Hysteroscopy vs punch biopsy

[Superscared]

I have a gynaecology appointment on Tuesday due to heavy bleeding after 18 months of none during perimenopause. I had an ultrasound which identified coarse uterine lining. I am aware I already have a small fibroid. This happened 3 years ago too. Upon arriving at the gynae appointment I was told I was having a hysteroscopy. It was incredibly painful (no anaesthetic or sedation) and I almost passed out afterwards. I am also having a pacemaker fitted on Friday due to 2:1 heart block, which is symptomatic on exertion. I am terrified if I have another invasive procedure during my gynae appointment that I will get stressed and go into heart block. I do not want another hysteroscopy. I phoned the gynaecology department and have been told I am not scheduled for a hysteroscopy, but may have a punch biopsy. I can’t really understand the difference between the two, apart from no camera involved. Has anyone had a uterine punch biopsy? Was it painful? How much? TIA.

I haven’t had a punch biopsy but I have had a hystoscopy and biopsies taken under spinal anaesthetic. I wouldn’t have agreed to have it done otherwise - I said I wanted a general or spinal. You have the right to refuse any procedure without adequate anaesthetic- you can ask for a general or spinal.

I didn’t know a spinal was possible. I’d prefer not to have a GA. I will definitely advocate for myself better this time. Last time I had absolutely no idea what the procedure involved, and was later shocked by how little discussion/information the dr provided and how much he downplayed the “discomfort” I’d experience.

It's within the RCOG guidelines that you can ask for a general. You've already had one hysteroscopy and found it was awful for you, so in your shoes I'd say I wouldn't be having any other invasive gynae procedures without anaesthesia.

Is there a way you can reschedule it (they may have to reschedule it anyway once you say you want a GA) so it happens after the pacemaker appointment?

They wouldn’t budge on the appointment date as it’s a 2ww referral. I am absolutely dreading next week! I was shocked to discover pacemakers are fitted under local anaesthetic!

Cross posted OP, I see you're not up for the idea of a general.

Here are the guidelines, in case there's something in here that is helpful. https://obgyn.onlinelibrary.wiley.com/doi/10.1111/1471-0528.17907

Anaesthetist POV… Worth bearing in mind that they’ll likely say it’s safer to get the pacemaker and ensure that’s working before thinking about a GA/Spinal depending on what your rhythm is. D’you know what size hysteroscope they used last time?…the jobby they use to do biopsies may be quite a bit smaller so might not be so stimulating.

The Jobby? No wonder women are put through this barbaric procedure when the so called medics call the medical instruments used to rip pieces of us out 'The Jobby'.

I’ve had a punch biopsy. It wasn’t pleasant, but the pain was quick instead of prolonged, iyswim