Hysteroscopy and / or dilation and curettage (D&C) are usually performed under general anesthesia (patient is asleep). Hysteroscopy is performed with a skinny telescope-like instrument (hysteroscope).  It is inserted into the uterus (womb) through the cervix (mouth of the womb) and requires no incision. The endometrial cavity (hollow space inside the womb) is examined for abnormalities using a small video camera attached to the hysteroscope. In order to better see the inside of the uterus, the walls of the cavity are kept apart by a gentle flow of fluid or gas, usually a fluid. This can be compared to placing a small telescope inside a balloon - with the balloon collapsed, not much could be seen; but if the balloon is inflated with air, there is room to see.
The most common reason hysteroscopy / D&C is performed is abnormal bleeding. Several different procedures can be performed at hysteroscopy:

• Tissue such as polyps, fibroid tumors, scar tissue, hyperplasia (overgrowth of tissue) or septa (dividing walls) can be removed.
• With recanalization of the fallopian tubes, a blockage of the tubes is opened using a small plastic catheter.
• Endometrial ablation involves destruction of the lining of the uterus with an electrocautery roller-ball to treat abnormal bleeding.

A dilation and curettage (D&C) may or may not be performed at the time of hysteroscopy. The D&C may be performed to remove a larger amount of the lining tissue, either for treatment or diagnosis. The cervix is dilated (the canal made larger), and the endometrium (lining of the uterus) scraped with an instrument that resembles a long iced-tea spoon. D&C is also commonly performed in the case of a miscarriage. This is called a suction D&C and removes tissue from the uterus with a vacuum device.
D&C used to be commonly performed by itself to diagnose and treat abnormal uterine bleeding. Diagnosing the cause of abnormal bleeding is now done with fluid-contrast ultrasound in the office. This avoids general anesthesia in the operating room.

Recovery from hysteroscopy / D&C is usually very quick. Most patients are able to return to normal activity the following day.