Materials and Methods: In this parallel-group randomized clinical trial conducted in Al-Zahra hospital, Tabriz, Iran, 114 women with uterine bleeding were randomly assigned to receive either clot evacuation before standard operative hysteroscopy or after that from December 2018 to September 2019. The study outcomes were the clarity of vision, amount of bleeding, the volume of required distension media, duration of the procedure, and postoperative complications.

Results: There were statistically significant differences in the frequency of the clear vision (P < 0.001), the severity of bleeding, mean procedure time (P < 0.001), mean used distension media and the mean postoperative hematocrit levels in favour of women with pre-hysteroscopy intrauterine evacuation. There was no difference in in-hospital stay and anaesthetic complications among the two groups. The procedure was successfully performed on all participants of both groups with no post-operative complications.

Conclusions: Removal of clots and other uterine contents before the insertion of the hysteroscope rendered better and faster access to the uterine wall to observe existing abnormalities. This additional surgical step could significantly impact surgical and clinical outcomes.