Hysteroscopy / endometrial sample / polypectomy / mirena coil?!?!?

[SweatySpider321]

I am meant to be having a hysteroscopy apparently. But then l got a letter in the post saying it would also include taking an endometrial sample as well. I have now attended the pre-assessment appointment, the practitioner l saw said they were advised l was having a hysteroscopy, polypectomy AND mirena coil insertion. Problem is none of these have been discussed with me and the Mirena coil is most likely a hard no. Initially they were declining to give me general anaesthetic or heavy sedation and said it wasn’t available. I highlighted the risk of it being a high pain procedure because of my cervical scarring, having a retroverted uterus, closed cervix / lack of vaginal deliveries etc. They kept on saying they were sure it would be “fine”. I advised them l was only going to accept heavy sedation or general anaesthetic which reluctantly appears to have been agreed.

At the pre-assessment appointment l queried if was going to be general anaesthetic or heavy sedation, the practitioner advised only general anaesthetic as heavy sedation would not be appropriate due to the polypectomy. I also advised none of the procedures have been discussed with me. Despite me asking repeatedly by phone and in writing to speak to someone about the plan then no one ever gets back to me. I was assured at the end of the pre-assessment appointment someone would ring me to discuss options and what is going to be done –this is yet to happen. I made clear at the pre-assessment appointment l wouldn’t be consenting to things that haven’t been discussed with me so l know reason, pro’s, con’s, alternatives etc.

Oh and for an encore as the pre-assessment appointment l saw someone had written down on my notes l agreed to take short notice appointments i.e. only 24 hours notice. I made clear that wasn’t realistic and l can’t do that, as l have 2 young children and work full time. The member of staff asked if it had been discussed with me and had l agreed to the short notice –l made clear no and no.

Local hospital are so inept that l wouldn’t be surprised if the pre-assessment expires (it is only valid for 3 months apparently) and they will cancel my appointment on the day (they have done that for another operation l had a few years ago at that hospital). Anyone else found the whole process difficult due to the hospital lack of organisation, poor communication and lying? I am currently planning on only consenting to procedures that l either want to have or have been discussed with me. As l do not see why l should either be forced to have a procedure that hasn’t been discussed but l also don’t want to miss this opportunity

All the women I know who have had a hysteroscopy have not been offered a general- 6 women, different areas of the country. I wasn't offered one either. The appointment for me came with advice to take paracetemol and no mention of what the procedure was. Lots of women go to the appointment and before they know it it's happening.

Under a GA it was great- lots of information and free to go within 3 hours.

Don't do this
ask for a GA
not having one is an awful way to find out your comfort levels regarding pain

there are countless threads about this, have a look
i had a hysteroscopy for polyp removal and coil insertion and chose a GA.

good luck

Your hospital sounds like a mess @SweatySpider321 .
I had all of these procedures last year under GA. They did try to do the hysteroscopy with no anaesthetic but I was in agony so they stopped and offered to book me in to do it under GA.
Really shit that they didn't discuss coil with you. And that they're saying you've agreed to short notice when you haven't.
I would complain.

It’s a complete dumpster fire, l have had enough already and it’s not even over. There is bound to be canceled procedures, forgotten instructions, even more poor practice etc

It’s not my fault they can’t organise themselves! I’m not not having a GA because the hospital is shit

I was called in for a Gynae appt with no indication of what it was for. GP couldn’t tell me; couldn’t get hold of anyone at the hospital. Assumed it was just a 6 month follow-up for something else, but no, it was for a hysteroscopy that should have been performed as part of a ‘cancer investigation pathway’ the previous year (?!?!?!). Couldn’t have it done, as I’d had unprotected sex that month. New appt made, another seven week wait; hysteroscopy failed because the nurse couldn’t get through my cervix. Put on a waiting list for a GA. Finally got an appt date this month, for a mere fifty two weeks after the initial appt.

so let’s hope there’s nothing concerning in there, right?

the amount of time and money draining out of the NHS on missed appts or needlessly repeated ones is depressing.

@SweatySpider321 I'm fully behind you with this as you have had terrible treatment (or rather no treatment yet.) And with your existing problems you described you should qualify for a GA.

It is worth reading the document (I left the link) from the RCOG and their guidance. This may well give you the info you need if you need it to ask for a GA.
The document gives insight into how doctors should offer this procedure, based on research and trials involving large numbers of women and what pain relief is necessary.

I hope things move forwards for you! If you have the option, your GP may be able to transfer your treatment to another hospital- you are supposed to have a choice of where you go.

Sorry l hope you don’t think lm irritable at you -it’s the situation plus suggestions l forego the GA as it’s “disruptive”. So what 🤷‍♀️. The whole thing is disruptive -the pain, bleeding, not being able to use tampax initially afterwards etc

I printed out that document the other week and highlighted the bits relevant to me. I ignored the reference to outpatients and heavy sedation as they are off the table now apparently

There is a campaign at the moment around painful hysteroscopy.
Don’t be put off over the sedation/GA. I was lucky that I insisted on sedation and got it.
They tried to push the Mirena coil and I said no. I keep saying no. I’m not far off 60 and EVERY time they tell me how it will help and I keep saying no.

No, I get how you feel.

The issue is that the document does say that for the majority of women, a local jab or no pain relief can be okay. That's based on stats/feedback of 1000s of women.

BUT the guidance says that women should be treated as individuals. So there is the option of a GA.

The issue for the NHS is that it's far more costly and means booking a theatre, more staff etc etc. So they tend to try to offer the alternatives as much as possible.

Your situation is not so much about GA/no GA, although that's important, but the appalling lack of info and communication about why you need the procedure in the first place.

You need a proper conversation about your results, what they show and if you need this procedure at all - and why. Results are open to interpretation and not all consultants will agree on what needs doing or not. You can also have input yourself, once you have the full picture. It's not the kind of procedure that is carried out without a face to face consultation and discussion.

You may not have any bleeding afterwards- not all women do- and if so it's usually minimal- a bit of spotting that a panty liner copes with.

What is the fixation with the mirena coil?! Is it because it’s cheap and/or is their commission? Doctors never stop going on about it for contraception and for gynae issues.

A friend of mine who is a nurse said they get a bit of commission for every one they push? Could be an urban myth.
I have said over and over I don’t want one, it’s in my notes.
One of my closest friends had one, it got embedded in her womb she had a serious infection and nearly died. I know a lot of women like them but having seen my friend in that state I declined.
They do deliver progesterone directly to the womb which can really help with bleeding in menopause but I even got offered one recently by my GP when I went in with…. an ear infection!

I have heard the womb embedding thing a few times and it sounds horrendous

A mirena coil in your ear?! That is a bit digression and reach by your GP

UPDATE:

I have had various phone calls from the hospital including 1 call trying to book me in, they were keen to do ASAP and told me l had done my consent form already! I said no l have not. I said yet again l cannot give informed consent if the procedure (s) have not been explored with me
Next call they are keen to reply to the complaint l have made in writing. I said go for it but my complaint is still ongoing! They were taken a back by this then offered me an appointment in 2 months time to discuss treatment plan. I then l pointed out this would probably mean the pre-assessment appointment would lapse as it is only valid for 3 months
We left it that l would get to meet another doctor (who probably won't do the procedure) and the actual operation they are not sure when. I advised l would make another complaint if the pre-assessment appointment lapsed, as they will have wasted my time and NHS resources. They were lots of huffing, puffing and don't knows from them.

I got referred to gynacology back in Autumn - an urgent referral. Six months later I got an appointment for a hysteroscopy with ultrasound. No appointment with a gynaecologist first to find out what the issue is just got told I had been triaged and deemed I needed the hysteroscopy. However I have pain issues in the area so there is no way I want this done with just gas and air so I rang the hospital they cancelled the appointment and put me on a list to see a gynaecologist. Finally had an appointment 9 months after the urgent referral and the consultant looked at my history and said straight away that I needed a general. Interesting that she was female and the original consultant who triaged me was male. So now I am on another long waiting list for an appointment. We really need to speak up for what we want and they need to explain the procedure and why we need it much better.