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Overview of hysteroscopy

Linda D Bradley, MD
Section Editor
Tommaso Falcone, MD, FRCSC, FACOG
Deputy Editor
Kristen Eckler, MD, FACOG


The development of hysteroscopy has provided a minimally invasive approach to common gynecologic problems, such as abnormal uterine bleeding. Increased clinician training, smaller diameter hysteroscopes, and increased emphasis on office-based procedures have led to a widespread use of this important technology.

A hysteroscope is a telescope that is inserted into the uterus via the vagina and cervix to visualize the endometrial cavity, as well as the tubal ostia, endocervical canal, cervix, and vagina. Hysteroscopy can be performed for diagnostic or therapeutic indications.

An overview of hysteroscopy is presented here. Vaginoscopy is discussed separately. (See "Vaginoscopy".)


Hysteroscopy is performed for evaluation or treatment of the endometrial cavity, tubal ostia, or endocervical canal in women with:

Abnormal premenopausal or postmenopausal uterine bleeding

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Literature review current through: Nov 2017. | This topic last updated: Nov 06, 2017.
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  1. Price TM, Harris JB. Fulminant hepatic failure due to herpes simplex after hysteroscopy. Obstet Gynecol 2001; 98:954.
  2. Hatfield JL, Brumsted JR, Cooper BC. Conservative treatment of placenta accreta. J Minim Invasive Gynecol 2006; 13:510.
  3. Hinckley MD, Milki AA. 1000 office-based hysteroscopies prior to in vitro fertilization: feasibility and findings. JSLS 2004; 8:103.
  4. Shalev J, Levi T, Orvieto R, et al. Emergency hysteroscopic treatment of acute severe uterine bleeding. J Obstet Gynaecol 2004; 24:152.
  5. Cicinelli E, Parisi C, Galantino P, et al. Reliability, feasibility, and safety of minihysteroscopy with a vaginoscopic approach: experience with 6,000 cases. Fertil Steril 2003; 80:199.
  6. De Angelis C, Santoro G, Re ME, Nofroni I. Office hysteroscopy and compliance: mini-hysteroscopy versus traditional hysteroscopy in a randomized trial. Hum Reprod 2003; 18:2441.
  7. Unfried G, Wieser F, Albrecht A, et al. Flexible versus rigid endoscopes for outpatient hysteroscopy: a prospective randomized clinical trial. Hum Reprod 2001; 16:168.
  8. Barbot J, Parent B, Dubuisson JB. Contact hysteroscopy: another method of endoscopic examination of the uterine cavity. Am J Obstet Gynecol 1980; 136:721.
  9. Vilos GA, Brown S, Graham G, et al. Genital tract electrical burns during hysteroscopic endometrial ablation: report of 13 cases in the United States and Canada. J Am Assoc Gynecol Laparosc 2000; 7:141.
  10. Phillips DR, Milim SJ, Nathanson HG, et al. Preventing hyponatremic encephalopathy: comparison of serum sodium and osmolality during operative hysteroscopy with 5.0% mannitol and 1.5% glycine distention media. J Am Assoc Gynecol Laparosc 1997; 4:567.
  11. Vilos GA, Abu-Rafea B. New developments in ambulatory hysteroscopic surgery. Best Pract Res Clin Obstet Gynaecol 2005; 19:727.
  12. Readman E, Maher PJ. Pain relief and outpatient hysteroscopy: a literature review. J Am Assoc Gynecol Laparosc 2004; 11:315.
  13. Marsh FA, Rogerson LJ, Duffy SR. A randomised controlled trial comparing outpatient versus daycase endometrial polypectomy. BJOG 2006; 113:896.
  14. Kremer C, Duffy S, Moroney M. Patient satisfaction with outpatient hysteroscopy versus day case hysteroscopy: randomised controlled trial. BMJ 2000; 320:279.
  15. Nagele F, Lockwood G, Magos AL. Randomised placebo controlled trial of mefenamic acid for premedication at outpatient hysteroscopy: a pilot study. Br J Obstet Gynaecol 1997; 104:842.
  16. Tam WH, Yuen PM. Use of diclofenac as an analgesic in outpatient hysteroscopy: a randomized, double-blind, placebo-controlled study. Fertil Steril 2001; 76:1070.
  17. Mercorio F, De Simone R, Landi P, et al. Oral dexketoprofen for pain treatment during diagnostic hysteroscopy in postmenopausal women. Maturitas 2002; 43:277.
  18. Teran-Alonso MJ, De Santiago J, Usandizaga R, Zapardiel I. Evaluation of pain in office hysteroscopy with prior analgesic medication: a prospective randomized study. Eur J Obstet Gynecol Reprod Biol 2014; 178:123.
  19. Issat T, Beta J, Nowicka MA, et al. A randomized, single blind, placebo-controlled trial for the pain reduction during the outpatient hysteroscopy after ketoprofen or intravaginal misoprostol. J Minim Invasive Gynecol 2014; 21:921.
  20. Luscombe KS, McDonnell NJ, Muchatuta NA, et al. A randomised comparison of parecoxib versus placebo for pain management following minor day stay gynaecological surgery. Anaesth Intensive Care 2010; 38:141.
  21. Ahmad G, Saluja S, O'Flynn H, et al. Pain relief for outpatient hysteroscopy. Cochrane Database Syst Rev 2017.
  22. Hassan A, Wahba A, Haggag H. Tramadol versus Celecoxib for reducing pain associated with outpatient hysteroscopy: a randomized double-blind placebo-controlled trial. Hum Reprod 2016; 31:60.
  23. Hassan A, Haggag H. Role of oral tramadol 50 mg in reducing pain associated with outpatient hysteroscopy: A randomised double-blind placebo-controlled trial. Aust N Z J Obstet Gynaecol 2016; 56:102.
  24. Grow DR, Iromloo K. Oral contraceptives maintain a very thin endometrium before operative hysteroscopy. Fertil Steril 2006; 85:204.
  25. Vercellini P, Perino A, Consonni R, et al. Treatment with a gonadotrophin releasing hormone agonist before endometrial resection: a multicentre, randomised controlled trial. Br J Obstet Gynaecol 1996; 103:562.
  26. Donnez J, Vilos G, Gannon MJ, et al. Goserelin acetate (Zoladex) plus endometrial ablation for dysfunctional uterine bleeding: a large randomized, double-blind study. Fertil Steril 1997; 68:29.
  27. Fedele L, Bianchi S, Gruft L, et al. Danazol versus a gonadotropin-releasing hormone agonist as preoperative preparation for hysteroscopic metroplasty. Fertil Steril 1996; 65:186.
  28. Marchini M, Fedele L, Bianchi S, et al. Endometrial patterns during therapy with danazol or gestrinone for endometriosis: structural and ultrastructural study. Hum Pathol 1992; 23:51.
  29. Cicinelli E, Pinto V, Tinelli R, et al. Rapid endometrial preparation for hysteroscopic surgery with oral desogestrel plus vaginal raloxifene: a prospective, randomized pilot study. Fertil Steril 2007; 88:698.
  30. Bradley LD. Complications in hysteroscopy: prevention, treatment and legal risk. Curr Opin Obstet Gynecol 2002; 14:409.
  31. Al-Fozan H, Firwana B, Al Kadri H, et al. Preoperative ripening of the cervix before operative hysteroscopy. Cochrane Database Syst Rev 2015; :CD005998.
  32. da Costa AR, Pinto-Neto AM, Amorim M, et al. Use of misoprostol prior to hysteroscopy in postmenopausal women: a randomized, placebo-controlled clinical trial. J Minim Invasive Gynecol 2008; 15:67.
  33. Oppegaard KS, Lieng M, Berg A, et al. A combination of misoprostol and estradiol for preoperative cervical ripening in postmenopausal women: a randomised controlled trial. BJOG 2010; 117:53.
  34. Ngai SW, Chan YM, Ho PC. The use of misoprostol prior to hysteroscopy in postmenopausal women. Hum Reprod 2001; 16:1486.
  35. Fung TM, Lam MH, Wong SF, Ho LC. A randomised placebo-controlled trial of vaginal misoprostol for cervical priming before hysteroscopy in postmenopausal women. BJOG 2002; 109:561.
  36. Barcaite E, Bartusevicius A, Railaite DR, Nadisauskiene R. Vaginal misoprostol for cervical priming before hysteroscopy in perimenopausal and postmenopausal women. Int J Gynaecol Obstet 2005; 91:141.
  37. Batukan C, Ozgun MT, Ozcelik B, et al. Cervical ripening before operative hysteroscopy in premenopausal women: a randomized, double-blind, placebo-controlled comparison of vaginal and oral misoprostol. Fertil Steril 2008; 89:966.
  38. Nada AM, Elzayat AR, Awad MH, et al. Cervical Priming by Vaginal or Oral Misoprostol Before Operative Hysteroscopy: A Double-Blind, Randomized Controlled Trial. J Minim Invasive Gynecol 2016; 23:1107.
  39. Fouda UM, Gad Allah SH, Elshaer HS. Optimal timing of misoprostol administration in nulliparous women undergoing office hysteroscopy: a randomized double-blind placebo-controlled study. Fertil Steril 2016; 106:196.
  40. Karakus S, Akkar OB, Yildiz C, et al. Comparison of Effectiveness of Laminaria versus Vaginal Misoprostol for Cervical Preparation Before Operative Hysteroscopy in Women of Reproductive Age: A Prospective Randomized Trial. J Minim Invasive Gynecol 2016; 23:46.
  41. ACOG Committee on Practice Bulletins--Gynecology. ACOG practice bulletin No. 104: Antibiotic prophylaxis for gynecologic procedures. Obstet Gynecol 2009; 113:1180. Reaffirmed 2016.
  42. Allen RH, Micks E, Edelman A. Pain relief for obstetric and gynecologic ambulatory procedures. Obstet Gynecol Clin North Am 2013; 40:625.
  43. Giorda G, Scarabelli C, Franceschi S, Campagnutta E. Feasibility and pain control in outpatient hysteroscopy in postmenopausal women: a randomized trial. Acta Obstet Gynecol Scand 2000; 79:593.
  44. Angioli R, De Cicco Nardone C, Plotti F, et al. Use of music to reduce anxiety during office hysteroscopy: prospective randomized trial. J Minim Invasive Gynecol 2014; 21:454.
  45. De Iaco P, Marabini A, Stefanetti M, et al. Acceptability and pain of outpatient hysteroscopy. J Am Assoc Gynecol Laparosc 2000; 7:71.
  46. Kremer C, Barik S, Duffy S. Flexible outpatient hysteroscopy without anaesthesia: a safe, successful and well tolerated procedure. Br J Obstet Gynaecol 1998; 105:672.
  47. Broadbent JA, Hill NC, Molnár BG, et al. Randomized placebo controlled trial to assess the role of intracervical lignocaine in outpatient hysteroscopy. Br J Obstet Gynaecol 1992; 99:777.
  48. Tangsiriwatthana T, Sangkomkamhang US, Lumbiganon P, Laopaiboon M. Paracervical local anaesthesia for cervical dilatation and uterine intervention. Cochrane Database Syst Rev 2013; :CD005056.
  49. Bettocchi S, Ceci O, Di Venere R, et al. Advanced operative office hysteroscopy without anaesthesia: analysis of 501 cases treated with a 5 Fr. bipolar electrode. Hum Reprod 2002; 17:2435.
  50. Floris S, Piras B, Orrù M, et al. Efficacy of intravenous tramadol treatment for reducing pain during office diagnostic hysteroscopy. Fertil Steril 2007; 87:147.
  51. Cooper NA, Smith P, Khan KS, Clark TJ. Vaginoscopic approach to outpatient hysteroscopy: a systematic review of the effect on pain. BJOG 2010; 117:532.
  52. Sagiv R, Sadan O, Boaz M, et al. A new approach to office hysteroscopy compared with traditional hysteroscopy: a randomized controlled trial. Obstet Gynecol 2006; 108:387.
  53. Guida M, Di Spiezio Sardo A, Acunzo G, et al. Vaginoscopic versus traditional office hysteroscopy: a randomized controlled study. Hum Reprod 2006; 21:3253.
  54. Garbin O, Kutnahorsky R, Göllner JL, Vayssiere C. Vaginoscopic versus conventional approaches to outpatient diagnostic hysteroscopy: a two-centre randomized prospective study. Hum Reprod 2006; 21:2996.
  55. Sharma M, Taylor A, di Spiezio Sardo A, et al. Outpatient hysteroscopy: traditional versus the 'no-touch' technique. BJOG 2005; 112:963.
  56. Comparative trial of tubal insufflation, hysterosalpingography, and laparoscopy with dye hydrotubation for assessment of tubal patency. World Health Organization. Fertil Steril 1986; 46:1101.
  57. Data from Conceptus Incorporated, San Carlos, CA.
  58. Loffer FD. Hysteroscopy with selective endometrial sampling compared with D&C for abnormal uterine bleeding: the value of a negative hysteroscopic view. Obstet Gynecol 1989; 73:16.
  59. Clark TJ, Voit D, Gupta JK, et al. Accuracy of hysteroscopy in the diagnosis of endometrial cancer and hyperplasia: a systematic quantitative review. JAMA 2002; 288:1610.
  60. Phillips DR, Nathanson HG, Milim SJ, Haselkorn JS. The effect of dilute vasopressin solution on the force needed for cervical dilatation: a randomized controlled trial. Obstet Gynecol 1997; 89:507.
  61. Hobo R, Netsu S, Koyasu Y, Tsutsumi O. Bradycardia and cardiac arrest caused by intramyometrial injection of vasopressin during a laparoscopically assisted myomectomy. Obstet Gynecol 2009; 113:484.
  62. Pellicano M, Guida M, Zullo F, et al. Carbon dioxide versus normal saline as a uterine distension medium for diagnostic vaginoscopic hysteroscopy in infertile patients: a prospective, randomized, multicenter study. Fertil Steril 2003; 79:418.
  63. Aydeniz B, Gruber IV, Schauf B, et al. A multicenter survey of complications associated with 21,676 operative hysteroscopies. Eur J Obstet Gynecol Reprod Biol 2002; 104:160.
  64. Jansen FW, Vredevoogd CB, van Ulzen K, et al. Complications of hysteroscopy: a prospective, multicenter study. Obstet Gynecol 2000; 96:266.
  65. Shveiky D, Rojansky N, Revel A, et al. Complications of hysteroscopic surgery: "Beyond the learning curve". J Minim Invasive Gynecol 2007; 14:218.
  66. Agostini A, Cravello L, Bretelle F, et al. Risk of uterine perforation during hysteroscopic surgery. J Am Assoc Gynecol Laparosc 2002; 9:264.
  67. Hulka JF, Peterson HB, Phillips JM, Surrey MW. Operative hysteroscopy. American Association of Gynecologic Laparoscopists 1991 membership survey. J Reprod Med 1993; 38:572.
  68. Serden SP, Brooks PG. Treatment of abnormal uterine bleeding with the gynecologic resectoscope. J Reprod Med 1991; 36:697.
  69. Darabi, K, Roy, et al. Collaborative studies on hysteroscopic sterilization procedures: final report. In: Risks, Benefits, and Controversies in Fertility Control, Sciarra JJ, Zatuchni GI, Speidel JJ (Eds), Harper & Row, Hagerstown MD 1978. p.81.
  70. Duffy S, Reid PC, Sharp F. In-vivo studies of uterine electrosurgery. Br J Obstet Gynaecol 1992; 99:579.
  71. Munro MG. Mechanisms of thermal injury to the lower genital tract with radiofrequency resectoscopic surgery. J Minim Invasive Gynecol 2006; 13:36.
  72. Agostini A, Cravello L, Shojai R, et al. Postoperative infection and surgical hysteroscopy. Fertil Steril 2002; 77:766.