Hysteroscopy is a procedure that allows the doctor to see the inside of the uterus with a thin camera. It can be used only to observe the uterine cavity or to treat problems such as polyps, small fibroids, adhesions or some uterine malformations.
The camera is introduced through the vagina and cervix. There are no cuts on the abdomen. In many cases, hysteroscopy can be done in a short procedure with rapid recovery.
In Lisbon, Dra. Joana Faria performs and coordinates diagnostic and operative hysteroscopy in Portuguese, English, French, and Spanish. Her focus is on clear explanations, gentle technique and keeping discomfort as low as possible.
This page explains what hysteroscopy is, when it is useful and what you can expect before and after the procedure. You can also read the pages on minimally invasive gynecologic surgery and benign diseases and infertility surgery.
What it is
Hysteroscopy is a technique that uses a slim telescope called a hysteroscope to look inside the uterine cavity. A small amount of fluid is used to open the cavity so that the doctor can see the lining of the uterus on a screen.
There are two main types of hysteroscopy:
- Diagnostic hysteroscopy used to inspect the cavity, confirm or exclude lesions and sometimes take biopsies of the endometrium.
- Operative hysteroscopy used to treat problems such as polyps, submucous fibroids, adhesions (synechiae) or to correct some uterine malformations that may affect bleeding or fertility.
Hysteroscopy is often used in cases of abnormal uterine bleeding, repeated miscarriages, infertility or when ultrasound suggests a lesion inside the cavity.
Main symptoms and when to worry
Hysteroscopy may be recommended when one or more of the following symptoms are present:
- Very heavy menstrual bleeding that affects daily life or causes anemia.
- Bleeding between periods or after sexual intercourse.
- Irregular bleeding while using hormonal contraception or hormone therapy, after basic causes have been excluded.
- Difficulty getting pregnant or repeated early miscarriages, especially when an abnormality of the uterine cavity is suspected.
- Abnormal findings on ultrasound, such as polyps, submucous fibroids or a possible uterine malformation.
You should seek a gynecologic opinion if you have bleeding that is heavier, longer or more irregular than usual, if you need to change pads or tampons very frequently, or if you feel tired and short of breath with your periods. You should also consult if you are trying to conceive and your doctor suspects a problem inside the uterus.
You should seek urgent care if you have very heavy bleeding with large clots, dizziness, fainting or strong pelvic pain with fever and malaise. These situations require immediate evaluation and may need emergency treatment.
Diagnosis: exams and what to expect before hysteroscopy
Before hysteroscopy is proposed, a careful evaluation is carried out to understand your symptoms and to choose the best moment for the procedure.
The assessment usually includes:
- Clinical history and gynecologic examination
Discussion about your cycle, pregnancies, miscarriages, contraception, previous surgeries and other diseases. A pelvic examination helps to evaluate the cervix and uterus. - Transvaginal ultrasound
Key exam to look at the uterine cavity, the thickness of the endometrium and to detect polyps, fibroids or other lesions. - Saline infusion sonography (when needed)
An ultrasound with sterile fluid injected into the cavity, which can highlight small polyps or fibroids and help decide whether hysteroscopy is needed. - Blood tests
Depending on the case, tests may include haemoglobin, coagulation and sometimes hormones or other parameters.
Before the procedure, you will receive clear instructions about how to prepare. In some cases, medication is given to soften the cervix. You will also be informed about the type of anesthesia or analgesia planned, which may range from local or light sedation to general anesthesia, depending on the complexity of the procedure and your preferences.
Treatment options and realistic expectations
Hysteroscopy is one of several options to evaluate and treat problems inside the uterus. The best approach depends on your symptoms, age, desire for pregnancy and results of previous exams.
Main options include:
- Medical treatment
In some cases of abnormal bleeding, hormones or other medicines are tried first. If symptoms improve and exams are reassuring, hysteroscopy may not be necessary. - Diagnostic hysteroscopy
Allows direct visualization of the cavity and targeted biopsies. It can confirm that the cavity is normal or identify lesions that can be treated later or during the same procedure. - Operative hysteroscopy
Removes polyps and small fibroids, treats adhesions and corrects some malformations. These procedures often improve bleeding patterns and can increase the chances of pregnancy in selected situations.
Realistic expectations are important. Most women go home a few hours after hysteroscopy and can return to light activities within one or two days. Mild cramping and light bleeding for a few days are common. Serious complications such as perforation of the uterus, infection or fluid overload are rare but can happen. Your doctor will explain these risks in simple language so that you can give informed consent.
How Dra. Joana Faria approaches hysteroscopy in practice
Dra. Joana Faria believes that hysteroscopy should be as comfortable and transparent as possible. She explains in advance what you will see, feel and hear at each step of the procedure.
In daily practice she:
- Starts from your symptoms and expectations, not just from ultrasound findings.
- Explains the indications for hysteroscopy, what will be done and which alternatives exist, including medical treatment.
- Uses gentle techniques and modern equipment to reduce discomfort, choosing the most appropriate setting and anesthesia for each woman.
- Works closely with fertility teams when hysteroscopy is part of a fertility investigation or preparation for assisted reproduction.
- Provides clear written instructions for recovery and warning signs such as fever, persistent pain or heavy bleeding, so that you know when to contact the team.
The aim is that you feel informed, respected and supported before, during and after hysteroscopy, with enough time to ask all your questions.
