Experiencing symptoms of endometrial cancer can be scary. If you have symptoms like unexpected vaginal bleeding or pelvic pain, you may need to get answers as quickly as possible. A hysteroscopy is one way to do that.

If your health care provider or oncology team has ordered a hysteroscopy, it’s important that you understand what the procedure is and what you can expect. That way, you’ll be able to take charge of your own health and understand your symptoms.

What Is a Hysteroscopy?

A hysteroscopy is a medical procedure where a health care provider looks inside your cervix and your uterus using a small scope. The scope is at the end of a rigid or flexible tube and usually has light on it to help your health care provider see your endometrium (intrauterine wall, or innermost lining of the uterus) and all of your uterine cavity.

Sometimes, health care providers use only a scope for the examination. Other times, they use additional tools to remove anything unusual that they find while they’re looking. This is called an endometrial biopsy. This is different from a dilation and curettage (D&C) procedure, which removes a larger amount of tissue than a hysteroscopy. Providers can combine a hysteroscopy with a D&C and other procedures.

To access your uterus, your health care provider will use a liquid or a gas to expand it before inserting the scope. This also flushes out any mucus inside so they can see clearly. This liquid is usually saline (sterile salt water).

Your health care provider may keep you awake and use a local anesthetic (numbing agent) during a hysteroscopy. Some health care providers may give you a more general anesthetic, a sedative, or both to help you rest. If other procedures in addition to the hysteroscopy are being performed, you may be more likely to get additional anesthesia.

A hysteroscopy is generally considered safe. About 1 percent of people experience negative side effects like infections, additional bleeding, damage or scarring to the inside of the uterus, or an allergic response to the anesthetic or the substance used to enlarge the uterus.

When Do You Need a Hysteroscopy?

A health care provider may use a hysteroscopy to determine the cause of abnormal bleeding, such as:

• Postmenopausal bleeding
• Bleeding between your periods
• Heavier or lighter periods than normal
• Shorter or longer cycles than normal

In some cases, health care providers can also use a hysteroscopy for other reasons, including:

• Identifying adhesions (bands of scar tissue) in your uterus from infections or surgery
• Determining the cause of recurrent miscarriages
• Finding an intrauterine device (IUD) that can’t be located by a conventional examination

A hysteroscopy may also be used to follow up on the results of other imaging tests. It gives health care providers a more complete visualization of what’s going on inside your uterus.

Note that hysteroscopy alone can’t diagnose endometrial cancer. Rather, it is an exam that allows your health care provider to see suspicious lesions (tissue damage or unusual growths). If your health care provider finds something abnormal during a hysteroscopy, they may remove it through the hysteroscope, or they may perform other procedures to remove it. They may then send the removed tissue sample to be tested for cancer cells.

If cancer cells are present, you will be diagnosed with endometrial cancer or another type of cancer, depending on what your health care team finds. You’ll also find out what grade the cancer is. Endometrial cancer is labeled grade 1 through grade 3. This is based on how different your cells are from normal endometrial cells. Based on these results, your health care provider will talk to you about how likely it is that your cancer has spread and what treatment options are right for you.

If your health care provider orders a hysteroscopy, it doesn’t mean you’re being diagnosed with endometrial cancer. Abnormal bleeding can also have noncancerous causes, like polyps or fibroids.

How To Prepare for a Hysteroscopy

You’re likely to get a lot of instructions before your hysteroscopy. These have to do with topics including:

• What medications you can take
• Whether you need to fast before the procedure
• What you should wear on the day of the procedure
• Whether you’ll need someone to drive you home afterwards

Your health care provider will tell you anything you need to know in advance.

What To Expect From a Hysteroscopy

Before your hysteroscopy, your health care provider should talk to you about the specifics of what will happen during the procedure. You’ll likely need to sign a consent form.

Your health care provider will probably ask questions about whether there is a chance you could be pregnant, what medications you’re taking, whether you have a bleeding disorder, and if you have any allergies to things like latex, medical tape, or anesthesia. If you haven’t gone through menopause, your medical team will also need to know when your last menstrual period was so they can schedule the procedure properly.

During Your Hysteroscopy

When you arrive at the procedure location, your health care provider may ask you to urinate and put on a hospital gown. They may place an IV line in your hand or lower arm.

You’ll be asked to lie down on a medical bed with your feet in stirrups, like you would for a normal pelvic exam. Most health care providers will start with a pelvic exam, then dilate (open) your cervix, insert the hysteroscope, and inflate your uterus with the liquid mentioned above.

Then, they’ll look at the endometrium. They will also be able to see the opening of your fallopian tubes. If they find anything unusual, they will likely remove it. If you’re having any other procedures done alongside your hysteroscopy, they’ll perform them at this time. When they’re done, they’ll remove the scope and help you wake up from the anesthesia, if needed.

Most hysteroscopies last somewhere from a few minutes to one hour. More complex procedures usually take longer.

Different people experience different levels of pain during and after a hysteroscopy. You may feel slightly more pain if you’re feeling anxious about the procedure or if you haven’t ever given birth. If you’re concerned about pain, talk to your health care provider ahead of time so you can make a plan together to effectively deal with any pain you might experience.

After Your Hysteroscopy

As long as you’re recovering normally, you should be able to go home the same day that you have a hysteroscopy, so it’s usually an outpatient procedure. If you’re having a reaction to the anesthesia or to something else, you may have to stay in a hospital overnight.

After the procedure, you might feel sick or like you’re going to faint, but this usually passes quickly. Light bleeding and cramping is normal for a few days, but call your health care provider if you find yourself in severe pain, or if you have heavy bleeding or a fever.

If you had other procedures done alongside your hysteroscopy, your health care provider may have additional instructions for you. Follow these instructions closely, because they’re based on the specific testing you had done.

Some health care providers will tell you not to douche or have sex for up to two weeks after a hysteroscopy. You may also have to avoid aspirin when treating your pain, as it can cause additional bleeding. Otherwise, you can go back to your normal routine as you feel up to it and as your health care provider allows.

Your Test Results

If your oncologist or gynecologist sent tissue samples to be tested, they’ll reach out to you when they hear back about your test results. At that point, they’ll advise you about what to do next and any additional steps you need to take, like cancer treatments. Otherwise, they may call you to follow up or to schedule a later appointment.

Talk With Others Who Understand

MyEndometrialCancerTeam is the social network for people with endometrial cancer and their loved ones. On MyEndometrialCancerTeam, members come together to ask questions, give advice, and share their stories with others who understand life with endometrial cancer.

If you’ve had a hysteroscopy, what was your experience like? Do you have any advice for people who are undergoing this procedure? Share your thoughts in the comments below, or start a conversation by posting on your Activities page.