If you’ve been told you need a diagnostic hysteroscopy, you probably have a lot of questions. What exactly is it? Why do you need it? Will it be painful? As a gynaecologist, I perform this procedure regularly, and I want to walk you through everything so that you feel informed and reassured.

What Is Diagnostic Hysteroscopy?

A diagnostic hysteroscopy is a simple, minimally invasive procedure that allows me to examine the inside of your uterus using a thin, flexible camera. Unlike an ultrasound, which gives an overview, a hysteroscopy provides a clear, direct view of the womb lining. This helps in diagnosing and sometimes even treating certain conditions in the same session.

It’s a valuable tool that gives us more certainty when something isn’t quite right. It can confirm issues like endometrial polyps, uterine fibroids (which can cause heavy bleeding and periof pain), uterine adhesions, a uterine septum, or uterine conditions that may lead to recurrent miscarriage, helping to determine the best course of action.

Why Might You Need a Diagnostic Hysteroscopy?

Women come to me for a hysteroscopy for many reasons. You might be experiencing unusually heavy periods, irregular or abnormal uterine bleeding, or bleeding after menopause. If an ultrasound suggests something unusual—such as a thickened womb lining, fibroids, or a uterine polyp—a hysteroscopy can confirm these findings with more accuracy.

Some women also have this as a fertility surgery procedure – part of fertility investigations. If you’re trying to conceive and a uterine abnormality is suspected, a hysteroscopy can help us understand if anything is affecting implantation. In some cases, minor corrective procedures can be done at the same time, improving your chances of conception.

Ultrasound scanning is helpful in the process of diagnosing what’s causing abnormal bleeding, but in my experience, it’s probably only around 70% accurate. I recently had a patient who came to see me because she had experiencing irregular bleeding for months. She had an ultrasound, but everything seemed normal. However, when we performed a hysteroscopy, we discovered a small polyp that had been missed. I was able to remove it in the same session, and within a few weeks, her symptoms had resolved completely.

Menstruation. White woman lying on pink background. Female lining with red feather. Women's critical days.

What Happens During the Hysteroscopy Procedure?

Hysteroscopy can be done in two ways—either as an outpatient procedure while you’re awake or in a hospital setting under general anaesthesia.

For safety reasons, it’s crucial to confirm on the day of your appointment that you are not pregnant, so you’ll be asked to bring a first-morning urine sample which will be tested there and then. It is essential to use contraception from the start of your period until the procedure.

To help minimise discomfort, I recommend taking paracetamol beforehand. A nurse will be present throughout to offer support. Approximately an hour before the procedure, you will be given an anti-inflammatory suppository and a low dose of sublingual (under-the-tongue) misoprostol to help prepare the cervix. A dose of antibiotics will also be provided after the procedure.

During the procedure, you will be positioned on a couch with your legs supported, and a sheet will cover you from the waist down for privacy.

A speculum is gently inserted into the vagina to allow visibility of the cervix, which is then cleaned. A local anaesthetic, similar to those used in dental procedures, is administered to numb the cervix. The entire process typically lasts between 5 to 10 minutes.

A hysteroscope is carefully guided through the cervix, and sterile fluid is introduced to gently expand the uterine cavity, providing a clear view of the womb’s interior. This allows for the identification of any abnormalities, such as polyps. You may notice a slight sensation of wetness as the fluid drains out. If necessary, a small tissue sample (endometrial biopsy) can be taken, and polyps can be removed using a specialised shaver. If a coil (such as a Mirena coil for heavy bleeding or contraception) needs to be fitted, this can be done at the end of the hysteroscopy.

For most women, an outpatient hysteroscopy is a quick and efficient option. There’s no need for general anaesthesia, and you can usually go home soon after. Many women are surprised at how much easier it is than they expected. Some even choose to watch the procedure on the screen as I explain what I’m seeing in real-time.

If a more detailed procedure is needed—such as removing a larger polyp or fibroid—or if a patient prefers to be asleep for the process, then an in-theatre hysteroscopy (a day case procedure) under a general anaesthetic is the better choice.

Understanding Diagnostic Hysteroscopy A Guide for Women Experiencing Abnormal Bleeding

Does a Hysteroscopy Hurt?

This is one of the most common concerns I hear. The truth is that pain levels vary from woman to woman. Some describe mild cramping similar to a period, while others experience more discomfort.

If you’re worried about pain, we can discuss options for pain relief. During an outpatient hysteroscopy, we can use local anaesthetic and pain relief medication. If you prefer not to feel anything at all, the procedure can be done under general anaesthesia in a hospital setting.

How to Prepare for a Hysteroscopy

Preparing for the procedure is straightforward. If you’re having an outpatient hysteroscopy, you can eat and drink as usual. Taking a painkiller like ibuprofen an hour before your appointment can help with cramping. Wearing comfortable clothing and bringing a sanitary pad for light spotting afterwards is also a good idea.

If your hysteroscopy is being done under general anaesthesia, you’ll need to follow fasting instructions provided by the hospital and arrange for someone to take you home afterwards.

What to Expect After the Procedure?

Recovery is usually quick. You may experience mild cramping or light spotting for a day or two, but most women feel well enough to return to normal activities the same day or the next. If you notice heavy bleeding, severe pain, or fever, it’s important to contact your doctor.

Are There Any Risks?

Hysteroscopy is a very safe procedure, but like any medical procedure, there are some small risks. The most common is mild cramping or discomfort. Rare complications include infection or, in very rare cases, a small tear in the uterus. However, these risks are minimal, and the benefits of getting a clear diagnosis far outweigh them.

Many women choose private treatment because NHS waiting lists for hysteroscopy can be long. If you’re eager for answers, a private consultation allows you to get tested and treated much sooner.

Understanding Diagnostic Hysteroscopy A Guide for Women Experiencing Abnormal Bleeding

Final Thoughts: Should You Be Worried?

I completely understand that any medical procedure can feel daunting, but a diagnostic hysteroscopy is quick, safe, and highly effective. It provides answers, reassurance, and, in some cases, immediate treatment. If you have concerns about abnormal bleeding or your fertility, this could be the key to understanding what’s going on inside your uterus.

If you’d like to discuss your symptoms and whether a hysteroscopy is the right step for you, don’t hesitate to reach out. I’m here to help you feel confident about your health.

Book a Consultation Today

If you’re experiencing abnormal bleeding and need answers, a hysteroscopy might be the best step forward. Don’t wait for symptoms to worsen—schedule a consultation today.