Hysteroscopy in Delhi, India

Hysteroscopy is a medical procedure that allows doctors to examine the inside of the uterus using a thin, lighted instrument called a hysteroscope. It helps detect abnormalities such as fibroids, polyps, scar tissue, or unusual bleeding. The procedure can be purely diagnostic, to understand the cause of symptoms, or operative, allowing doctors to treat certain conditions at the same time. Hysteroscopy is minimally invasive, generally quick, and usually performed on an outpatient basis, which means most patients can go home the same day. It provides a clear view of the uterine cavity, helping doctors make accurate diagnoses and plan appropriate treatment.

Hysteroscopy can be broadly divided into two types:

Diagnostic Hysteroscopy

Diagnostic hysteroscopy is used primarily to examine the inside of the uterus and identify any abnormalities. It helps doctors understand the cause of symptoms such as abnormal uterine bleeding, infertility, recurrent miscarriages, or menstrual irregularities. During this procedure, a thin, lighted instrument called a hysteroscope is inserted through the vagina and cervix to provide a clear view of the uterine cavity. No major surgical intervention is performed, and the procedure is usually quick and minimally uncomfortable.

Operative Hysteroscopy

Operative hysteroscopy goes a step further by allowing treatment of certain conditions during the procedure itself. Doctors can remove fibroids, polyps, adhesions, or scar tissue, and address other structural issues of the uterus. This approach reduces the need for multiple procedures, shortens recovery time, and is generally performed on an outpatient basis. Operative hysteroscopy is slightly longer than diagnostic hysteroscopy but still minimally invasive and effective in resolving many uterine problems.

Hysteroscopy is recommended when there is a need to examine the uterus for abnormalities or treat certain conditions. Some common reasons include:

• Abnormal Uterine Bleeding: Irregular, heavy, or prolonged menstrual bleeding may indicate polyps, fibroids, or other uterine problems that can be assessed with hysteroscopy.
• Infertility Evaluation: For women experiencing difficulty in conceiving, hysteroscopy helps detect issues such as uterine adhesions, septum, or other structural abnormalities that may affect fertility.
• Recurrent Miscarriages: Repeated pregnancy loss can sometimes be caused by problems inside the uterus, which hysteroscopy can identify and, in some cases, treat.
• Polyp or Fibroid Removal: Small growths in the uterus, such as polyps or fibroids, can be removed during operative hysteroscopy.
• Scar Tissue (Asherman’s Syndrome): Adhesions or scar tissue inside the uterus can be detected and treated to restore normal uterine function.
• Post-Menopausal Bleeding: Any unusual bleeding after menopause may require hysteroscopy to rule out serious conditions.
• Evaluation Before or After Treatment: Hysteroscopy can be used to assess the uterus before fertility treatments or to check the effectiveness of previous interventions.

Before a hysteroscopy, there are several aspects of the procedure and preparation that patients are usually informed about. Knowing these in advance can help reduce anxiety and make the experience smoother:

• Consultation with Your Doctor: The doctor will review your medical history, discuss symptoms, and explain why hysteroscopy is recommended. Any questions or concerns can be addressed during this visit.
• Medical Tests: Routine blood tests or imaging, such as an ultrasound, may be suggested to check overall health and understand the uterus’s condition.
• Medication Guidance: Your doctor may provide instructions regarding current medications, including blood thinners, which might need to be adjusted.
• Menstrual Cycle Timing: For some cases, hysteroscopy is scheduled at a specific time in the menstrual cycle for better visibility of the uterine lining.
• Fasting Instructions: Depending on the type of anaesthesia, you may be asked to avoid food or drink for a few hours before the procedure.
• Arrangements for the Day: It is advisable to arrange for someone to accompany you, especially if sedation or general anaesthesia is used. Comfortable clothing and minimal jewellery help make the visit easier.

A hysteroscopy is usually straightforward and minimally invasive. Here’s what patients can typically expect:

• Anaesthesia Administration: The procedure begins with the administration of anaesthesia. Local anaesthesia numbs the cervix, sedation helps patients relax, and general anaesthesia may be used for operative hysteroscopy or longer procedures. The type of anaesthesia depends on the complexity of the procedure and the patient’s needs.
• Cervical Preparation: The cervix may be gently dilated using special instruments if necessary. This allows smooth passage of the hysteroscope into the uterine cavity.
• Insertion of the Hysteroscope: A thin, lighted tube called a hysteroscope is carefully inserted through the vagina and cervix. The hysteroscope is connected to a camera and monitor, providing a clear, magnified view of the uterine lining.
• Expansion of the Uterus: To improve visibility, the uterus is usually expanded using saline or carbon dioxide gas. This helps the doctor examine the uterine walls and detect any abnormalities more clearly.
• Examination of the Uterine Cavity: The doctor systematically inspects the entire uterine cavity, checking for polyps, fibroids, adhesions, or other structural abnormalities. Detailed assessment ensures accurate diagnosis.
• Operative Procedure (if required): If any issues are found, small instruments can be passed through the hysteroscope to remove polyps, fibroids, or scar tissue. Adhesions can also be cut or treated during this stage.
• Completion of the Procedure: After the examination and any necessary treatment, the hysteroscope and instruments are carefully withdrawn. The uterus returns to its normal state, and the procedure is concluded.

Diagnostic hysteroscopy generally takes 5–15 minutes. Operative hysteroscopy may take 20–60 minutes, depending on the extent of treatment needed.

After a hysteroscopy, patients may experience some mild and temporary effects as the body recovers from the procedure. Here’s what is typically expected:

• Recovery Period: Patients are usually monitored for a short time in a recovery area immediately after the procedure, especially if sedation or general anaesthesia was used. Vital signs are checked to ensure stability before discharge.
• Mild Discomfort or Cramping: Some patients may feel light cramping or pelvic discomfort similar to menstrual cramps. This usually eases within a day or two.
• Spotting or Light Bleeding: It is common to notice light vaginal bleeding or spotting for a few days after the procedure, particularly if operative hysteroscopy was performed.
• Resuming Daily Activities: Most patients can resume normal activities within 24 hours. Strenuous exercise, heavy lifting, or sexual activity may be advised against for a short period depending on the extent of the procedure.
• Pain Management: Over-the-counter pain relievers may be recommended to manage mild discomfort. Any severe or persistent pain should be reported to a doctor immediately.
• Follow-Up Appointment: A follow-up visit is usually scheduled to review findings, discuss results, and plan any further treatment if necessary.

Hysteroscopy is generally considered a safe procedure, but like any medical intervention, it carries some potential risks. Understanding these risks can help patients make informed decisions and know what to watch for after the procedure.

1. Infection

Although rare, there is a small risk of developing a uterine or pelvic infection after hysteroscopy. Signs may include fever, foul-smelling discharge, or persistent pelvic pain. Prompt medical attention and antibiotics can effectively treat infections.

2. Bleeding

Some light bleeding or spotting is normal after the procedure, especially following operative hysteroscopy. In rare cases, heavy or prolonged bleeding may occur, requiring medical evaluation.

3. Uterine Perforation

During the insertion of the hysteroscope or operative instruments, there is a minimal risk of puncturing the uterine wall. Uterine perforation is uncommon and usually heals on its own, but severe cases may require further treatment or surgery.

4. Damage to Surrounding Organs

In very rare situations, instruments may accidentally injure nearby organs such as the bladder, bowel, or blood vessels. Careful technique and experienced surgeons greatly reduce this risk.

5. Fluid Overload

During hysteroscopy, fluid is used to expand the uterus for better visibility. Excessive absorption of this fluid can cause temporary fluid imbalance in the body. This is very uncommon and monitored closely during the procedure.

6. Adhesions or Scar Tissue Formation

Although hysteroscopy can treat existing adhesions, in some cases, scar tissue may develop after the procedure. Follow-up care helps detect and manage any recurrence.

7. Anaesthesia-Related Risks

If sedation or general anaesthesia is used, there are minimal risks related to allergic reactions or complications from the anaesthetic. These are rare and are carefully managed by the medical team.

Can hysteroscopy affect fertility in the future?

Hysteroscopy is generally safe and does not negatively affect fertility. In many cases, it can actually improve the chances of conception by diagnosing or treating uterine problems such as polyps, fibroids, adhesions, or scar tissue that may interfere with implantation or pregnancy. Operative hysteroscopy allows correction of these issues, often in the same session.

Is the procedure suitable for women of all ages?

Hysteroscopy can be performed in women of all age groups, from young women experiencing menstrual irregularities to post-menopausal women with abnormal bleeding. The doctor evaluates individual health, reproductive goals, and uterine condition to determine the safest and most effective approach.

Can hysteroscopy be done during menstruation?

While it is usually preferred to perform hysteroscopy after menstruation when the uterine lining is thin for clearer visibility, the procedure can sometimes be performed during menstruation if urgent evaluation is required. Your doctor will determine the optimal timing based on your condition.

How soon after a hysteroscopy can a patient try to conceive?

After a diagnostic hysteroscopy, patients can generally attempt conception in their next normal menstrual cycle. For operative hysteroscopy, a short waiting period (usually one to two cycles) is often recommended to allow the uterus to heal and reduce any risk of complications. Your doctor will provide personalized guidance based on the treatment performed.

Will hysteroscopy cause long-term changes in menstrual cycles?

Most patients do not experience long-term changes in their cycles. Temporary spotting, light bleeding, or mild cramping may occur for a few days after the procedure. In rare cases where extensive operative procedures are performed, minor changes may occur but typically resolve over time.

Is hysteroscopy painful, and what pain relief is available?

Some patients may feel mild cramping or pressure during the procedure. The type of anaesthesia is chosen based on the procedure type and patient comfort. Pain after the procedure is usually mild and short-lived and can often be managed with over-the-counter pain relief. Severe or persistent pain should be reported to a doctor immediately.

How soon can normal work or daily activities be resumed?

Most patients can return to normal activities within 24 hours. Light work and routine activities are usually safe, but strenuous exercise, heavy lifting, or sexual activity may need to be avoided for a few days after operative hysteroscopy, depending on the treatment performed.

Are there any restrictions on diet or lifestyle after the procedure?

There are generally no strict dietary restrictions. Patients are advised to stay hydrated and maintain a balanced diet. Avoiding heavy physical activity for a short period and following any additional instructions from the doctor helps support recovery.

Can hysteroscopy detect early signs of cancer or pre-cancerous changes?

Hysteroscopy provides a direct view of the uterine lining and can help detect abnormal growths, lesions, or suspicious tissue. Biopsies can be performed during the procedure if needed, allowing early detection and timely treatment of cancerous or pre-cancerous changes.

How is hysteroscopy different from other uterine imaging tests like ultrasound or MRI?

Ultrasound and MRI provide images of the uterus but cannot allow treatment. Hysteroscopy provides a direct view of the uterine cavity and, in many cases, enables simultaneous treatment. It is more accurate for detecting small lesions, adhesions, polyps, or fibroids that may be missed by imaging tests.

Will there be scarring after hysteroscopy?

Hysteroscopy is minimally invasive and typically does not cause scarring. Minor internal scarring can occur in some cases after operative procedures, but it rarely affects uterine function or fertility. Any scar tissue formation is usually monitored during follow-up visits.

How often is follow-up required after the procedure?

Follow-up depends on the type of hysteroscopy and findings. For diagnostic procedures, a single follow-up may be sufficient. After operative hysteroscopy, follow-ups may be scheduled to monitor healing, assess treatment success, and ensure there are no complications or recurrence of abnormalities.

Are there any alternatives to hysteroscopy for diagnosing or treating uterine problems?

Alternatives for diagnosis include ultrasound, MRI, and sonohysterography. However, these methods do not allow treatment. Hysteroscopy is preferred when both diagnosis and treatment are needed, as it provides direct visualization and immediate correction of certain uterine issues.

Can hysteroscopy be repeated if needed, and is it safe to do so?

Yes, hysteroscopy can be safely repeated if necessary. Doctors usually recommend waiting for a safe interval to allow the uterus to heal, especially after operative hysteroscopy. Repeat procedures are often needed for monitoring, treating recurrent problems, or further evaluation.

Reviewed by Dr. Anuradha Kapur, Principal Director (Obstetrics & Gynaecology) & Head of UnitObstetrics And Gynaecology, Robotic Surgery, Gynaecologic Laparoscopy, on 02 February 2026