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A. An OPH is a procedure that involves examining the inside of your uterus (womb). This is done by passing a thin telescope-like device, called a hysteroscope, that is fitted with a small camera through the neck of your womb (cervix).
The doctor doing the procedure can then see whether there are any problems inside your uterus that may need further investigation or treatment.
It may be possible for a minor procedure to be done at the same visit, such as:
A. You may have been referred for OPH for one of the following reasons:
The purpose of your appointment is to find the cause of your problem and plan or undertake treatment if needed.
A. You should eat and drink normally. It is recommended that you take pain relief (400 mg of ibuprofen or 1 gram of paracetamol or whatever pain relief you find useful for period pain) at least 1 hour before your appointment.
Bring a list of any medications that you are taking with you.
You may wish to have a friend or family member accompanying you.
A. The procedure must not be performed if there is any chance that you are pregnant. To avoid this possibility, it is important to use contraception or avoid sex between your last period and your appointment.
You may be offered a urine pregnancy test on arrival at your appointment.
A. It is best to keep the appointment. Sometimes it can be difficult to do the test if you are bleeding heavily. If you have any concerns, please speak to your doctor.
A. There may be other things to consider when deciding whether OPH is the right choice for you, such as:
You may choose to have your hysteroscopy with either a general or spinal anaesthetic. This will be done in an operating theatre, usually as a day care procedure.
You can discuss this option with your doctor.
You may choose not to have a hysteroscopy at all, though this may make it more difficult for your doctor to find the cause of your symptoms and to offer the right treatment for you. They may then recommend a scan and a biopsy to find out more information and/or may ask you to come back if your symptoms continue.
A. A hysteroscope is passed through the cervix to give a clear view of the inside of your uterus. No cuts are needed. Fluid (saline solution) is used to help see the inner lining of your uterus and you will feel wet as the fluid trickles back out.
If no problems are found, the actual procedure will only take about 10–15 minutes. Sometimes, a biopsy (small sample) from the lining of your uterus may be taken and sent to the laboratory for examination. The biopsy can be painful, but the pain should not last long.
If a fibroid or polyp is found, it can sometimes be removed at the same time by using additional instruments. You may be offered a local anaesthetic to make you more comfortable, particularly if a wider hysteroscope is to be used. Tell your doctor if the procedure is becoming painful.
During the OPH, your docotr will look inside your uterus on a screen and you can also watch the screen if you choose to. Photographs of the findings inside your uterus are often taken and kept in your healthcare notes.
A. The possible complications include:
A. For most women, OPH is quick and safe, and is carried out with little pain or discomfort. OPH is often done without inserting a speculum, by using a thin telescope (called vaginoscopic OPH) as this is more comfortable.
However, everyone’s experience of pain is different and some women will find the procedure very painful. If it is too painful for you, let your doctor know as the procedure can be stopped at any time if you wish.
Your doctor may offer a local anaesthetic injection into your cervix. This will require using a speculum to see your cervix and your healthcare professional will discuss this with you.
Some hospitals may offer nitrous oxide (Entonox or ‘gas and air’) to help with your pain. In this situation, you may be advised to wait a bit longer in the hospital for recovery before you can drive.
If you feel anxious about the procedure, you should talk to your healthcare professional before your appointment.
A. The actual procedure may only take 10–15 minutes. However, the total visit may take up to 1–2 hours including consultation, having the procedure and recovery. If polyps or small fibroids are removed at the same time, this may take a bit longer.
You can rest in the outpatient clinic’s recovery area for as long as you need (usually about 20 minutes).
A. You may get some period-like pain for 1–2 days. You may also have some spotting or fresh (bright red) bleeding that may last up to 1 week. These symptoms usually settle very quickly. Most women feel able to go back to their normal activities on the same day.
You can shower as normal.
Normal physical activity and sex can be resumed when any bleeding and discomfort has settled.
If needed, you can take pain relief such as 400 mg of ibuprofen every 8 hours or 1 gram of paracetamol every 4 hours, or your usual period pain tablets.
If your pain is not controlled with the above medication, you should contact your doctor.
A. If no problems are found, you may not need any follow-up appointments. If a biopsy has been taken, you will be contacted with the results as soon as they become available. Your doctor will discuss any further treatment with you.
A. Key points to remember are:
Possible risks with hysteroscopy include pain, feeling faint or sick, bleeding, infection and rarely uterine perforation (damage to the wall of the uterus). The risk of uterine perforation is lower during OPH than during hysteroscopy under general anaesthesia.