- ATHENS OFFICE MED4WOMAN ATHENS
- VOLOS OFFICE MED4WOMAN VOLOS
Obstetrician-Gynecologist
PhD, University of Athens Medical School
Obstetrician-gynecologist Panagiotis Polyzos practices at the Institute of Life, the IVF Unit of IASO Maternity Hospital.
Hysteroscopy is a diagnostic examination of the inside of the cervix and the endometrium using a thin camera (known as a hysteroscope). It reaches the cervix through the vagina. The hysteroscope is only a few millimeters in diameter, and it allows a precise, real-time view of the uterine cavity and the openings of the fallopian tubes on a screen. This lets the gynecologist examine the uterine cavity with a precision that other methods do not offer.
Magnification and direct viewing of the uterine cavity make the exam more reliable and more accurate than ultrasound, CT or MRI, or dilation and curettage (D&C). With hysteroscopy we can see any possible abnormality of the uterine cavity and cervix more accurately. Along with the diagnostic exam, a minimally invasive operative hysteroscopy can also be done under local anesthesia. A polyp or fibroid can be removed, and a tissue sample can be sent for histological evaluation. Based on the hysteroscopy findings, the physician will determine the most appropriate treatment for each case.
Indications for hysteroscopy include:
Hysteroscopy for the evaluation of uterine bleeding is performed in a hospital setting under light anesthesia (conscious sedation). General anesthesia is not required; however, the patient feels no pain or discomfort during the procedure.
The process is simple and minimally bothersome for the woman — not during the procedure itself, but possibly for a few hours or days afterward. The timing of the hysteroscopy is specific; therefore, proper scheduling is important. It is typically performed after the last day of menstruation, ideally between the 6th and 10th day of the cycle. As mentioned earlier, mild analgesia is administered, allowing the woman to remain conscious and able to watch the entire procedure, magnified, on a monitor.
Post-procedure discomfort is similar to menstrual pain for 1–2 days and can be managed with simple pain relievers. Light spotting may occur after diagnostic hysteroscopy for 1–2 days, and after operative hysteroscopy for 1–3 weeks. The intensity is mild and does not significantly affect daily activities.
Hospital stay rarely exceeds 4 hours, after which a woman can safely return home and resume her normal routine.
If the procedure is performed under local anesthesia or conscious sedation, the woman will need to fast for a few hours beforehand, avoiding both liquids and solid foods.
Depending on the nature of the procedure, additional preoperative tests may be required, such as a complete blood count.
Hysteroscopy is a safe procedure when performed by an experienced medical team using modern technology. The post-procedure period generally does not require any special precautions, apart from a few basic recommendations such as temporarily avoiding sports or strenuous physical activity. Additionally, a woman should refrain from sexual intercourse. Any bleeding should have completely stopped before resuming sexual activity.
The benefits of hysteroscopy are not limited to treating abnormalities of the uterine cavity. It also offers important benefits to women who plan to undergo in vitro fertilization. It is an extremely simple and safe method that allows an immediate diagnosis, while also contributing significantly to more successful IVF pregnancies and fewer miscarriages.
Modern techniques used in hysteroscopy ensure the highest possible level of safety. The most common complications, however, remain bleeding and discomfort, both of which are temporary. Overall, hysteroscopy continues to be one of the safest diagnostic and operative procedures in gynecology.
During your consultation, your doctor will discuss all potential risks in detail and answer any questions you may have regarding the cost of the procedure. For more information, please contact us.
Hysteroscopy is recommended when we need to look directly inside the uterus:
The diagnostic hysteroscopy is performed with a very thin hysteroscope, often in the office and without sedation, and takes 5 to 15 minutes. The doctor views the uterine cavity on a screen and, if needed, takes a biopsy.
The operative hysteroscopy treats the problem at the same time: removal of polyps and fibroids, cutting a septum, releasing adhesions. It is done in the operating room under sedation or light anesthesia, and the woman goes home the same day. In selected cases it is combined with laparoscopy.
Modern office hysteroscopes are only a few millimeters in diameter. With the vaginoscopic technique, the doctor guides the hysteroscope through the vagina and cervix with the help of saline, often without a speculum and without a clamp on the cervix. This makes the exam much more tolerable.
A few practical tips reduce discomfort even further:
If the discomfort is significant or a more extensive procedure is needed, the exam is completed on another day under sedation in the operating room.
Hysteroscopy has an important place in fertility testing, but not every woman needs it. Large randomized studies have shown that, when the uterine ultrasound is normal, routine hysteroscopy before a first IVF cycle does not increase live births.
On the other hand, the exam has real value when:
Choosing the right women who will benefit spares the rest an unnecessary procedure.
Any bleeding after menopause needs to be investigated. The first step is a transvaginal ultrasound to measure the thickness of the endometrium. When the endometrium is thick or uneven, or the bleeding keeps coming back, hysteroscopy with a targeted biopsy gives the most reliable answer.
At this age the cervix is often narrower because of falling estrogen levels. Your doctor may recommend local preparation beforehand so the hysteroscope can pass more easily. Most findings are benign, such as endometrial atrophy or polyps, but the exam is necessary to rule out anything more serious early. You will find more about the changes of this stage on the page about menopause and its symptoms.
Sometimes, after a miscarriage or childbirth, tissue remains inside the uterus and causes prolonged bleeding or pain. Traditionally it was removed with a D&C without direct vision. Hysteroscopic removal lets the doctor target only the leftover tissue without injuring the healthy endometrium. This lowers the risk of intrauterine adhesions, which is especially important for women who want a future pregnancy.
Serious complications are rare, especially with diagnostic hysteroscopy. For operative hysteroscopy, your doctor will discuss with you:
Contact your doctor if, in the following days, you develop a fever, pain that gets stronger instead of easing, bleeding heavier than a period, or foul-smelling discharge.
The three exams do not compete with each other. They complement one another, and the choice depends on the question that needs to be answered.
Write down your questions in advance. A few minutes of discussion clarify what to expect and ease the stress of the day.
When the strings of an intrauterine device (IUD) cannot be seen during the exam or removal in the office fails, the first step is an ultrasound to confirm that the IUD is inside the uterus. Hysteroscopy then lets the doctor locate it and remove it with fine forceps under direct vision. If it has become embedded in the wall, it is removed carefully so the uterus is not injured. The same procedure can also be used when a woman wants to get pregnant and the IUD cannot be removed the usual way.
Diagnostic hysteroscopy usually causes mild, period-like cramps and is done without anesthesia or with light sedation. Operative hysteroscopy is done under anesthesia.
Ideally in the first days after your period ends, usually between day 6 and day 10 of the cycle, when the endometrium is thin and the view is clear. If your cycle is irregular or you have reached menopause, your doctor will choose the right day.
Diagnostic hysteroscopy usually takes 5 to 15 minutes. Operative hysteroscopy, to remove a polyp, fibroid or septum, takes from 15 minutes to about an hour, depending on what needs to be removed.
The same day or the next day. Light bleeding for a few days is expected.
When a polyp, adhesions or a septum are suspected, or after failed embryo transfers, correcting the cavity improves the conditions for implantation.
After a diagnostic hysteroscopy or polyp removal, usually from the next cycle. After removal of a large fibroid or a septum, your doctor may ask you to wait one or two cycles.
Often not. With the vaginoscopic technique, the thin hysteroscope passes through the vagina and cervix without a speculum, which makes the exam more comfortable.
It is usually avoided, because blood clouds the view. In urgent cases or with continuous bleeding the exam can be done, but ideally it is scheduled a few days after your period ends.
What is seen on the screen is discussed right after the exam. If a biopsy is taken or tissue is removed, the histology results usually come back in one to two weeks.
After an in-office hysteroscopy without medication, usually yes. If you had sedation or anesthesia, you need someone to accompany you and should not drive the same day.
