Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Recognise procedural complications early
Severe or increasing abdominal pain, haemodynamic change, heavy bleeding, fever, vomiting, distension, breathlessness, chest pain, oliguria or collapse after hysteroscopy or laparoscopy can indicate haemorrhage, perforation, visceral injury, infection or thromboembolism.
Action: Assess urgently with ABCDE, involve the operating gynaecology team and surgery, anaesthesia or critical care as indicated, and do not attribute disproportionate deterioration to expected postoperative discomfort without investigation.
Synopsis
Distinguish uterine-cavity hysteroscopy from peritoneal laparoscopy, select each procedure for a defined unresolved question, and provide consent-led preparation, analgesia, operative planning and complication follow-up.
Hysteroscopy passes a narrow telescope through the cervix to inspect the uterine cavity; laparoscopy passes a telescope through the abdominal wall under anaesthesia to inspect and potentially treat pelvic and abdominal disease.
Choose hysteroscopy for focal cavity questions such as polyps, submucosal fibroids or endometrial pathology, and laparoscopy for peritoneal disease, adhesions, tubal pathology or selected unresolved pelvic pain.
NICE prioritises outpatient hysteroscopy for heavy menstrual bleeding when history suggests submucosal fibroids, polyps or endometrial pathology; ultrasound alone can miss cavity lesions.
Key red flags
Possible pregnancy generally precludes elective hysteroscopy or laparoscopy until status and clinical need are clarified; urgent pregnancy complications follow specialist pathways.
Uterine perforation
Sudden loss of resistance, unexpected instrument depth, severe pain, bleeding or instability during hysteroscopy raises perforation and requires immediate cessation and assessment.
Investigation priorities
01
Outpatient diagnostic hysteroscopyFirst step
Directly inspect the uterine cavity and identify focal polyps, submucosal fibroids or endometrial abnormalities.
Management branches
Hysteroscopy routeInspect the cavity with an agreed diagnostic and treatment limit
Symptoms or imaging suggest a focal uterine-cavity or endometrial lesion.
Confirm indication, pregnancy status, bleeding and infection context, and explain outpatient, analgesic, anaesthetic and no-procedure alternatives with their limitations.
Obtain specific consent for visualisation, biopsy and any see-and-treat intervention, then use a small atraumatic technique and stop for withdrawal, severe pain or suspected perforation.
Key medicines
Paracetamol before outpatient hysteroscopyTake 1 g orally about one hour before the appointment when suitable; subsequent doses must remain at least four hours apart and within the patient-specific daily maximum.
Ibuprofen before outpatient hysteroscopyTake 400 mg orally with food about one hour before the procedure if an NSAID is appropriate and no interacting dose has already been taken.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.