What is hysteroscopy and why is it performed?

Hysteroscopy is an advanced gynecological diagnostic and treatment method that enables direct and detailed visualization of the uterine cavity. In this procedure, a thin optical device equipped with a high-resolution camera and light source is inserted through the vagina, passing the cervix into the uterus. The inner surface of the uterus is displayed on a monitor and examined in detail. Hysteroscopy allows for the definitive diagnosis of intrauterine problems that cannot be clearly evaluated with conventional methods such as ultrasound or hysterosalpingography (HSG) [1].

Today, hysteroscopy is widely preferred in gynecology and obstetrics, and as a minimally invasive method that does not require surgical incisions, it prioritizes patient comfort. By directly observing intrauterine pathologies, it provides accurate and clear evaluation.

Hysteroscopy can be performed for both diagnostic and therapeutic (operative) purposes. In diagnostic hysteroscopy, the uterine cavity is only examined, whereas in operative hysteroscopy, identified problems can be treated in the same session. In this respect, it is a highly effective method that saves time and prevents the need for a second procedure [1].

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Hysteroscopy is considered the gold standard method for directly visualizing the uterine cavity, offering both diagnosis and treatment in a single session. It can detect 20–40% of pathologies that are not visible on standard ultrasound.

Why Is Hysteroscopy Performed?

Hysteroscopy is performed to identify the causes of various intrauterine problems and to treat them when necessary. Studies show that hysteroscopy can detect intrauterine pathologies in 20–40% of cases despite normal transvaginal ultrasound findings [1]. It is especially an important diagnostic tool in cases such as menstrual irregularities, heavy bleeding, infertility, and recurrent pregnancy loss.

Intrauterine polyps, submucosal fibroids, adhesions, and congenital uterine anomalies can be easily detected with hysteroscopy. Additionally, postmenopausal bleeding should always be evaluated carefully; hysteroscopy is a reliable method for identifying the underlying cause in such cases [2].

What Is Diagnostic Hysteroscopy?

Diagnostic hysteroscopy is a procedure in which the uterine cavity is examined solely for observation and evaluation purposes. During this procedure, no surgical intervention is performed. It is usually completed in a short time and can often be performed without anesthesia or with local anesthesia.

It is particularly preferred in patients with unexplained infertility, recurrent miscarriages, and irregular menstrual bleeding. The suitability of the uterine environment for embryo implantation can be clearly evaluated with this method. It also allows for definitive diagnosis in cases of suspected uterine septum, adhesions, or polyps.

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Operative (Therapeutic) Hysteroscopy

Operative hysteroscopy is a method used to treat known intrauterine problems or conditions identified during diagnostic hysteroscopy. During this procedure, surgical instruments are introduced through the hysteroscope to remove or correct abnormal tissues.

According to the current SOGC Guideline No. 446 [2]:

• Hysteroscopic adhesiolysis is strongly recommended for infertility or recurrent pregnancy loss associated with intrauterine adhesions (Asherman syndrome).
• Hysteroscopic polypectomy is recommended to improve reproductive outcomes in patients trying to conceive naturally or undergoing ovulation induction.
• Hysteroscopic myomectomy may be considered in patients undergoing assisted reproductive treatments or attempting natural conception.

These procedures are performed using minimally invasive techniques without the need for open surgery, and patients are often discharged on the same day.

When Is Hysteroscopy Preferred?

Main indications include:

• Unexplained infertility
• Recurrent pregnancy loss
• Heavy or irregular menstrual bleeding
• Postmenopausal vaginal bleeding
• Pre-IVF/IUI uterine evaluation
• Suspected polyps, fibroids, or adhesions
• Uterine anomalies (septum, bicornuate uterus, etc.)

Preparation Before Hysteroscopy

Before hysteroscopy, the patient’s general health status is evaluated and necessary tests are performed. The procedure is usually scheduled in the early days following menstruation, as this allows better visualization of the uterine cavity. Diagnostic hysteroscopy is often performed without anesthesia or with local anesthesia, while operative hysteroscopy may require general anesthesia. Following the physician’s instructions is essential for a safe procedure.

Post-Hysteroscopy Process

After hysteroscopy, patients can usually return to their normal activities within a short time. Mild pelvic pain or light spotting may occur but typically resolves quickly. After operative procedures, certain medications may be prescribed. Follow-up appointments should not be missed in order to properly evaluate the healing process.

Advantages of Hysteroscopy

• Direct and clear visualization of the uterine cavity → high diagnostic accuracy
• Minimally invasive method without incisions
• Diagnosis and treatment in the same session
• Rapid recovery; most patients discharged the same day
• Lower complication risk compared to open surgery
• Evaluation of uterine health before IVF

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