The chances are that if you are facing struggles with infertility or undergoing investigations surrounding certain symptoms linked to your womb such as abnormal bleeding, unusually heavy periods, pelvic pain, you might be referred for a procedure called a hysteroscopy. Having undergone a number myself I thought it might be helpful to share my first-hand experience.
My first hysteroscopy was done at the same time as a laparoscopy when I was being investigated for endometriosis. This was the first time my infertility was being mooted as potentially linked to a medical condition. Up until this point my husband and I had no idea why we weren’t getting pregnant naturally. We were throwing everything at it and still month after month, nothing. So, when our Gynecologist suggested a further look into what might be going on inside and I understood the procedure to be very routine, I actually welcomed this next part of the journey; to hopefully get some answers and a bespoke plan. The combined laparoscopy and hysteroscopy procedure took place and endometriosis was found.
I had then had subsequent hysteroscopies during my IVF journey as it transpired that I had a tricky and rather acute angle from cervix to womb that made passing a catheter through quite troublesome. Not ideal for IVF! So, for my IVF journey hysteroscopies were essential and used to help ensure that my tricky angles were really understood and that consultants were as familiar as possible, enabling smooth embryo transfers.
So what is a hysteroscopy?
A hysteroscopy is a largely straightforward procedure lasting between 20 - 60 minutes in which a surgeon will insert a tiny telescope, called a hysteroscope, through your vagina and into your uterus. A solution is then passed into the uterus to help expand the area for a clearer view while a light helps further investigation including in and around the openings to the fallopian tubes. The camera will show images of the inside of your uterus (the uterine cavity) onto a screen for them to be able to ascertain any medical findings. During the procedure, a surgeon may widen (dilate) your cervix to allow the hysteroscope to move through into the uterus. Hysteroscopies are quite fundamental if the ultrasound findings are abnormal or unclear when a woman is undergoing fertility investigations. It ensures direct sight of the inside of the uterus, the uterus lining, as well as the cervical canal and is important in helping detect any abnormalities that might impact pregnancy.
So, from a clinical perspective, hysteroscopies are often considered ‘minimally invasive’ and ‘routine’. That said, when a woman is undergoing a procedure to help identify or treat any medical issue, particularly those that are fertility-related, real care is needed to ensure she is fully supported and listened to throughout. Being regularly examined is part and parcel of the assisted fertility journey, but when each prod or poke will result in further understanding of your fertility picture. What might be seen as a standard approach, can quickly become a fundamental and deciding factor in a patient’s future outlook. Do share any concerns or fears you have with your doctor and they will be there to guide and support you all the way.
Why may you need a hysteroscopy?
As well as helping identify any potential conditions that could impact your ability to fall pregnant, the procedure can also be carried out on an operative basis where the surgeon may remove polyps, fibroids and adhesions, as well as take biopsies.
Do I need an anaesthetic for a hysteroscopy?
The procedure can range from being carried out with no anaesthetic to a full general anaesthetic depending on whether the purpose is to investigate, diagnose and/or treat a condition. You are unlikely to need an overnight stay in hospital. As with all medical investigations, experience really varies from patient to patient. I have never been awake during a hysteroscopy and am thankful for that. Some women can have them carried out with no anaesthetic and experience very little discomfort. Others can find them most uncomfortable. It is important to know that if you are awake and are in any pain during the operation, you can of course ask the surgeon to stop at any point.
What happens after a hysteroscopy?
Once I was recovering from my hysteroscopies, I would usually experience a dull, deep ache and some cramping (similar to period pain) for a few days, all completely normal. After some rest a sofa and a boxset on the television) over the following days, these side effects would subside. Some women do experience light bleeding/spotting too. The general advice is to avoid sex for a week after the procedure and most women return to normal activities including work within a day or two.
Be mindful though that every body and therefore every hysteroscopy is different and the best thing to do is to listen to your own body first and foremost both during and after.