Hysteroscopy is a minimally invasive endoscopic procedure in which a gynecologist examines the inner uterine cavity using a special optical device — a hysteroscope. This tool is equipped with a miniature camera and light source, allowing real-time imaging of the uterine cavity on a monitor. This enables the doctor not only to diagnose but also to treat identified abnormalities during the same session.

Hysteroscopy is recognized as the "gold standard" in diagnosing intrauterine pathology and is widely used worldwide. It is usually performed on an outpatient basis, often without the need for hospitalization or extended recovery.

Types of Hysteroscopy

There are two main types of hysteroscopy:

• Diagnostic Hysteroscopy

 Performed to examine the uterine cavity for conditions such as:

• intrauterine septa
• endometrial polyps
• submucosal fibroids
• adhesions (synechiae)
• uterine malformations
• causes of abnormal bleeding, infertility, and miscarriages

Operative (Therapeutic) Hysteroscopy

 Used to remove or correct detected pathologies. Miniature instruments (scissors, forceps, electrodes, laser) are inserted through the hysteroscope to:

• remove polyps
• cut adhesions
• remove intrauterine septa
• resect fibroids
• perform endometrial ablation in cases of hyperplasia

Diagnostic and operative hysteroscopies are often combined in one procedure.

Indications for Hysteroscopy

The procedure is recommended for:

• uterine bleeding (intermenstrual, heavy, or postmenopausal)
• menstrual disorders
• unexplained infertility
• recurrent miscarriages
• suspected polyps or fibroids
• post-curettage, abortion, or IUD removal control
• endometrial biopsy under visual control

How Hysteroscopy is Performed

• Usually done during the first phase of the menstrual cycle (days 5–10)
• Diagnostic hysteroscopy may be done without anesthesia or under local anesthesia
• Operative hysteroscopy is usually performed under IV sedation or general anesthesia
• The hysteroscope is inserted through the vagina and cervix. Sterile saline or CO₂ is used to expand the uterine cavity

Modern flexible hysteroscopes with smaller diameters (2.9–3.5 mm) minimize discomfort and often do not require cervical dilation.

Complications and Safety

Hysteroscopy is a safe procedure with a complication rate of less than 1%, including:

• cervical or uterine perforation
• infection
• allergic reactions to anesthesia
• gas embolism (extremely rare when using CO₂)

When performed by a skilled specialist according to protocol, hysteroscopy poses minimal risks.

Conclusion

Hysteroscopy is one of the most informative and gentle methods for diagnosing and treating uterine conditions.

When indicated properly, it can significantly improve the chances of conception, successful pregnancy, and overall women's health.