To think it's madness that my GP can't put me forward for a hysterectomy?

[AreWeNearlyThereYet84]

I suffer with prolonged bleeding sometimes for a month at a time. It's extremely heavy and with blood clots, caused by Endometriosis. I can soak a thick incontinence pad within ten minutes. It's badly affecting my quality of life and makes me question what is the point of being here regularly. I have flooded onto chairs at work, which is humiliating and the pain is unbearable.

My usual medication hasn't been stopping the bleeding lately, only making it worse.

When I last spoke to my GP around three months ago he referred me for an endometrial ablation.I haven't heard anything from the hospital regarding an appointment, so chased this and they said they would send a letter when they're ready to see me.

So yesterday, in desperation for a normal life where i'm not shattered and flooding constantly, I saw my GP again. I explained that I now would like to be considered for a hysterectomy, but he said that he cannot refer me for one and that I will need to speak to the gynae consultant when the hospital finally get in touch. I am totally at the end of my tether. I will wait for the letter inviting me in to arrive of course, but is this right that my GP can't refer me for a hysterectomy? Is it right that I will just rock up at my appointment which was for an ablation, to then discuss the possibility of an hysterectomy? My GP said the consultant would need to be persuaded that an hysterectomy would be best for me too. It doesn't give me much hope at all. I'm so fed up!

The GP won’t be doing an ablation or a hysterectomy, the gynaecologist will. So I think they’re right in saying you need to speak to the gynaecologist about your options. It’s not for the GP to decide which procedure.

You could ring the gynaecology secretaries at the hospital and ask how long your wait will be? Ask if they can try to squeeze you into a cancelled appointment sooner?

Are you sure you have been referred directly for an ablation? In similar circumstances I was referred initially to a gynecologist and treatment options were discussed at this appointment.

The gp is the specialist here. It's up to the gynae to decide the best treatment for you. I am sorry you are suffering like this. Have you tried a mirena or medication?

Just state you want to become a man and they would have that womb whipped out in no time. I'm not even joking there!

Your GP can state that you would like a hysterectomy but the decision would be down the Gynae consultant. There are long waits for gynae stuff at the moment due to a shortage of Dr's.

These are nice guideline, have a read through them as you can be more informed of current policy etc.

cks.nice.org.uk/topics/menorrhagia/management/management/

I'm assuming you've tried the coil?

No, a GP can refer to a surgeon but they cannot refer you for a surgical procedure. They aren't the specialists doing the procedures so wouldn't know what is appropriate to book.

It's your gynae who has to decide that.

If you are young or single, expect a refusal. I've been asking since I was 17, for the same reasons, plus other medical issues. It could kill me if I have a child, but "I might change my mind", even though I'm mid 30s now and been with my partner nearly 20 years.

Guys can get a vasectomy with no issues.

GP has already referred you to
Gynae, that's who would do a hysterectomy anyway. GP could have explained this better.

i don't think you'll just get an appointment for an ablation, it will most likely be an appointment with a gynae consultant first, then possibly investigations such as a hysteroscopy and/or MRI scan to confirm the best course of treatment, and then you'd get a procedure. I wouldn't get your hopes up I'm afraid, before Covid it took me 16 weeks to get an initial consultation with the gynae and they had a 26 week wait for a hysteroscopy.

This is so frustrating I know. Do you think you could get a private opinion from a gynaecologist that also works in the NHS? Then perhaps you can get listed for whatever they think you need rather than having a prolonged wait?

Your GP isn't in a position to refer you for an ablation; a gynaecologist can do that.
You can discuss an hysterectomy with your Consultant and he can request one on your behalf, but most funding bodies want to see that an ablation has been tried, prior to signing off on an hysterectomy.

Do you want a GP (GENERAL practitioner) to be able to make a decision like that?!
I’m sorry that you’re at the end of your tether, and I can see why, but you know it can’t be your GP. Hope you see the consultant soon.

It sounds dreadful and I can see why you want progress. You definitely need to see a specialist and discuss your options.

But your GP isn’t a specialist. They don’t have much experience in, or the time and energy to keep up with developments in research in every area. Their job is to signpost you to a specialist who can do that. Who can asses you with beyond GP level gynae knowledge, know what usually works for people in your position (and what doesn’t) the latest research and the risks you might face, and then you can make a decision with them. Your GP can’t do that. There might be all kinds of other things that may help, or risks you aren’t aware of. I’m not saying it’s a good a bad decision, just that your GP isn’t the right doctor to help you make it.

So yes, YABU in that the GP shouldn’t be referring for a major procedure like a hysterectomy without a consultant specialist involved. But you are not being unreasonable to feel so in need of help and support. I hope you get referred soon and there’s a good outcome.

Are you in a position to see a gynaecologist privately? NHS waiting times are awful.

Ask for an NHS choose & book referral to your nearest private hospital, you will get seen quicker. Be prepared for a fight to get a hysterectomy, I had to go to a stage 3 appeal & get my MP involved to get one. They will try to fob you off with the ablation or a Mirena Coil, but stick to your guns, I had a keyhole hysterectomy for endometriosis, was only in hospital one night.

In my experience the consultant gynae surgeon at the hospital will discuss all possible options with you - ablation, hysterectomy, oophorectomy.

I had an endometrial cyst on an ovary but had never heard of endometriosis before I was diagnosed. I had been stressed at work and thought I had a ulcer!

The surgeon discussed that he might have to remove the ovary if the cyst would not come away. He also discussed whether I had thought about hysterectomy- I was 40 then and had completed my family so it could have been an option. In the end he removed only the cyst and as much endometrial tissue as possible, and I've been fine since with symptoms being controlled by the contraceptive pill.

Good luck! I know how painful it can be. 💐

This is so infuriating.

a woman will be refused an operation she badly wants and needs because she might change her mind, but teenagers will be given puberty blockers and other treatment easily. Why are they trusted more to have made the right decision?

I was treated very quickly as my symptoms - bloating, severe pain, severe constipation on period, and suddenly really heavy periods- also those of ovarian cancer and I even had elevated CA 125 levels. The first thing the GP did was a pregnancy test and a blood test. I had a scan at the hospital within a couple of weeks and surgery within six weeks - this was all NHS and seven years ago.

www.mayoclinic.org/diseases-conditions/ovarian-cancer/symptoms-causes/syc-20375941

I had this. My GP was great though and I got quickly seen by a gynae consultant who explained the process.

Hysterectomy operations are expensive so gynaes have to apply for funding. Funding is only granted if a) there is cancer; or b) every other treatment has been tried first.

So you'll need to have a scan, a coil, an ablation, maybe the pill... if you're still bleeding loads, you can get the op.

Ask your GP for transexamic acid.

Just to say you may not have to fight with the gynae for a hysterectomy. Mine presented various options and was quite happy for me to choose a hysterectomy, bypassing more minor procedures. I have similar symptoms to you, but from huge fibroids, not endo.

The wait has been significant, though. I have to have an endometrial biopsy before even being put on the waiting list for the hysterectomy. It has taken seven months from the gynae consultation to get an appointment for that, and I believe it will be several more months after that before the op itself.

YABU. The GP refers you the relevant specialist for the problem, the specialist decides the treatment. The GP can’t tell the specialist to perform a hysterectomy, nor is the GP the best person to decide on the correct treatment.

When you see the gynaecologist they will be able to discuss the pros and cons of the different options with you and decide on a plan.

Your GP has referred you to see a gynaecologist, they are the specialist.
Discuss your options with them when you get an appointment.

Your GP is absolutely correct.

Whilst I agree with pp re seeing gynae, I also agree with mouldy re identifying as a man, they have no concerns about the cost or implications if that is the case.

I just wanted to say OP that I'm sorry to hear you're having such a struggle with this. A friends of mine has similar issues and finds the whole situation debilitating and very restrictive in terms of leaving the house.

Have you had the GP put you forward as an emergency/ fast-tracked/ expediated case? Do they actually understand the impact this has on your quality of life?

If you possibly can, go private. I've paid £175 for a private consultant appointment, booked within 3 days of a GP referral letter. I'm going under the knife early next month (they could have done it this month, but I needed to arrange childcare) and it will be money well spent because my quality of life will improve dramatically.

I didn't have private medical insurance, so am paying for this from savings- make sure you mention this if you get a quote as the cost is usually about £3,000-£4,000 cheaper if you are paying yourself, rather than through insurance.

I realise in straightened times, this may not be an option, but if you can scrape the money together, it's worth getting it done quickly. My alternative was a 56 week wait for an appointment to see a new consultant "And we don't book that far in advance...."