Preparing for a hysteroscopy involves a handful of straightforward steps: timing the procedure correctly in your cycle, adjusting certain medications, following fasting rules if sedation is planned, and knowing what to expect for recovery. Most of the preparation happens in the days leading up to the procedure, not weeks in advance.
Schedule It at the Right Point in Your Cycle
If you have regular periods, the best window for a hysteroscopy is during the first half of your cycle, after your period ends but before ovulation. The American College of Obstetricians and Gynecologists recommends the follicular phase because the uterine lining is thinnest at that point, giving your doctor the clearest view. Brigham and Women’s Hospital suggests aiming for the first seven days after your period ends.
Later in the cycle, the thickened uterine lining can mimic polyps and make diagnosis harder. If your periods are unpredictable, your doctor may schedule the procedure at any time, though ideally not while you’re actively bleeding since that can also impair visibility.
Medications to Stop or Adjust
Several common medications need to be paused before the procedure:
- NSAIDs like ibuprofen (Advil, Motrin) and aspirin: stop one day before the procedure, or as your doctor directs.
- Blood thinners like warfarin (Coumadin), rivaroxaban (Xarelto), apixaban (Eliquis), or clopidogrel (Plavix): talk to your surgeon about exactly when to stop, since timing varies by medication.
- GLP-1 medications for diabetes or weight loss, including semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro): skip one dose before the procedure. These drugs slow stomach emptying, which matters if you’re receiving sedation.
- Oral diabetes medications: do not take them the morning of the procedure.
If you take any of these, confirm the plan with your doctor’s office well before the procedure date. Don’t stop blood thinners on your own without specific guidance.
Fasting Before the Procedure
Whether you need to fast depends entirely on what type of anesthesia you’ll receive. If the hysteroscopy is done in the office with no sedation or only a local anesthetic, fasting typically isn’t required.
If you’re receiving general anesthesia, regional anesthesia, or sedation, standard fasting guidelines apply. You can drink clear liquids (water, black coffee, clear tea, juice without pulp) up to two hours before the procedure. A light meal, like toast with clear liquids, is fine up to six hours before. Fatty or fried foods need eight or more hours of fasting time. Your surgical team will give you a specific cutoff time the night before.
Pre-Procedure Tests and Screening
A pregnancy test is mandatory for anyone of reproductive age. This is non-negotiable and will be checked before the procedure proceeds. Beyond that, your doctor may order a complete blood count to establish a baseline, particularly for operative hysteroscopy where there’s some risk of bleeding. Depending on your medical history and the type of procedure, blood typing and screening may also be done.
If you have symptoms like vaginal discharge, cervical cultures for infections like chlamydia or gonorrhea may be taken beforehand. You should also have an up-to-date Pap smear, or at least one where any abnormal results have already been evaluated, since the procedure involves passing instruments through the cervix. For women over 35 with irregular bleeding, or perimenopausal and postmenopausal women, an endometrial biopsy may be recommended as part of the workup.
Cervical Preparation
In some cases, your doctor will prescribe a small dose of medication to soften and slightly open the cervix before the procedure. This is a tablet inserted vaginally the night before. Not everyone needs it. It’s more commonly used when both a hysteroscopy and endometrial biopsy are being done together, or when the cervix is expected to be tight (common in women who haven’t had vaginal deliveries). Your doctor will let you know if this applies to you.
The Days Before Your Procedure
Avoid sexual intercourse for at least two days before the hysteroscopy. This reduces the risk of infection and helps ensure accurate test results if any cultures or biopsies are taken during the procedure.
Arrange your day so that you have a ride home if you’re receiving sedation or general anesthesia. Even if you feel fine afterward, you won’t be cleared to drive. If the procedure is office-based with no sedation, you can typically drive yourself, but having someone available is still a good idea in case you feel crampy or lightheaded.
Wear comfortable, loose clothing. You’ll change into a gown, but comfortable clothes make the trip home easier. Eat a normal dinner the night before unless your fasting instructions say otherwise, and stay hydrated.
What Recovery Looks Like
Recovery is faster than most people expect. If you had no anesthesia or just a local anesthetic, you can usually return to normal activities, including work, later that same day or the next morning. With general anesthesia, plan to take it easy for a day or two. If you had a more involved operative procedure, like fibroid removal, you may want a few days off.
Mild cramping and light spotting are normal for a day or two. Avoid sex for one week after the procedure, or until any bleeding stops, to reduce infection risk. Most women describe the recovery as significantly easier than they anticipated.