Hysteroscopy in Chicago — Looking Inside the Uterus Without an Incision

Hysteroscopy is how we look inside the uterus. A thin lighted telescope, about the width of a drinking straw, passes through the vagina and cervix into the uterine cavity. Nothing is cut. There is no incision anywhere on your body.

It is the most direct way to answer questions that ultrasound can only guess at — and in many cases the same visit that finds the problem can fix it.

Diagnostic and operative hysteroscopy

Diagnostic hysteroscopy is purely a look. The uterus is gently distended with sterile fluid so the walls separate and the surgeon can see the cavity, the lining, and the openings of both fallopian tubes. It takes a few minutes and can often be done in the office with little or no anesthesia.

Operative hysteroscopy uses the same scope with a working channel, so instruments — small scissors, graspers, a tissue-removal device, or an electrosurgical loop — pass through it to treat what is found. The uterus is treated entirely from the inside.

The line between them often blurs in practice: a "see and treat" hysteroscopy finds a polyp and removes it in the same sitting.

Why hysteroscopy is done

Abnormal bleeding. Heavy periods, bleeding between periods, or any bleeding after menopause. Hysteroscopy shows the cause directly — polyps, fibroids inside the cavity, thickened or abnormal lining — and allows a targeted biopsy rather than a blind sampling. See menstrual issues and menopause management.

Polyps. Soft growths of the uterine lining, usually benign, frequently the reason for irregular bleeding. Hysteroscopic removal is definitive.

Submucosal fibroids. Fibroids bulging into the cavity cause bleeding and interfere with implantation out of proportion to their size. Removing them through the scope — hysteroscopic myomectomy — avoids any abdominal surgery. Larger or deeper fibroids may need myomectomy instead.

Infertility and recurrent pregnancy loss. Hysteroscopy identifies a uterine septum, intrauterine scar tissue (Asherman syndrome), or a cavity abnormality that imaging suggested but could not confirm, and corrects it. See infertility.

Retained tissue. Products of conception or placental tissue remaining after a miscarriage or delivery can be removed under direct vision, which is more precise and gentler on the lining than a blind procedure.

A lost or embedded IUD. When the strings cannot be found, hysteroscopy locates and retrieves the device. See birth control.

Repeated abnormal biopsies or thickened lining on ultrasound. Direct visualization plus targeted sampling gives a far more reliable answer.

What hysteroscopy cannot do

It only sees inside the uterine cavity. It does not evaluate the ovaries, the outside of the uterus, the pelvic walls, or endometriosis implants — that requires laparoscopy. Fibroids sitting mostly within the muscle wall or on the outer surface of the uterus are not reachable through the scope.

What to expect

Before. You may be asked to schedule the procedure in the week or so after your period, when the lining is thin and visibility is best. Pregnancy is ruled out. For operative cases a medication may be given to soften the cervix a few hours beforehand. If you are having sedation or general anesthesia, nothing to eat or drink after midnight and someone must drive you home.

Anesthesia options. Office diagnostic hysteroscopy is often done with no anesthesia or a local cervical block, with ibuprofen beforehand. Operative hysteroscopy is usually done under sedation or general anesthesia in a surgical setting. The choice depends on what is being treated, on cervical anatomy, and on your preference — this is worth discussing rather than accepting by default.

During. You are positioned as for a pelvic exam. A speculum is placed, the cervix cleaned and sometimes gently dilated, and the scope passed. Fluid distends the cavity. On a monitor you can, if you want, watch along. Diagnostic hysteroscopy takes about five to ten minutes; operative procedures typically fifteen to forty-five minutes.

After. Cramping like a strong period for a few hours. Light bleeding or watery pink discharge for several days up to a couple of weeks. Shoulder discomfort occasionally occurs from gas or fluid used during the procedure and passes on its own.

Recovery timeline

Same day: office diagnostic hysteroscopy — most women return to normal activity within a few hours. With sedation, plan to rest for the day and do not drive.
Days 1–2: cramping settles. Over-the-counter ibuprofen or acetaminophen is usually sufficient.
Days 2–7: back to work and routine activity for most patients after operative hysteroscopy.
1–2 weeks: light bleeding or discharge tapers off. Avoid tampons, douching, and intercourse until it stops or until your surgeon clears you — typically one to two weeks.
2 weeks onward: your next period may arrive early or late, and the first one or two may be heavier or lighter than usual.

Pathology results from anything removed generally come back within about a week, and we will call you with them.

Risks

Hysteroscopy is among the safest gynecologic procedures, but risk is not zero:

Infection, uncommon and usually treated with oral antibiotics
Bleeding, most often minor
Uterine perforation — the scope or an instrument creating a small hole in the uterine wall. It is the most common significant complication, usually heals without intervention, but occasionally requires laparoscopy to confirm nothing else was injured.
Cervical injury during dilation
Fluid overload, from absorption of the distending fluid during longer operative cases. This is why fluid is measured continuously and why long procedures are sometimes staged into two.
Intrauterine scarring after extensive operative work, which can itself affect fertility
Anesthesia-related risks, when sedation or general anesthesia is used

Call the office for fever over 100.4°F, heavy bleeding soaking a pad an hour, foul-smelling discharge, or severe abdominal pain that is not relieved by over-the-counter medication.

Alternatives to consider

Pelvic ultrasound, including saline infusion sonohysterography, can characterize the cavity non-invasively and is often the reasonable first step.
Office endometrial biopsy samples the lining without a scope, but it is blind — it can miss a focal lesion that hysteroscopy would see directly.
Medical management with hormonal therapy or a levonorgestrel IUD may control abnormal bleeding without any procedure, when cancer has been excluded.
Watchful waiting is legitimate for small, asymptomatic findings.

Hysteroscopy earns its place when imaging is ambiguous, when a focal lesion needs removing, or when a blind biopsy has already failed to explain your symptoms.

Book a consultation

Dr. Adeeb Alshahrour, MD, FACOG, is board certified in obstetrics and gynecology and practices at the Women's Health Center of Chicago, 4009 W Fullerton Ave. If you have been bleeding abnormally, have an unexplained finding on ultrasound, or are working through infertility, a consultation will establish whether hysteroscopy is the right next step — and whether a simpler test would answer the question first.

Book a consultation, review our locations, or read about Dr. Alshahrour and our gynecological surgery services.

Medical disclaimer

This page provides general health information and is not a substitute for personal medical advice. Whether hysteroscopy is appropriate depends on your symptoms, imaging, history, and goals, and can only be determined by a licensed physician who has evaluated you. Seek emergency care for heavy bleeding, high fever, or severe abdominal pain.