Hysteroscopy

Hysteroscopy is a procedure that enables direct visualization of the interior of the uterus (the endometrial cavity) using a hysteroscope, a thin, lighted telescope inserted through the vagina and cervix. The examination may be diagnostic or combined with operative measures.

Indications include abnormal uterine bleeding, infertility assessment, recurrent pregnancy loss, and evaluation of intrauterine lesions such as polyps, fibroids that protrude into the cavity, or intrauterine adhesions. It can also be used to perform minor surgical procedures, such as polypectomy, myomectomy, removal of adhesions, or endometrial sampling, often in an outpatient setting.

The procedure can be performed in an office or operating room. It may be diagnostic only or operative. The uterus is distended with fluid or gas to improve visualization. Local, regional, or general anesthesia may be used depending on the case and setting. A slender hysteroscope is passed through the cervix into the uterine cavity, and instruments may be advanced through the hysteroscope for therapeutic interventions.

Risks are generally low but include uterine perforation, infection, heavy bleeding, and fluid overload or electrolyte imbalance from distension media. Other possible complications include anesthesia-related risks and vasovagal symptoms. Recovery is typically brief, with mild cramping and light vaginal bleeding possible; patients are usually advised to resume normal activities gradually and to avoid intercourse for several days.

Alternatives to hysteroscopy include imaging studies such as ultrasound or MRI, endometrial biopsy, and dilation and curettage, though these do not always provide the same direct visualization or treatment.