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Hysteroscopy

Hysteroscopy
by T

Why Would You be Doing a Hysteroscopy?

Hysteroscopy, when your cervix is dilated and a small set of surgical tools is inserted into the uterus, is usually recommended when your doctor has noticed something strange during an HSG or saline sonogram. Sometimes both these tests are normal, but other issues (pregnancy loss, bleeding, IVF failure) may indicate hysteroscopy. Hysteroscopy allows your doctor to envision the uterine lining using fiber optics, after pumping the womb full of sterile air or fluid. She can then easily detect any irregularities. Septums, uterine polyps (benign overgrowths of the lining), and some fibroids can be carefully removed. Hysteroscopy is considered the gold-standard treatment for growths like polyps, which are too often missed during blind D & Cs.

What You Can Expect

Depending on where the procedure falls in your cycle and why it’s being done, you may be prescribed birth control pills to keep your lining thin and make it easier for your doctor to figure out what’s going on. I was able to schedule mine for early enough in my cycle to avoid this.

Most hysteroscopies are performed as outpatient surgeries under general anesthesia. This means you will need someone to take you to and from the surgery, and you will have to fast. Make sure you understand exactly what’s expected by the particular surgical center, as they often have varying protocols.

If, like me, you are scheduled for an afternoon slot, chug as much water as you can right up to the midnight cut off. Also, it’s good to avoid any anesthesia-related regularity issues by taking a stool softener and/or eating ample fiber in advance. The cramping post-procedure can make constipation a real downer, to put it mildly.

Once you’ve arrived at the surgical center, you’ll have an IV started and may be given a pregnancy test. After your doctor and anesthesiologist have spoken to you briefly to review what’s about to happen, you’ll be taken into the operating room. A few seconds after the anesthesiologist administered a drug into my IV, I was out like Rip van Winkle. Depending on the timing, your doctor might speak with you or your companion about the results of the procedure. In my case, my husband got the report, as I was still down for the count. If you think you’ll have questions that your companion won’t think to ask, write them down.

Though hysteroscopies do not involve any incisions, the dilation and activity in the uterus do lead to unpleasant cramping, pain, and bleeding. I was given naproxen (Aleve) to take for the cramping, as well as hydrocodone for pain. Even if you think you won’t need them, fill these prescriptions ahead of time if possible. The cramping may not start right away, but it will come and you’ll welcome the relief.

Though you’ll likely get a pad from the center to deal with the bleeding, I brought along my favorite kind, just for comfort’s sake. You may also want to wear comfy clothing like a loose dress or sweats and take a cardigan, hoodie, or other cozy wrap to keep you warm before and after surgery. Bring your favorite pillow to keep the pressure of the seat belt off your belly for the ride home, and snacks for the trip home like juice, yogurt, and water. Stock up beforehand on some tasty, nourishing, fairly bland and soft comfort foods for the evening after surgery. Some gals even suggest throwing a little get together, though I personally was content to sprawl on my pillows and watch DVDs.

After a few days, you’ll likely be feeling pretty good, if not completely back to normal. If you can manage it, take it easy the day of and the day after the procedure. Get some good books, good movies, treats, and take really good care of yourself. You may have some spotting or bleeding for a few days afterward.

Ask your doctor before you go under about post-op follow up, signs that you need additional medical assistance, and how long you should avoid tampons, sex, and any other cervical annoyances. Though I can’t recall getting specific instructions, some online research showed that two to three weeks of pelvic rest was best. Anything removed from your lining will likely be sent to a pathologist for testing, though malignant growths are extremely rare in pre-menopausal women. Though some women have mentioned that they’ve had unusual periods following the procedure, I only noticed that mine was a little later and lighter than usual.

Personal Tips

We discovered that I had polyps thanks to a saline sonogram, after a normal HSG. Polyps were suspected in my case because of luteal phase spotting. If you have persistent, regular spotting but a normal HSG, get a saline sonogram just in case. It may give you additional information, and it’s basically painless compared to the HSG.

I combined my hysteroscopy with a laparoscopy, an increasingly common diagnostic combo in infertility. This two-birds-one-stone approach seemed to work very well: I was already out cold, and my doctor could give us the full picture of my pelvic and uterine health, thus increasing my peace of mind. In the end, three small benign polyps were removed, and two spots of endometriosis blasted with a laser. The entire procedure took less than an hour, all told.

With the addition of the lap, I had more pain than you normally would with hysteroscopy alone, due to the incisions and the gas used to inflate the abdomen.

Rest is the most important part of recovery. I slept and lounged my way through two days, when I started to feel much better and no longer needed the pain medications. Any friends or family willing to contribute meals and keep you resting should be heartily encouraged. The more you sleep now, the better you’ll feel in the long run.

28 comments

1 Hillary { 05.04.09 at 7:09 pm }

Thanks for such a great run-down of the procedure! I’m having a hysteroscopy in a few weeks and feel more prepared now. :)

2 Sky { 06.21.09 at 2:30 pm }

I had a "fiber optic Hysteroscopy" last year – nothing but 800 mg Ibuprofen. Total cake!

3 Jamie { 02.22.10 at 10:47 am }

This is really helpful! Thank you for writing it. I’m scheduled for hysteroscopic polypectomy and uterine ablation March 12th and wondering what to expect from it. I’ve never had surgery before under a general and this really helps to hear this kind of story. It sounds a lot less frightening than what I have in my head right now LOL!

4 Mary { 03.25.10 at 11:02 am }

This is helpful, thanks! After I had a HSG a few weeks ago, we found out I have polyps. I was told to start taking birth control pills the first day of my next period and call my doctor’s office to schedule the procedure to be done within the next 3 weeks (after I start taking the pills). Does anyone know why the procedure has to wait until my next cycle and within the first 3 weeks?

5 Mary { 04.14.10 at 8:18 am }

oh, and one more thing, they also told me they don’t know how many polyps I have and what size. I find that kind of odd.

6 Dre { 11.12.10 at 11:31 am }

Thank you for this! I am having one next week, combined with a d&c, and hearing a “real” account of what to expect is reassuring.

7 Sarah { 05.26.12 at 11:38 am }

By far the worst part of my hysteroscopy was the medicine they gave me to dilate my cervix the night before. It caused the worst cramping I’ve ever experienced, and the hydrocodone they gave me didn’t touch it. I called the doctor, and she told me to fish the pills out of my vagina. The lowered the severity of the pain from excruciating to very, very bad.

The procedure itself wasn’t too bad, although two days later, I’m still waking up with bad cramps every morning.

I have adenomyosis as well, so I’m wondering if my cramping issues are more severe because of this.

8 Anon { 11.29.12 at 2:45 pm }

Had my hysteroscopy 2 days ago. Went back to work today for 3.5 hours. The misoprostil that I needed to take night before and day of surgery wasn’t that much fun but I wouldn’t call it pain. Surgery went well according to dr and my 2 cm polyp was removed. No real pain post procedure just cramping that I only was advised Tylenol and or Advil for. Truthfully i don’t need think I need more than that. The hardest part as I’ve found in all my surgeries is the brain fog post anesthesia. Technically I am allowed to drive today 2 days post op but I wouldn’t trust me on the road! I’m a virgin and everything expects everything to hurt way more for me. I have to say its not true and although yes I was scared for anyone being fearful – it wasn’t so bad!

9 Denise { 02.12.13 at 9:01 pm }

I am having this done on Friday. Very nervous, but hope all goes well.

10 Shay { 02.15.13 at 10:37 pm }

I had a hysteroscopy done this morning. All seemed to go well. I think it took longer for the anesthesia to wear off than the actual procedure. It’s hard to retain what the doctor is saying to you when you are still incapacitated but all i can recall is her saying she got it out, the surgery was successful, and showed me a printout of the pictures of the polyp before and after removal.
Bleeding has been minimal, spotting is a more accurate description. I think it’s mostly tiny remnants of the procedure than bleeding. (sorry if that’s too much information!) 12 hours post surgery and I the only discomfort I feel is period-like bloating. I napped on and off after I got home. My doctor prescribed vicodin, which I don’t have the need for. I have Aleve and Advil but haven’t needed either.
I’ve read other blogs where women who have had a hysteroscopy said that they resumed intercourse 2 days post surgery. I don’t think that’s wise. Wait. Although my doctor forgot to mention that information to me, the discharge nurse said to wait until I have my post-op visit. You might have small tears and do not want to risk infection, which obviously can complicate and create unwanted issues. It’s better to err on the side of caution and make sure you have fully healed.

11 In need a hyster-what now? | IF Pomgranate { 05.16.13 at 4:35 pm }

[...] Ok so Dr. H wants to make sure everything is hunky dory up in uterus land so would like to do a Hysteroscopy. Yes I went home and looked it up. But he also explained the procedure. He says that I will need to [...]

12 Jen { 05.29.13 at 7:57 pm }

Thanks for the extremely detailed description of what to expect before, during, and after the procedure. I’m going in a few weeks, and your site has been the most helpful one I’ve found so far. Informative and reassuring. And now I know to bring a pillow for the long trip home – I would never have thought of that!

13 Debbie { 06.07.13 at 5:31 pm }

I had mine done six weeks ago and am still bleeding, nothing major but still a couple of pads a day. :(

14 Shane { 07.02.13 at 3:38 am }

Bottom line: I’d be so mad if they insisted on putting me out for this under general or even I.V. sedation! It goes so quickly and I had NO PAIN. Especially for a simple diagnostic hysteroscopy, in my personal opinion it is probably not necessary to be put under (and I had what is called an operative hysteroscopy, where they remove a polyp). Ladies, we’re so much stronger than we give ourselves credit for. Don’t be afraid of this procedure. Had this done in my gynecologist’s office on Friday to remove a polyp. Did the whole thing on only 4 Advil (taken an hour before) and local anesthetic injected into my cervix (which doctor let take effect for 10 minutes before she started procedure). It was a breeze! I have a “hard” cervix and have not had any children – and it was pretty painless, totally painless when she was dilating my cervix, which is apparently the part that’s supposed to hurt. A tiny, tiny, bit crampy here and there throughout, but nothing major and not even as bad as my normal menstrual cramps. Every woman is different, though. I may just be very lucky that my body tolerated it so well. But had to share my experience. My doctor wanted to do it in OR. I did my research and said no. So she agreed to do it in-office. (I’m stubborn. I don’t give up control very easily. But hey, it’s MY body!) After more research, on the day of, I refused the Toradol shot, an anti-”dizzy” shot and the IV shot of valium she wanted to give me (all the shots and drugs freaked me out more than the prospect of possibly being uncomfortable for a few minutes, so I said no). For some reason, I knew I would be okay without it. (Doctor almost wouldn’t do the procedure, but said she’d “try”). I barely felt the shots in my cervix (she sprayed numbing spray before the shots). And I barely felt her cutting off the tiny little apple seed-sized polyp. I was totally fine, talking about clothes the entire time with the nurse. It went really quickly. Loved seeing the inside of my uterus on the TV screen! Bled a little after and was crampy for a few hours. But you will have all that anyway even if you’re given GA or sedation. I’m the type of person who hates medical procedures and doctors and needles, etc. But I can sometimes get myself into fight mode (iPod helps) and just power through things that I know won’t take that long. Some people like to be “out”. It’s a little extreme for me unless completely necessary and it makes me nauseous afterward, so I was happy to have none of that and go about my day. I can’t stress enough how easy this was for me. I’m very lucky as I know it might not be that easy for other women. Am so mad at myself for wasting so much time worrying about it the days leading up to the procedure. I think we all need to be more outspoken and ask questions of our doctors when it comes to surgeries and procedures like this. Not just do what they tell us to do because we assume they know what’s best for us. Or because it’s easier on the doctor when the patient is unconscious and not talking or in pain (which is often the reason they want to put us out for something simple like this). Oh, she gave me a 3-day course of Cipro afterward to prevent infection. Good luck and good health to all of you!

15 Shane { 07.02.13 at 3:49 am }

Clarifying above post (as if it isn’t long enough!) I want to stress that I had a PARA-CERVICAL block, which is important. It not only numbs the cervix, but much of the lower part of the uterus, as well, which is where most of the work is being done. So, ask for the para-cervical block! I think it did wonders for me. The endometrial biopsy I had weeks ago (with no numbing, just Advil) hurt more than the polyp being removed in the hysteroscopy.

16 Amalia { 07.25.13 at 10:35 am }

I have one week hysteroscopie about 1cm how to have a sex or can I have a sex now?

17 Kay { 10.09.13 at 3:51 pm }

I had on in the doctor’s office. I was not told to take anything beforehand for the pain, as well as I didn’t know anything about the procedure. I was given no pain medication and the cramping was uncomfortable,but when they took the polyp off it was very painful, in fact I screamed. The doctor joked I was a tough cookie, cause they normally put people out for this…I don’t know if he was serious or making a joke, but I wasn’t laughing. I would suggest looking into numbing the area because I was shaking after procedure and I think it was because my body was in shock.

18 mel { 11.11.13 at 7:05 pm }

Shane,
What were your symptoms before having this done?

19 kath { 12.12.13 at 2:36 pm }

Had hysteroscopy today. Completely fine. Dentists is worse. Took ibuprofen. 1 x 400ml 3 hours before. Worrying about it prior was much worse than procedure itself. Insertion of optic totally fine.just want to reassure anyone waiting for the procedure.

20 Reene { 03.29.14 at 1:17 pm }

It took me a while to decide on this procedure (as I’m a virgin) despite the fact I had extremely heavy bleeding last month that lowered my HB level from 12 to 8.4 in just a few days.

I had the procedure this morning with general anasthesia and I could leave the hospital a couple of hours after I woke up in the recovery room.

By the way, the doctor prescribed me a medicine that I had to take 10 hours before the procedure. The purpose is to ‘relax’ my cervix. I had some itchiness under my skin of all hand fingers for a couple of minutes, later I felt it in both of my tighs for a minute or so. But I could sleep well within an hour as the effects stopped in a few minutes.

The hysteroscopy procedure took about 30-45 minutes and I woke up shortly after it finished.
It was good to hear when the obgyn said my hymen was still intact a after the procedure. Yet, I have to wait until Thursday for the result of the biopsy. Hopefully it will also be a good news.

Before I left the hospital, the obgyn prescribed me: antibiotics, painkillers and anti-bleeding drugs

21 Ac { 04.02.14 at 8:58 pm }

I had a polyp removed 5 days ago and still super crampy but only at the end of my long days. I’m shocked everyone else is just fine when I’m experiencing pain that is awful.

22 Tins { 04.11.14 at 7:01 am }

Hi, yesterday morning i had a hysterscopic myomectomy for removal of a 3 cm fibroid. It seems the size of fibroid was a bit more than seen in MRI. Presently i have this dull back ache and very light bleeding with no severe cramps and a tiny sore spot un lower abdomen when touched. However a bit weak as i am anemic from previous periods which had heavy bleeds and clotting . I also have several fibroids which are intra uterine wall. Is it all normal to have this dull back ache and sore?

23 Parod { 04.23.14 at 7:43 pm }

I had a HSG done today in a radiologist office. No meds prior or during. No pain what so ever. It was uncomfortable but that was from my uterus being filled with the dye. The only thing that hurt was the speculum being left in during the test which lasted 25-30 mins. No bleeding afterwards.

24 Joy hunt { 05.02.14 at 10:35 am }

Thanks for your detailed description,
I had an inconclusive Hysteroscopy just over a week ago with a pipelle biopsy. They said they took lots of samples, but so far no results. It’s just living with the worry of what it might be that’s so hard I think!
Family are worried too & message me constantly to see if I’ve got results!
The procedure was done under General as they couldn’t do in outpatients as my cervix was ‘stenosed’ presumably as I am post menapausal!

25 lisa { 05.08.14 at 3:58 am }

I am sheduled to have hysteroscopic polypectomy next month due to infertility problem but have been worried about the procedure. Now that i have heard enough from diff women, i am now relaxed and ready to do it without fear. Thanks for your contributions.

26 T Garrett { 06.09.14 at 10:44 am }

Thanks for the information. As a result of your detailed explanation, I went into my hysteroscopy knowing exactly what to expect before and after the procedure. I can’t wait to completely heal and see if the procedure really worked for me.

27 emmz { 07.28.14 at 12:02 pm }

i had an hysteroscopy and polypectomy last thursday 24th july and am still in a lot of pain from having it done cramping pains and a little discharge should I be worried about this??

28 Charm { 07.29.14 at 6:27 am }

I had my hysteroscopy two weeks ago. An hour before the procedure, I took a painkiller that was provided with my prep packet. The procedure lasted under 30 minutes, a polyp removed. The only discomfort I felt was cramps when the instrument passed through my cervix. I’ve had worse cramps during menstruation! For about three days after, I had a very light discharge, brownish in colour… I felt a few slight twinges, barely noticeable. I waited for a week before having sex, by which time my body was fully back to normal. Apart from the pre-op painkiller, I did not require any other medication. The only thing, now, is that my period appears to be delayed… I expected it two days ago. So, all in all, for me, it was a piece of cake, thankfully. :-)

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