Hysteroscopy and D&C During Menstruation
Yes, a patient can undergo hysteroscopy and D&C during menstruation, but it is not optimal—the procedure should ideally be scheduled during the follicular phase after menstruation has ceased for best visualization of the endometrial cavity. 1
Optimal Timing for the Procedure
In premenopausal women with regular menstrual cycles, the optimal timing for diagnostic hysteroscopy is during the follicular phase of the menstrual cycle after menstruation, when the endometrium is thinnest and visualization is maximized 1
The American College of Obstetricians and Gynecologists specifically recommends performing the procedure after menstrual bleeding has stopped to ensure adequate visualization of the endometrial cavity 1
When Menstrual Timing May Not Matter
If the patient is postmenopausal, timing relative to menstruation is irrelevant since these patients do not have menstrual cycles 2
In urgent clinical scenarios (such as heavy bleeding requiring stabilization, suspected malignancy requiring immediate tissue diagnosis, or hemodynamic instability), the procedure should not be delayed for optimal timing 3
Patients with unstable vital signs, severe anemia, or hemorrhagic shock require admission and prompt D&C regardless of menstrual timing 3
Practical Considerations
Pregnancy must be reasonably excluded before performing hysteroscopy, regardless of menstrual timing 1
Active menstrual bleeding creates technical challenges including poor visualization due to blood in the cavity and difficulty distinguishing normal endometrium from pathology 1
The use of distending media during hysteroscopy is more challenging when blood is present in the uterine cavity, potentially compromising diagnostic accuracy 4
Clinical Algorithm for Scheduling
For elective diagnostic hysteroscopy: Schedule during follicular phase (days 4-14) after menstruation ceases 1
For suspected endometrial cancer or atypical hyperplasia: Schedule as soon as feasible, preferably after menstruation, but do not delay if clinically urgent 2, 3
For acute bleeding requiring intervention: Proceed immediately regardless of menstrual status, as hemodynamic stability takes priority 3
For office-based procedures: Optimal timing is particularly important since visualization challenges may necessitate conversion to operating room procedure 1
Common Pitfalls to Avoid
Do not delay urgent evaluation for suspected malignancy simply to wait for optimal menstrual timing—tissue diagnosis is the priority in symptomatic postmenopausal women or those with risk factors 2
Do not proceed with elective office hysteroscopy during active menstruation, as this increases the likelihood of inadequate sampling and the need for repeat procedures 1, 5
Remember that office endometrial biopsies have a 10% false-negative rate, so if initial sampling during suboptimal timing is non-diagnostic, hysteroscopy with directed biopsy under better conditions will be necessary 2