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What are Some of the Major Hysteroscopy Complications?

Hysteroscopy is used to diagnose and treat varied intrauterine conditions and issues, primarily the causes of abnormal uterine bleeding. The hysteroscopy test helps the healthcare provider to examine these conditions in detail, determining the cause.

This helps both the doctor and the patient get a clear understanding of what the course of treatment should be. Before we look at the major complications of hysteroscopy, let’s take a brief look at what hysteroscopy is and how it is performed.

1] What is Hysteroscopy?

If you’re experiencing heavy menstrual periods and abnormal bleeding, or the doctor has to find out about your reproductive health, he might recommend a hysteroscopy. A hysteroscopy is a method that allows a comprehensive visual examination of the cervix and uterus.

Gynaecologists are actively embracing diagnostic and operative hysteroscopy as a way to evaluate women experiencing heavy periods – Menorrhagia, infertility, post-menopausal bleeding, and recurrent pregnancy loss.

During the procedure, the doctor will insert a hysteroscope – a light, thin, flexible tube through the vagina into the uterus. With the help of the hysteroscope, the doctor will detect any issues inside the cervix and uterus.

  • Indiagnostic hysteroscopy, tissue samples may be taken for further testing.
  • Whereas, for operative hysteroscopy,polyps or fibroid growths might be removed to stop the bleeding

2] How is Hysteroscopy Performed?

Before the hysteroscopy procedure, you will be given local anaesthesia or general anaesthesia.

During the procedure:

  • The doctor will first insert a speculum,which typically is an instrument that will open up the vagina.
  • The hysteroscope will then be inserted through the vagina into the cervix and the uterus.
  • Next, a gas or fluid is used to expand the uterus. This helps make the area more visibleso the doctor can view the lining of the uterus and the fallopian tubes on a video screen.
  • Small instruments can then be inserted with the help of a hysteroscope to remove tissues for biopsy, or to remove polyps/fibroids.

The entire procedure is quite straightforward and painless compared to open surgery and hysterectomy. After the procedure, you can go home the same day. Pain medicines may be prescribed to help you relax. However, complete recovery from hysteroscopy, i.e. operative hysteroscopy, may take 3 to 4 days.

3] Early Hysteroscopy Complications

  • Bleeding and uterine perforation

Bleeding and uterine perforation are potential early complications of hysteroscopy. In uterine perforation, the instruments may be inserted too deep in the uterine cavity leading to a small puncture to the uterine wall. Additionally, uterine perforation and related complications can bring about haemorrhage or sepsis.

Lateral uterine perforation at the time of hysteroscopy is rare yet a possible complication. The overall risk of hysteroscopy complications is low. However, operative hysteroscopy has more risk involved compared to diagnostic hysteroscopy.

  • Infection and Vaginal Discharge

Another side effect of hysteroscopy is infections, which again are quite rare. Acute pelvic inflammatory disease (PID) is also rare following operative hysteroscopy. However, for adhesiolysis, the risk of infection is higher compared to polyp resection or endometrial resection. Also, to reduce the risk of infection after hysteroscopy, it is advised to refrain from having sex for at least two weeks or until the bleeding stops.

Some amount of pain after hysteroscopy is also normal. In addition, you might experience vaginal discharge, which again is no cause for worry. However, if the discharge has a foul smell, then it is best to visit the doctor immediately.

  • Fluid overload – OHIA syndrome

One of the most common complications of hysteroscopy or hysteroscopic surgery can result from the overload of distension media. The type of complication may differ, depending on the media or fluid used. In both diagnostic and operative hysteroscopy procedures, excess amount of fluids could lead to cardiac arrhythmia, hypoglycemia,  nausea & vertigo, and transient hypertension. This complication can be prevented by choosing a professional women’s healthcare specialist, who has the experience and expertise to carry out keyhole surgeries.

4] Post Hysteroscopy Complications

  1. Incomplete Resection

While this post hysteroscopy complication is quite rare, incomplete hysteroscopic resection or incomplete removal of submucous fibroids is a possibility for type 2 fibroids. The fear of uterine perforation or fluid overload is one of the main reasons that may lead to incomplete resection. However, studies have found that any residual tissue (as a result of incomplete removal) may undergo spontaneous regression. In which case, subsequent surgery for the incomplete removal may not be necessary.

  1. Intrauterine Adhesions (IUA)

Intrauterine adhesions or adhesions inside the uterus are also known as Asherman syndrome. Surgical procedure is one of the main causes of intrauterine adhesions. However, the risk of intrauterine adhesions post hysteroscopic surgery is very rare. In most cases, IUA may be formed post a D&C procedure, which is used following a miscarriage. Other causes of adhesions could be endometrial ablation or infections of the uterine lining.

  • Overview of Operative Hysteroscopy Complications
Early Operative Hysteroscopy ComplicationsLate Operative Hysteroscopy Complications
Uterine perforationIntrauterine Adhesions
InfectionIncomplete Resection
Fluid overloadCervical Laceration
Air embolismUterine Rupture (after metroplasty)
HaemorrhagePost ablation sterilisation syndrome (after endometrial ablation)
Cervical trauma
Electrosurgical burnHaematometra (after endometrial ablation)


While one can’t ignore the importance of hysteroscopy in the treatment of intrauterine conditions, being well-informed about the common (though rare) hysteroscopy complications is also essential. Any surgical procedure carries with it a few potential risks, so there is no cause for worry. However, for any gynaecological surgical procedure, it is advised to consult with a specialist who is knowledgeable about these procedures to minimise complications, risks and infections.

If you have any queries about hysteroscopy, then don’t hesitate to get in touch with us!

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Neha Goel

Neha Goel, a Psychology alumna and MBA graduate from CASS Business School, London, brings together her expertise as a Reiki Practitioner and Practice Manager. She integrates psychology and business strategies to foster holistic well-being and personal development.