Would you have this hystersocpy under a GA?

[lyrapie]

In March 23 I started HRT. The prior year I had one or two periods. I also went 10m without a period. Since March 23 I have had either no monthly shows or v light spoting. All consistent with my HRT. Last Thursday I had a heavy bleed. Ditto Friday. Called Dr. They referred me to 2w emergency cancer screen. Today I had a pelvic scan. Lining 5.6mm. Normal for peri. Thick(ish) for post menopausal. I have been booked for hysteroscopy under GA (passed out last time due to bent cervix). I think the risk of cancer is too low to warrant this procedure and GA. The gynae said they were 95% sure there is no cancer. What would you do?

I’d have it done to be thorough , I’ve just been surprised with a large ovarian cyst and need full hysterectomy so in your situation would rather have the test to know for sure

Absolutely do not refuse a warranted gynae procedure - it's a few days of inconvenience as opposed to the life changing horror of anything worse. When so many people are dying of cancer and not getting good care why would you refuse? It seems crazy not to listen to advise that would give you complete certainty of what is happening inside

i had this for similar reasons. They did it without general and it was ok- they were all really lovely and told me what they were doing. They took some of the lining which felt like a pinch. Definitely have it done and hopefully like mine it will be ok.

It's not guaranteed you are post menopausal and it could be the HRT suppressing. So I would definitely check out what is going on.

this procedure under GA is completely fine - I had it earlier this year. It’s barbaric without.

you’ll recover from GA almost immediately

I’d have it done

When I had a hysteroscopy I had spinal anaesthetic^ rather than GA. Is that an option you'd prefer, if it's the GA that worries you?

(^The anaesthetist's recommendation as i had a slightly runny nose that i now realise is permanent due to allergy rather than any virus.)

i had one earlier this year, without GA.. its not great! its not unbearable. I wasn't given the option of a GA. my consultant was a male, and he was very mater of fact about the whole thing.. they found a polyp and he wanted to take it out there and then again with no GA... absolutely no way! he felt i was being ridiculous

They also found a small cyst today which needs moniotoring. I am sorry about your need for a hysterosctomy. Hope it all goes ok. Thanks for the response.

Complete certainty - helpful reminder. Thanks.

Thanks for sharing your experience. Appreciate that.

Not ridiculous. Ffs. Hope polyp gets resolved.

I've just agreed to an operation to remove a polyps with sedation, rather than GA. They assured me that will be fine. I've not had one before, though.

Good suggestion. Thank you! I had this for an egg collection (IVF) and came round during it l but went out again quick enough. The radio was playing Rocket Man.

Thanks all. Have decided I am being an idiot and should just do it. 6% of women reporting irregular post menopausal bleeding are diagnosed with uterine cancer which made me feel a bit of a drama lama going for the hysteroscopy, especially under a GA and especially while I might still be peri but these are helpful responses. Thanks.

Hope all goes well OP Im possibly facing this too.

Had an ultrasound on Tuesday and got the results today. Polyp on my cervix and womb lining slightly thicker than it should be. So im looking at a hospital appointment and possible hysterocopy. All because i took HRT for three months and came off it two weeks ago due to a heavy bleed. Keep getting asked when my last period was and i KEEP saying i had three very light bleeds which lasted less than a day in 2022 and ive been on the mini pill for nearly three years which stops periods so i may not even be menopausal or post menopausal yet. I wish id never touched the fucking stuff
Its normal to bleed 3 to 6 months after starting HRT. I started bang on the 3 month mark. I was on HRT for 14 weeks Stopped it two weeks ago.

Just jumping in to agree with the others; I had a hysteroscopy a few weeks ago with an epidural and wouldn't have contemplated it without some kind of anaesthesia.
And it's a no brained about having the procedure.
Hope all goes well.

I've just had one but did my research beforehand, and insisted I took Diazepam, and I was also offered gas and air. My cervix was apparently had a post loop appearance and was stenosed so had to be dilated.
I can remember approx 30 seconds of discomfort (not pain) but other than that I was completely oblivious. I'm so glad I had it done as I'd had a scan that had showed a worrying foci. I was given the all clear and discharged, with advice to my GP to change the HRT I'm on. Still battling with that change as night sweats and bleeding are back, but at least I know it's nothing serious. Good luck.

Do it 100%

Mine is 19mm and STILL waiting for a referral a YEAR later

I had one with sedation, and it was fine. I don't think you are actually knocked out but I may as well have been as I remembered nothing afterwards. You could ask for that if you would prefer to avoid a full GA. Definitely have it for peace of mind though, however you do it. Hope all goes well.

Since March 23 I have had either no monthly shows or v light spoting. All consistent with my HRT.

@lyrapie Light spotting after 6 months on continuous combined HRT is not normal. You wouldn't expect to bleed at all on this type of hrt. If you had spotting after 6 months, your dr should have considered changing you to a sequential form ( a cycle) with a monthly bleed. This is in all the guidance around when to offer combined continuous HRT.

https://www.menopausematters.co.uk/postmeno.php

POST MENOPAUSAL -
Continuous combined therapies.
"Period free" or continuous combined therapy can be used by women who are 54 + yrs, or more than one year since last period at any age. The criteria should be fulfilled in order to offer such treatment to women who no longer have a continuing ovarian cycle, so that steady levels of both estrogen and progestogen can be achieved. When there are steady levels of estrogen and progestogen from daily administration of both, the womb lining stays thin. Although some bleeding in the first 6 months of therapy is common, there should not be bleeding after that and the lining does not go through the stages of stimulation and then shedding as it does during a normal cycle and with sequential therapy. Start with low dose preparations and increase as necessary for symptom control. The products marked * are licensed for osteoporosis treatment/prevention.
See below: WHY AND WHEN TO OFFER CONTINUOUS COMBINED THERAPY.

Patients should be advised to expect some bleeding in the first few months of treatment, but should have settled by six months. Any bleeding persisting beyond 6 months of continuous combined therapy, or bleeding occurring at a later date, should be investigated.

It's possible that you weren't post menopause when your were put on that form of HRT. Post meno is no periods at all for 12 months.

The risk of cancer in women on HRT is very low - the figure you mentioned (6%) is for women with post-meno bleeding, which doesn't include women using HRT.

The cut off point for women post meno is 5mm. The cut off point for women on sequential HRT is 10mm. And scans should be done immediately after any bleed to get an accurate reading.

Would you consider a local jab instead of a GA? It can work just as well.

You need to make up your own mind on this but if you've had spotting for over a year it looks as if you may not be post meno.

It may have been barbaric for you, but for me it wasn’t at all. A bit uncomfortable with some cramping afterwards, but perfectly ok.
The problem is, until someone has the procedure without sedation, they won’t know how it will affect them.

Many women manage without pain relief. It's a personal experience.
A lot depends on the skill / experience of the dr doing it.
I had to be dilated but didn't feel any pain.

There is the option of a local anaesthetic rather than a general.

Conscious sedation should not be routinely used in outpatient hysteroscopic procedures as it confers no advantage in terms of pain control and the woman's satisfaction over local anaesthesia. Life-threatening complications can result from the use of conscious sedation.

This is in the RCOG report on Best Practice in Hysteroscopy (online so you can read it all.)

I had a hysteroscopy earlier this year and was terrified. Burst into tears as soon as I arrived at the hospital. They gave me gas and air which took the edge off.

It was unpleasant but bearable. If I had to have another one then I wouldn’t loose any sleep over it. Definitely recommend gas and air.

I had an hysteroscopy with Myosure in the summer. I had a local anaesthetic in my cervix and honestly didn’t feel a thing.
I realise I’m very lucky, but just keep in mind that it’s not dreadful for every woman.

This procedure was most definitely barbaric!! I had it done without any pain relief & omg... I have never felt pain like it... I almost passed out & thrown up due to indescribable immense pain! (I actually have a high pain threshold, given birth to 3 babies without pain relief)
my cervix was completely closed & needed to be dilated for the procedure (post menopause)

My scan showed the lining as 8mm (2.5 years post menopause). & a Dermoid cyst on right ovary 43mm. Results came back clear & 3 months later a scan showed the lining was back in normal range & cyst remained without change.

I would suggest another follow up scan before having the procedure & if the lining has increased then definitely have the GA.