul-smelling discharge, seek help without delay. You should be given telephone numbers you can reach, including an out-of-hours number.
If I cannot bear it, will the procedure be stopped?
Yes. The procedure can be stopped at any moment. If pain or discomfort becomes unbearable, telling the team is enough; the procedure is stopped immediately. The team is also obliged to take into account that you may not be in a position to say so.
Sources
- De Silva PM, Smith PP, Cooper NAM, Clark TJ — Outpatient Hysteroscopy. RCOG Green-top Guideline No. 59, BJOG 2024. Areas of use, choice of device, prevention of infection, complication rates and patient information.
- RCOG patient information — outpatient hysteroscopy: the duration of the procedure, the timing of a painkiller, what to be careful about afterwards and the criteria for seeking help.
- ESHRE Guideline on Recurrent Pregnancy Loss (2022 update) — the effect of surgical treatment of intrauterine adhesions, a septum and fibroids distorting the cavity of the womb on pregnancy loss.
The information on this page is based on the national and international guidelines listed above. The page is reviewed whenever those guidelines are updated.
Practice and Contact Details
The information on this page is general. Please speak to your doctor about your own situation.
- DoctorOp. Dr. Murat Alpay — Specialist in Obstetrics and Gynaecology
- AddressOp. Dr. Murat Alpay Practice, Tekelioğlu Cd. No:51 B Kat:2, Filo Apt., 07160 Muratpaşa / Antalya
- Telephone0505 351 77 88
- HoursMonday – Saturday 09:00 – 18:00 · Closed on Sunday