Hysteroscopy

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AIBU to think the NHS should offer realistic pain relief for this?

I am currently going through Benenden to get my hysterectomy because after 18 months the NHS is still failing to sort it. Had an appointment with a private consultant and first evaluative step is hysteroscopy.

Now I had this done on the NHS previously and it was barbaric. When I left the room my knees buckled. Staff were obviously all geared up for this to happen because there was a handy wee trolley there, just for all of us ladies leaving that room to lie down on when we collapsed.

So when the private consultant said I needed hysteroscopy, I asked if I could have some decent pain relief. And she said it would be small general anaesthetic as a matter of course. They wouldn't expect anyone to have this without it. If I didn't want it that's fine, but recommendation is to have it.

This is a different world! But why doesn't our health service do this? If you have a procedure with effects so horrendous that women routinely buckle after having it, why would you just persist with the same method? Why is women's pain baked in as an expectation?

As someone who has just had post menopausal bleeding and been referred on the urgent pathway i feel v lucky to have decided to use my private medical scheme through work. I also suffered v badly from
endo for years, had a previous hysteroscopy and subsequent removal of a large ovarian cyst and wouldn’t have considered this without GA. I will insist on it this time as well, I have a high pain threshold after suffering from endo for years, regularly fainting etc but no way are they doing this under local, it’s disgraceful, fully agree with PP comments that not enough is known about female health, I mean it’s only recently that endo has been classed as a debilitating illness. I was super lucky 20 years ago to have an amazing female GP who diagnosed and pushed for treatment ( as a result of trying to have a baby and being unable to!).
im really worried about what this bleeding could mean as I’ve been on HRT for 18 months so to add no pain relief isn’t an option!!
hope your appt goes ok today pp, and that you are able to push for GA.

really worried about what this bleeding could mean as I’ve been on HRT for 18 months

I’ve had this three times all with a two week referral, for it’s been a mixture of hormones from the HRT causing the bleeding, my coil being too low and some small polyp’s and cysts that needed to be removed. Try not to worry, it’s good you’re getting it checked out.

It could be fibroids, it could be polyps, it could just be the HRT. 90% of cases it's one of those.

Of my friends on HRT all of us have ended up having a hysteroscopy! In all cases it was clear. It's hard not to worry I know but the chances are it's one of the above things.

I have had four hysteroscopies - two in clinic and two in theatre. I think I have a high tolerance for pain. The first time I read the leaflet, took two paracetamol and was completely relaxed about the whole thing, expecting it to be like a smear. The atmosphere could not have been nicer - two nurses asking what music I would like, one either side and each took my hand. I was a bit surprised but I went with it. I was put in position and had a local anaesthetic but chatted about Christmas and all was fine and then the procedure started and I have never known pain like it. I realised that the lovely nurses weren't holding my hands in a show of solidarity - they were holding me down!

I had to go back for a second one for the polyps to be be removed and that was scheduled for theater.

Then last year the symptoms started again (I am in my 60's so as soon as I noticed the bleeding I was straight to the GP. Again I had an appointment for the procedure in the clinic. I was terrified and called the surgery who gave me a prescription for Diazepam. So I was pretty out of it when my appointment came round. A different consultant and no nurses to hold me in place. We talked about the first experience and he said that he would stop any time so I could rest or we would make a different plan. When it came to it he was unable to take a sample because of the size of the polyp and it's position and he couldn't get at the womb lining so he didn't try. So no excruciating pain. He did say however that I would have to have it removed in theatre under a local anaesthetic.

I wasn't keen but when it came to it the anaesthetist put my mind at rest, explaining that the options they had in theatre were different from clinic and I would be fine. In the event the surgeon said it was not possible under local and so I had a spinal. It was all fine.

The only word to sum up that first clinic experience was barbaric. It was 8 years ago but it is seared into my mind and I can't believe people still have to go through that.

I had mine under anaesthetic.

Thanks @MissHalloween and @Movinghouseatlast , I’m trying not to! Have a gynae appt tomorrow, I have awful lower back pain as well which is like endo/ cyst pain so hoping you’re right! Appreciate the support.

I had mine under GA on the NHS. The hospital rang me to schedule it and no pain relief was offered.

I asked some questions because, despite having unremarkable smears and similar gynae stuff all my adult life, menopause has made it all much more difficult and uncomfortable.

After some prodding I was booked in for the GA.

I'm in two minds about it because many women say it was fine and no one wants an unnecessary GA but I feel like the option of routinely doing procedures that might be so painful that you have to tell them to stop isn't a great plan either.

I was sedated for a colonoscopy but apparently they don't offer sedation for hysteroscopy for reasons of consent? I don't really understand it.

It's horrific. I had one last Christmas and it was only because it was the holidays that DH could come with me, and I'm so grateful he did as I couldn't have driven home. I had mine in out-patients (for examination of unusual uterine thickening) and I was told it might be mildly uncomfortable but they had gas & air to hand if I needed it. It was excruciating, I cried all of the way through it and I think I usually have a decent pain threshold. I almost chewed through the mouthpiece for the G&A, and whilst the staff were lovely it has to be one of the most traumatic experiences I've ever had. I apologised for being a wuss when it was over as I genuinely thought it was just me being pathetic - and then I researched it later and I was so angry that I was never given the GA option.
If this was a male issue then they would be offered GA as standard but women are expected to just suck it up and endure painful procedures. It's like being in the dark ages, women don't matter it seems.

It’s partly misogyny and partly that the only thing that matters to the NHS is cost.

This is why I never take any medical advice anyone in the NHS tells me at face value - I always always look and find out what/how things are done in other countries - the US, France, Germany, Australia etc before I decide anything.

On the NHS you will only be offered the cheapest likely solution - not necessarily what is best for you.

Never had one but is it similar to having a coil fitted? They hurt before I had given birth but not so much for me that I would have wanted a GA.

No, for most women it's nothing like having a coil fitted. I'd had coils fitted in the past and having the hysteroscopy bore no relationship whatsoever when it came to the pain levels.

I completely support the campaign by Hysteroscopy Action.
It’s true that not all women experience significant pain but a large proportion do, and the proportion who experience severe pain is way too high.
One of the most disgusting aspects is that the staff are told to use “distraction” to take women’s focus off the pain. The idea that it’s ok to subject women to severe gynaecological pain as long as you chat to them about holidays, like a hairdresser, is abhorrent.

Oh my God @FictionalCharacter you've just reminded me, they had a TV on the wall showing a nature programme for me to watch so that I could be distracted - like watching some hippos in a mud bath is going to make it painless!

I've had 3 on NHS and all with general anaesthetic!

Interesting. It’s all very personal I suppose. I’ve had a few now, polyp removal too. At worst it was uncomfortable

Totally agree. I had a hysteroscopy before starting IVF as they thought i had a polyp on scans, that and the HSG test were horrendous. I was told before they started the hysteroscopy i could have gas and air if i struggled, only to then be told 'it'll be over soon' and 'it can't be that painful' when I asked for it due to being in excruciating pain.

4 years later and I can still remember the pain and have vaginismus which started following those procedures. Definitely recommend doing the survey shared by a PP.

I am now having pelvic physio and have been referred for psycho-sexual counselling, which could have been avoided had proper pain relief options been offered, and had i (like many others) not been gaslit by health professionals.

My rule is anything that says uncomfortable or take 2 paracetamol is something I want sedation, GA or a spinal block for unless I've had it before and know I'm fine with it

Totally works doesn’t it 🙄 I mean how insulting. It’s a technique you use on e.g. kids having a blood sample taken, absolutely anyone should be able to understand that it won’t help with the pain of having a tube shoved in your cervix and instruments in your uterus (and in my case, a biopsy I didn’t know they were going to do - bonus!)
Why not abolish anaesthesia for all minor surgery and use a selection of nature videos instead?!

I also had a great woman she too said always under GA - this was a private appt a few months ago

Penny drop moment for me - it could have been the trigger for my vaginismus but I hadn’t even considered that.

I am resting up after a hysteroscopy this morning with polyp removal and a coil fitted. I have to say this time and the original investigative hysteroscopy were both not too painful apart from some discomfort and cramplike pain. The whole precedure is unpleasant but, for me, it was mostly uncomfortable not agony. I definitely wouldnt have needed a GA (the time money and aftecare required from that would far outway the discomfort I had). But how can you tell if it is going to be bad for you or not?

I think your question is the problem because how can we tell what we need?

I was absolutely fine with no pain relief (I only had a biopsy rather than anything being removed). I really did breathe through the couple of times it was painful.

But. Lots of women have an awful time. I was offered a general anaesthetic but I didn't want to wait longer for an appointment. Then on the day the staff explained everything and kept emphasising that they would stop anytime I needed and if I wanted it give me gas and air or a local. They were also encouraging me that if it was bad they would stop altogether and re book me for a general. They really centred me and I'm sure it helped me with the procedure.

I've read awful experiences here where people weren't listened to and their pain dismissed and I hope the campaigning means that no one has to go through that going forward.

I was offered GA if I wanted it, but they suggested I try it without, and if it hurt too much they'd stop, and make appt for GA. Even though I've not given birth or even had a coil, it didn't hurt at all under a local. There were several lovely nurses in with me who constantly asked me if I was Ok and told me what was happening. This seems like a good approach to me.

I hadn't realised myself until the gynae physio was taking my history about when the issue started and it all went back to that and the HSG which was around a similar time and where i was also told to just take paracetamol before and had a similar experience of nurse holding me down, telling me it would be over soon. I now find any examinations incredibly painful, sex is almost impossible.

I have read many horrendous stories since when researching. I know for some women it is fine but the fact it can be excruciating for a high number should mean sedation / GA or better pain management options are discussed and offered.

They tried to do this to me last November unprepared middle of a gynae appointment I just screamed the place down as unknown to me I probably had vaginal atrophy going on and after 20 minutes and 2 positions later they said ga was the way forward as they’d run out of the allotted time I suspect.

Bit annoyed/confused with myself as it seems I can tolerate internal scans, but not this.

4 months later into theatre I go, ended up coming round fairly rapid due to low blood sugars and as for pain relief they sent me home few hours after having oramorph for the period cramping which probably had more to do with the coil insertion carried out same time. Worse was to come where I’d been sleep I was told the fibroid had dis appeared, I still had symptoms and took myself off to a private scan where I learnt it was still there, in a live setting you’d hope they would show someone the camera.

To be honest if I knew it was a hysteroscopy for a small fibroid they’d never treat beyond the coil I’d have refused it.

There has been a few press stories over the time quite rightly. Personally I don’t understand it as when you go for a colonoscopy (just don’t ask! this fibroid likes to have the last laugh) the first thing is would you like to be sedated? and all the options appear for that and no one appears waking anyone up telling mistruths.