Hysteroscopy (Diagnostic)

A diagnostic hysteroscopy is an examination of the inside of the uterus with a thin, lighted camera. The camera passes through the cervix, so no incision is needed. The clinician views the endometrium (the lining of the uterus) and the walls of the uterine cavity in real time. No imaging test provides the same direct view. Major professional society guidelines regard it as the gold standard for evaluating the inside of the uterus.¹²

It can detect polyps, which are small growths of the lining. It can detect fibroids that bulge into the cavity (submucosal fibroids). It can detect scar tissue inside the uterus, as seen in Asherman syndrome. It can detect a uterine septum, a wall of tissue that divides the cavity. It can also detect an isthmocele, a pouch in a previous cesarean scar. For women with regular cycles, the best timing is after the period ends and before ovulation (the early follicular phase). The lining is thin at that time, so the view is clearest.¹

Clinicians often use it when an ultrasound or other imaging result is unclear. It also helps when abnormal bleeding or recurrent miscarriage suggests a problem in the uterus. It can be part of a full evaluation of the uterine cavity for couples facing infertility. A saline ultrasound (SIS) offers a less invasive first look. If SIS shows an abnormality, hysteroscopy confirms it by direct view. The same visit can then proceed to treatment with operative hysteroscopy.²