What is the procedure for a hysteroscopy?

During a hysteroscopy, a thin, lighted telescopic instrument called a hysteroscope is gently inserted through the vagina and cervix into the uterine cavity—no incisions are required. Prior to the procedure, the cervix may be dilated slightly using medication or mechanical dilators, especially if the patient has not given birth vaginally or if the cervical canal is particularly narrow. To visualize the endometrial lining clearly, the uterus is distended with either a sterile saline solution or carbon dioxide gas, which separates the anterior and posterior walls of the uterine cavity. The hysteroscope transmits real-time images to a video monitor, allowing the clinician to systematically examine the cervical os, endocervical canal, endometrial surface, tubal ostia (openings of the fallopian tubes), and any anatomical variations or abnormalities such as polyps, submucosal fibroids, adhesions (Asherman syndrome), or congenital malformations like a septate or bicornuate uterus. If indicated, diagnostic hysteroscopy can be combined with operative interventions—including polypectomy, myomectomy, adhesiolysis, or endometrial biopsy—using specialized instruments passed through the hysteroscope’s working channel. The procedure is typically performed in an outpatient setting under local anesthesia, conscious sedation, or general anesthesia, depending on patient factors, anticipated complexity, and institutional protocols.