Hysteroscopy, Best Practice in Outpatient (Green-top Guideline No. 59)

Published:

This guideline provides clinicians with evidence-based information regarding outpatient hysteroscopy, with a focus on minimising pain and optimising the woman’s experience.

This is the first edition of this guideline.

The second edition of this guideline is currently in development.

December 2014: New evidence and guidance in this field were reviewed in 2014 and it was decided that revision of this guideline would be deferred to a later date. The version available on the website and app will remain valid until replaced.

The British Society for Gynaecological Endoscopy published this statement in December 2018:

"Diagnostic hysteroscopy is a commonly performed investigation; it is safe and of short duration. Most women are able to have the procedure in an outpatient setting, with or without local anaesthesia, and find it convenient and acceptable. However, it is important that women are offered, from the outset, the choice of having the procedure performed as a day case procedure under general or regional anaesthetic. Some centres are also able to offer a conscious sedation service in a safe and monitored environment. It is important that the procedure is stopped if a woman finds the outpatient experience too painful for it to be continued. This may be at the request of the patient or nursing staff in attendance, or at the discretion of the clinician performing the investigation."

Outpatient hysteroscopy is an established diagnostic test that is in widespread use across the UK. The procedure involves the use of miniaturised endoscopic equipment to directly visualise and examine the uterine cavity, without the need for formal theatre facilities or general or regional anaesthesia. Outpatient hysteroscopy is indicated primarily in the assessment of women with abnormal uterine bleeding, but is also employed in the diagnostic work-up of reproductive problems.

Advances in endoscopic technology and ancillary instrumentation have facilitated the development of operative hysteroscopic procedures in an outpatient setting with or without the use of local anaesthesia. Common procedures include endometrial polypectomy, removal of small submucous fibroids, endometrial ablation, removal of lost intrauterine devices and transcervical sterilisation.

Outpatient hysteroscopy, whether diagnostic or operative, is successful, safe and well tolerated. However, as with any procedure requiring instrumentation of the uterus,outpatient hysteroscopy can be associated with significant pain, anxiety and embarrassment. This not only impacts upon women’s satisfaction with their experience, but also limits the feasibility and possibly the safety, accuracy and effectiveness of the procedure. To minimise pain and discomfort, variations in hysteroscopic equipment, adaptations to the technique and use of pharmacological agents have been advocated.

This guideline assesses these components along with issues relating to optimal service provision.

Hysteroscopy, Best Practice in Outpatient (Green-top Guideline No. 59)

Patient information