A hysteroscopy is a procedure that lets a doctor look directly inside your uterus using a thin, lighted instrument called a hysteroscope. The scope is inserted through your vagina and cervix into the uterine cavity, where a liquid or gas gently expands the space so the doctor can see the entire lining clearly. It can be purely diagnostic, used to find the source of a problem, or operative, meaning the doctor treats the issue during the same procedure. Most hysteroscopies are outpatient, and many are done right in a doctor’s office.
Why a Hysteroscopy Is Done
The most common reason is abnormal uterine bleeding, whether that means periods that are unusually heavy, irregular, or occurring after menopause. A hysteroscopy lets the doctor see what’s causing the bleeding rather than guessing from imaging alone. It’s also used to investigate and treat uterine polyps, fibroids that grow into the uterine cavity, and adhesions (bands of scar tissue) that can distort the lining.
Infertility is another major reason. Between 11% and 45% of patients undergoing IVF have uterine polyps, and these growths are a common finding in people with repeated implantation failure. Removing them hysteroscopically can improve the chances of embryo implantation and pregnancy. In one large review, about 78% of patients whose primary complaint was infertility achieved at least one successful pregnancy after hysteroscopic polyp removal, and roughly half of pregnancies in premenopausal patients occurred spontaneously without assisted reproduction.
Doctors also use hysteroscopy to locate and remove a displaced IUD, to take a targeted biopsy of suspicious tissue, and to perform certain sterilization procedures.
Diagnostic vs. Operative Hysteroscopy
A diagnostic hysteroscopy is a quick look inside. The doctor passes a narrow scope into the uterus, inspects the cavity, identifies both fallopian tube openings, and notes any abnormalities. No tissue is removed. This version often takes only 5 to 10 minutes and can be done with little or no anesthesia in an office setting.
An operative hysteroscopy goes a step further. Small instruments are passed through channels in the hysteroscope to cut, remove, or cauterize tissue. Polyps can be snipped off, fibroids shaved down, adhesions divided, and abnormal tissue biopsied. Because the work is more involved, operative procedures are more likely to be scheduled in an operating room with regional or general anesthesia, though smaller operative cases can still be done in an office with local numbing.
How the Procedure Works
You lie in the same position used for a pelvic exam. In the traditional approach, a speculum is placed, the cervix is grasped to hold it steady, and the opening is gently dilated to fit the hysteroscope. Some doctors use a “vaginoscopic” technique instead, skipping the speculum entirely and guiding the scope through the vagina by sight until it reaches the cervical opening and passes through on its own.
Once the scope is inside the uterus, a distension medium fills and expands the cavity. This is typically normal saline (sterile salt water), though carbon dioxide gas is sometimes used for diagnostic cases. A continuous flow of fluid keeps the view clear by washing away blood and debris. The doctor watches a monitor connected to a tiny camera on the tip of the scope, inspecting the full lining and both tubal openings before performing any planned treatment.
Anesthesia Options
The type of anesthesia depends on where the procedure happens and how complex it is. For a simple diagnostic look in the office, you may need nothing more than an over-the-counter pain reliever taken beforehand, or a local anesthetic injected near the cervix. Regional anesthesia, similar to what’s used during labor, numbs the lower half of your body and is an option for longer procedures. General anesthesia, which puts you fully to sleep, is reserved for more involved operative cases done in a hospital or surgery center.
Preparing for the Procedure
The ideal timing is during the first seven days after your period ends, when the uterine lining is thin and easiest to see through. If your cycles are irregular, your doctor may prescribe a short course of hormonal medication to thin the lining before your appointment. You’re typically asked to take 800 mg of ibuprofen the night before and again about an hour before the procedure to help with cramping. If you haven’t delivered a baby vaginally before, your doctor may also prescribe a medication to soften your cervix, making it easier to pass the scope through. A urine pregnancy test is standard before starting.
Unlike many surgeries, you can usually eat a healthy breakfast the morning of the procedure, unless you’re having general anesthesia, which requires fasting.
What Recovery Looks Like
Most people go home the same day, often within an hour or two. Cramping similar to period pain is normal and usually responds well to ibuprofen or a heating pad. Light spotting or watery discharge can last several days. If an operative procedure was performed, you may have slightly heavier bleeding for a short period.
Recovery time depends on the scope of the procedure. A diagnostic hysteroscopy rarely requires any time off. After an operative case, most people return to normal activity within one to two weeks. Your doctor may recommend avoiding intercourse, tampons, or baths for a brief window to reduce infection risk, though specific restrictions vary by practice. Lifting restrictions are uncommon for hysteroscopy alone, since no incisions are made through the abdomen.
Effectiveness for Common Conditions
Hysteroscopic polyp removal has a success rate above 75% and is the standard treatment for symptomatic uterine polyps. In a large pooled analysis, 85% of patients reported improved symptoms after polypectomy. Polyps do recur in some cases, with recurrence rates ranging from about 10% to 15% in most studies, though some report rates as high as 44% depending on the technique and follow-up period. The method of removal matters: using scissors to cut polyps at the base has been associated with lower recurrence (about 10%) compared to grasping and twisting them off (about 18%).
For fibroids growing into the uterine cavity, hysteroscopic removal often resolves heavy bleeding without the need for a hysterectomy. Fertility outcomes also improve. Among patients with infertility linked to polyps, spontaneous pregnancy rates of 50% to 61% have been reported after removal, regardless of polyp size or number.
Risks and Complications
Hysteroscopy is one of the safer gynecologic procedures. A large prospective study found an overall complication rate of just under 1% for operative cases. The most common issues are bleeding (about 2.4% of cases), uterine perforation (0.8% to 1.5%), and minor cervical tears (1% to 11%, most of which heal on their own).
Fluid overload is a complication specific to hysteroscopy. Because liquid is continuously pumped into the uterus to maintain the view, too much can occasionally be absorbed into the bloodstream. This happens in fewer than 5% of cases but can cause electrolyte imbalances if it does occur. The surgical team monitors fluid levels throughout the procedure to catch this early. Infection and pelvic inflammatory disease are possible but rare late complications.
Perforation, when the scope or an instrument pokes through the uterine wall, sounds alarming but in most cases causes no lasting harm. If it happens, the procedure is stopped, and the small hole typically heals on its own. Rarely, a perforation requires further intervention.