Hysteroscopy Diagnosis & Treatment with Minimal Intervention

What is Diagnostic & Operative Hysteroscopy?

Diagnostic hysteroscopy is a minimally invasive gynecological procedure that allows the doctor to directly examine the inside of the uterus using a thin instrument called a hysteroscope. Through this, the doctor can detect and/or treat conditions such as polyps, fibroids, adhesions, or endometrial abnormalities — without the need for incisions or surgery.

An additional application of hysteroscopy that has proven useful in in vitro fertilization (IVF) cycles is operative hysteroscopy or endometrial scratching. This involves a gentle mechanical stimulation of the endometrial lining, which activates a localized regenerative and inflammatory response, potentially enhancing the chances of embryo implantation in subsequent IVF cycles.

Both diagnostic and operative hysteroscopy are completely safe, quick, typically painless procedures, performed either under local anesthesia or mild sedation, depending on the type and purpose of the intervention

When is Hysteroscopy Recommended?

Hysteroscopy is used both diagnostically and therapeutically and is recommended in cases such as:

Unexplained miscarriages or repeated implantation failures

Suspected benign tumors – polyps or fibroids – adhesions or uterine septum

Abnormal bleeding or menstrual irregularities

Postmenopausal bleeding

Extraction of intrauterine secretions for histological examination

Preparation for in vitro fertilization (IVF)

Removal of residual tissue after miscarriage

Removal of devices such as intrauterine contraceptives (IUDs)

What is the Hysteroscopy Procedure?

The procedure takes place in a specialized setting and is completed in just a few steps:

Preparation: Sterilization and application of local anesthesia or mild sedation are performed.

Insertion of Hysteroscope: The thin instrument is inserted through the vagina and cervix to reach the uterus.

Diagnosis or Intervention: Using a high-definition camera, the doctor examines the uterine cavity and may remove any polyps, cut adhesions, or perform endometrial scratching as needed.

The examination typically lasts 10 to 30 minutes depending on diagnostic findings. In most cases, hospitalization is not required and the patient can return to normal activities within a few hours.

What Are the Advantages & Disadvantages of Hysteroscopy?

Advantages

Minimally invasive procedure

Accurate diagnosis and immediate treatment

No incisions or stitches required

Immediate return to daily activities

Helpful before IVF to improve chances of success

Disadvantages

Mild discomfort immediately after the procedure, such as cramping or light bleeding

Rare complications like infection or cervical trauma

Scientific Data & Clinical Indications

Research shows that hysteroscopy before in vitro fertilization can improve implantation and pregnancy success rates, particularly in women with a history of failed attempts. Additionally, early detection and removal of polyps or fibroids helps regulate the cycle and resolve unexplained bleeding.

(Source: El-Toukhy et al., Fertility & Sterility, 2022)

Hysteroscopy and Menopause

Hysteroscopy is not only recommended for women of reproductive age but can also be extremely useful for women in menopause or perimenopause. In these cases, it may be used to investigate:

Postmenopausal bleeding, which is not considered normal and may indicate polyps, hyperplasia, or more serious pathology.

Endometrial thickening detected on ultrasound, which cannot be accurately assessed without visual confirmation.

Histological evaluation when a targeted biopsy is required.

Unlike other techniques such as blind curettage, hysteroscopy offers accurate and targeted diagnosis, avoiding unnecessary interventions. Thus, for women in menopause or perimenopause, hysteroscopy can offer reassurance and early-stage prevention

Hysteroscopy

Is hysteroscopy painful?

Hysteroscopy is generally not painful. Depending on the case and purpose, local anesthesia or mild sedation is applied, and most women experience only slight discomfort.

How long is the recovery period?

The patient returns to her daily activities immediately. However, mild bleeding or cramping may occur for 1–2 days after the hysteroscopy.

When should it be scheduled?

Preferably, hysteroscopy should be scheduled after menstruation so the endometrium is clean and visibility is optimal.

Are there any complications?

Complications are rare and include infections, bleeding, or minor trauma. An experienced doctor significantly reduces these risks.

What is the difference between diagnostic and operative hysteroscopy?

Diagnostic hysteroscopy is performed to observe and document possible abnormalities inside the uterus without intervention. In contrast, operative hysteroscopy involves direct treatment of any issue identified during diagnostic hysteroscopy, such as polyp removal, curettage, or adhesiolysis. Often, the procedure begins as diagnostic and proceeds to therapeutic if a correctable issue is found.

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Dr. Maria Oikonomou Obstetrician – Gynecologist

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Dr. Chrysostomos (Makis) Papadopoulos Obstetrician – Gynecologist, MD, PhDc, MIC I

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