Hysteroscopy: What to Expect, How to Prepare, and Recovery
A hysteroscopy is an outpatient procedure that uses a small camera to look inside your uterus. Your doctor may recommend it to investigate abnormal bleeding, difficulty getting pregnant, or repeated pregnancy loss. Depending on the procedure, it can also be used to treat findings such as uterine polyps, certain fibroids, or scar tissue.
If you are getting a hysteroscopy, you deserve to understand more than the name of the procedure. Will you have anesthesia? Can your doctor treat something they find during the same appointment? What will recovery involve, and when can you try to get pregnant again?
I'm Dr. Natalie Crawford, a board certified OB/GYN and reproductive endocrinologist. Here is what I want you to understand before your hysteroscopy so you can ask informed questions and know what to expect.
IN THIS VIDEO:
00:00 Getting a hysteroscopy: What to expect
00:56 Hysteroscopy types and anesthesia options
02:04 How is a hysteroscopy performed?
03:46 What can a hysteroscopy detect?
04:38 Hysteroscopy for uterine polyp removal
05:27 Hysteroscopy vs. HSG and saline sonogram
05:55 Fibroid removal: Hysteroscopic myomectomy
06:57 Uterine scar tissue and infertility
08:02 Hysteroscopy after a failed embryo transfer
08:38 Retained tissue after miscarriage or delivery
09:02 Uterine septum and recurrent pregnancy loss
10:14 Hysteroscopy procedure day: How long does it take?
10:39 Hysteroscopy recovery: When can you try to get pregnant?
11:26 Cramping and spotting after hysteroscopy
11:38 Why take birth control pills before hysteroscopy?
What is a hysteroscopy?
A hysteroscopy allows your doctor to directly examine the uterine cavity, the space inside your uterus where an embryo implants.
During the procedure, your doctor places a speculum in the vagina and passes a long, thin camera through the cervix into the uterus. Fluid is used to gently separate the uterine walls so your doctor can see the cavity clearly on a screen.
That matters because the uterus is not an open triangle like the drawings you may have seen. Its walls normally rest against one another. A standard transvaginal ultrasound does not always show everything between those walls.
Looking inside with a camera gives your doctor a different view. It can reveal findings that may not be clear on a screening test.
Diagnostic vs. operative hysteroscopy: What is the difference?
A diagnostic hysteroscopy is used to look inside the uterus and identify a problem. An operative hysteroscopy allows your doctor to treat a problem using small instruments passed through the scope.
Some procedures combine diagnosis and treatment. Others are planned only to look, meaning a separate procedure may be needed if your doctor finds something that requires treatment.
In my practice, I prefer to be able to diagnose and treat during the same procedure when possible. That is why one of the most useful questions you can ask beforehand is:
“If you find something abnormal, will you be able to treat it right away, or would I need another procedure?”
Will you have anesthesia for a hysteroscopy?
Anesthesia varies by clinic and by the type of hysteroscopy being performed. Some clinics perform diagnostic hysteroscopy while you are awake, sometimes using local anesthesia such as a cervical block.
In my practice, we perform operative hysteroscopy with an anesthesiologist and IV sedation. I describe this as twilight sedation, similar to the sedation used for a colonoscopy.
Do not assume that every hysteroscopy will involve the same experience. Ask your care team what anesthesia or pain relief is planned for your specific procedure.
Why might your doctor recommend a hysteroscopy?
A hysteroscopy may be part of an evaluation for abnormal uterine bleeding, problems with embryo implantation, or recurrent pregnancy loss. What your doctor is looking for depends on your symptoms, medical history, and prior testing.
Uterine polyps
Endometrial polyps are growths inside the uterus. They can cause spotting between periods and may affect your ability to get or stay pregnant.
During an operative hysteroscopy, a doctor can use tiny instruments to grasp or cut a polyp and remove it while watching the procedure on the screen.
Fibroids that extend into the uterine cavity
Not every fibroid can be evaluated or removed with hysteroscopy. The relevant ones are fibroids that protrude into the uterine cavity, where they may interfere with embryo implantation.
Removing a fibroid this way is called a hysteroscopic myomectomy. Depending on the size of the fibroid and the area treated, your doctor may recommend additional steps to support healing afterward.
Scar tissue inside the uterus
Scar tissue can form inside the uterus after a pregnancy or prior uterine surgery. In the video, I discuss circumstances such as a prior D&C, pregnancy related infection, retained placental tissue, or surgery to remove fibroids.
Bands of scar tissue may need to be cut and removed during hysteroscopy. Sometimes their position makes them difficult to see on screening tests.
Retained tissue after miscarriage or delivery
Hysteroscopy may also be used to evaluate or remove retained pregnancy or placental tissue after a miscarriage or delivery.
Continued spotting or a pregnancy test that remains positive can prompt further evaluation. Your doctor will interpret those findings in the context of your recovery.
A uterine septum
A uterine septum is a piece of tissue dividing part of the uterine cavity that remains from the way the uterus formed before birth. It may not cause noticeable symptoms until someone experiences difficulty with pregnancy, including pregnancy loss.
Hysteroscopy can be used to remove a septum. In my practice, I typically use a uterine balloon and medications afterward to support healing, with a healing period of about four to six weeks.
What can a hysteroscopy not diagnose?
Hysteroscopy examines the inside of the uterine cavity. It does not evaluate everything in the pelvis.
It does not diagnose endometriosis outside the uterus, ovarian cysts, or adenomyosis in the uterine muscle. Although your doctor can see the openings of the fallopian tubes inside the uterus, hysteroscopy does not tell you whether those tubes are open.
Understanding these limits helps you know what questions the procedure can answer and why your doctor may recommend other testing as well.
Hysteroscopy vs. HSG vs. saline sonogram
These tests are related, but they do not give your doctor the same view.
HSG: Imaging with dye and X-rays
An HSG, or hysterosalpingogram, uses dye placed into the uterus and X-ray images. In the video, I describe it as a screening test that provides information about the uterine cavity.
Saline sonogram: Ultrasound with fluid
A saline sonogram uses fluid inside the uterus while ultrasound images are taken. Separating the uterine walls with fluid helps your doctor see the cavity more clearly. Like an HSG, it is a screening test rather than a direct look with a camera.
Hysteroscopy: A direct view inside the uterus
A hysteroscopy uses a small camera passed through the cervix to examine the uterine cavity directly. An operative hysteroscopy may also allow your doctor to treat a finding during the same procedure.
A normal screening test does not always mean there is nothing more to find. The location or shape of a small finding can make it easier to recognize with a camera than on an imaging test.
Why consider hysteroscopy after a failed embryo transfer?
If embryo transfers have not been successful, your doctor may discuss whether a closer look inside the uterus would be helpful, even if prior screening looked normal.
In the video, I share an example of a patient whose saline sonogram appeared normal. During hysteroscopy, we found small bands of scar tissue near the top of the uterus that had not been visible on the screening test.
That example illustrates why screening and direct examination are not interchangeable. It does not mean everyone with a failed transfer has scar tissue or that hysteroscopy guarantees a successful pregnancy. The decision depends on your individual situation.
How to prepare for a hysteroscopy
Preparation should start with understanding what procedure is planned and how your care team expects you to recover.
Before your appointment, ask:
Will this be a diagnostic or operative hysteroscopy?
What anesthesia or pain relief will I receive?
Can you treat a finding during the same procedure?
Will I need medication before or after the procedure?
Could I need a uterine balloon or other treatment to support healing?
What restrictions should I expect afterward?
When will we review the findings and discuss next steps?
Why might your doctor prescribe birth control pills beforehand?
In my practice, I often use birth control pills before hysteroscopy to keep the uterine lining thin. A thinner lining can make it easier to see and fully remove a finding such as a polyp.
I explain it like finding a tree stump in a yard: it is easier to see exactly where to work when the grass is freshly mowed than when it has grown tall.
If you are trying to get pregnant, taking birth control may feel counterintuitive. In this setting, it is a short term part of preparing for the procedure. Ask your doctor why it is being recommended in your case.
What happens on the day of a hysteroscopy?
For the procedure with IV sedation described in the video, you typically arrive about 30 minutes to one hour beforehand. You receive an IV and speak with the anesthesiologist before going to the procedure room or operating room.
The hysteroscopy itself typically takes about 15 to 30 minutes. Afterward, you spend approximately another 30 minutes to one hour in recovery while waking up.
These times describe the usual process in my practice. Your care team can tell you what to expect for your appointment.
Hysteroscopy recovery: Cramping, spotting, and restrictions
Some cramping on the day of the procedure and spotting for up to a week can occur. If a uterine balloon is placed, you may also notice pressure while it is in place.
Some patients may be able to work the next day, but your recovery plan depends on what was done. Removing a small polyp is not necessarily the same recovery as treating a larger fibroid, scar tissue, or a septum.
In some circumstances, I use a balloon to keep the uterine walls apart during healing, along with medications such as estrogen and antibiotics. Not everyone needs these steps.
When can you have sex or try to get pregnant again?
There is no single timeline that applies to every hysteroscopy. Your doctor may recommend avoiding intercourse while the uterus heals and will give you instructions about when to resume trying to conceive or proceed with fertility treatment.
The postoperative plan may not be finalized until your doctor knows what was found and treated.
Before you leave, make sure you understand:
Which medications you need and for how long.
What activity or intercourse restrictions apply to you.
Whether you need to wait for a period before trying again.
When your follow up appointment will take place.
When you can resume fertility treatment or attempts to conceive.
Frequently asked questions about hysteroscopy
Is hysteroscopy an outpatient procedure?
Yes. In the video, I describe hysteroscopy as a day surgery or outpatient procedure. If you have sedation, you spend time in recovery afterward while waking up.
Is hysteroscopy painful?
Your experience depends in part on the anesthesia or pain relief used. In my practice, patients receive IV sedation for operative hysteroscopy. Other clinics may perform diagnostic procedures while patients are awake. Cramping can occur afterward, so ask what to expect with your clinic's approach.
Can a hysteroscopy remove polyps or fibroids?
An operative hysteroscopy can remove uterine polyps and certain fibroids that protrude into the uterine cavity. Whether treatment can happen during your appointment depends on the planned procedure and the finding.
Can a hysteroscopy find endometriosis?
No. Hysteroscopy looks inside the uterine cavity. It does not diagnose endometriosis outside the uterus.
Can you need a hysteroscopy after a normal saline sonogram?
Sometimes. A saline sonogram is a screening test, while hysteroscopy provides a direct view. In certain circumstances, including failed embryo transfers, your doctor may discuss hysteroscopy even when screening results were normal.
How soon can you get pregnant after hysteroscopy?
The timing depends on what was found, what treatment was performed, and how your uterus needs to heal. Ask your doctor for a specific plan rather than assuming you can try immediately or that everyone needs the same waiting period.
The takeaway: Know the purpose and the plan
Hysteroscopy can help your doctor understand what is happening inside your uterus and, in some cases, treat a problem during the same procedure. Its value comes from answering a specific question about your bleeding, uterine cavity, or fertility care.
Before your appointment, focus on three things: why the procedure is being recommended, whether treatment can happen at the same time, and what your recovery plan will involve. Understanding those details can help you feel more prepared and take an active role in your care.
For a deeper understanding of your hormones, fertility, and reproductive health, explore The Fertility Formula.