diagnostic hysteroscopy

Diagnostic hysteroscopy has replaced "blind" D&C (dilatation and curettage, commonly referred to as a scrape) for the investigation of abnormal menstruation (e.g. heavy and/or prolonged periods), irregular bleeding (e.g. bleeding between periods, bleeding after intercourse, postmenopausal bleeding), and is also often done when assessing women with subfertility or recurrent pregnancy loss, and premature cessation of periods.

As diagnostic hysteroscopy is generally quick and not usually too uncomfortable, it is often done as an outpatient procedure; local anaesthesia can be given if it becomes too sore. Carbon dioxide gas or a liquid such as saline is used to distend the uterine cavity to give a clear view. The image is usually projected on to a television screen using a small video camera, which means that if you are awake, you can also follow the investigation.

Hysteroscopy allows us to examine the endometrium (lining of the uterus), tubal ostia (small channels on either side which lead to the fallopian tubes), the size and shape of the uterine cavity to make sure it is normal for pregnancy. The picture on the right shows a normal cavity, but we sometimes find polyps, fibroids, adhesions (scar tissue), septa (a midline division), or simply that the endometrium is unusually thickened. We can also inspect the canal of the cervix where we may find polyps. At the end of the procedure, a small biopsy may be taken from the endometrium, but you should hardly feel it.