Hysteroscopy with a tilted womb?

[Feckedupbundle]

I recently had a bit of post menopausal spotting,and have been referred for investigation under the 2 week pathway.
I had an external and internal scan on Friday and yesterday, received a brief text telling me that an appointment with a gynecologist has been made for this Saturday. There was no information about what they'd found or what the appointment was actually for,so I responded saying that I would attend,but didn't know what to expect. I had another text saying that it was to see the gynecologist,and that ' a hysteroscopy may be offered '. Does that mean that they'll want to go it there and then? I'm scared enough about what might be causing the spotting,but the thought of the hysteroscopy is making me panic.
I have a tilted uterus and smear tests are always difficult and painful,my GP took some swabs again my appointment and that was painful too.The lady scanning me commented on my tilted uterus and I have to angled myself so that she could do the scan properly.
I'm scared that they'll try and railroad me into having a hysteroscopy without a GA,but with all the previous pain and discomfort I've experienced with apparently "pain free" procedures,I REALLY don't want to go through this. To be honest,I don't think they'd even be able to attempt it,as I'd be shaking too much for it to be safe.
Anyone had similar? Am I within my rights to ask for a GA? Thanks for reading.

Yes you can ask for a ga. Absolutely ask they tried to do a hysterscopy during a gynae appt for a fibroid which was useless as they had no intention to help that, it was the worst day ever I’d taken no painkillers and had an episode of diarrhoea only hours before so feeling less then great thinking this could be really embarrassing when the idea was sprung on me as a necessary for a blooming relatively small fibroid - 20 minutes later, 2 positions and out of the allotted time they gave up, telling me it’s far easier for those who birthed children and offered a ga made me easy pray for getting a coil additionally no way would they have been popping that in on that day. I was in theatre 4 months later I think as semi urgent.

Some hospitals have really dedicated hysterscopy clinics who are experienced and helpful in fearful situations as I was fortunate to go to one later on a third attempt to have the coil specifically taken out as naturally as I could avoiding a further ga. Over my dead body will I ever get a coil again or not ask the why is this procedure needed but I’ll appreciate this is after event.

Thank you for telling me about your experience.I'm sorry that you had such an awful time. I can't have a coil as I had an ectopic years ago,so don't have to worry about that.
I rang the hospital today to try and find out what the appointment will entail,as I really don't want to get there and be told that this is what they are going to do. The lady on the phone didn't know,just said I'd get a letter. In my experience,the letter normally turns up after the appointment.
I've had two babies,one without pain relief,so I'm not generally fragile,and thinking about it,I also had a lap and dye test,and that is practically the same as a hysteroscopy,and that was under GA as standard. I don't get why they expect us to go through painful, undignified surgical procedures with just paracetamol?

Oh well,I'll have to wait and see. I'm taking DH with me as I've been to see consultants before and their account of the appointment afterwards,and ours were totally different. If DH hadn't been with me at the last one,I'd have thought that I was going mad. He's also not one for being talked over or bullied.

Do you have the NHS app? I'm on the same pathway and have had all my appointment details in there after an initial text telling me the time/date and where to go, there is detailed information about what will happen at the appts. No paper letter yet and I had my first appt today. I appreciate all hospitals do it differently though.

No I don't,but thank you,I'll look it up. I had a letter confirming my appointment today, I'm seeing a gynae nurse, apparently,with no more information than that other than to allow an hour for the appointment. That sounds suspiciously long for just a chat. I probably sound paranoid,but I'm not, I have previous experience of having tests done without my knowledge and consent when I was pregnant. I only found out that they'd been done when I was refused a home birth because of the test results that I had no idea about,as they weren't routine ones.This is the same hospital.
I'm so stressed about the whole palaver that my IBS has flared up and I'm getting cold sores.
I hope that everything goes well for you,and they find nothing to worry about.

Thanks, they couldn't complete the scan yesterday because of the position of my uterus so I am having another one tomorrow at a different clinic, they did take a biopsy though and I am expecting to get called back for a hysteroscopy. I hope yours all comes through with nothing major too, it is such a worry.

I also have a tilted uterus. I tried hysteroscopy without GA and found it agonizing. The NHS push it because it’s cheaper and can be performed by a nurse. I now have annual hysteroscopy with GA and would not accept anything else. I’ve also birthed a child - my supposedly stretched cervix just would not cooperate!

Fingers crossed for you ExtraDisorganised that the scan can be done and you don't need any further investigations or treatments.
Vinvertebrate thank you,that's interesting, although I'm sorry that you had to go through that. I've read through the RCOG guidelines and have 2 of the contraindications for having a GA. I don't even mind having a nerve block or sedation. I'm reluctant to try gas and air as when I had DD1,the midwife took it away from me as she reckoned that I wasn't pushing hard enough,so I had my first baby with no pain relief, I 'm not risking that happening. It makes no sense to me to go through a trial by pain on the off chance that it will be ok,as that is a waste of an appointment and equipment.

I've just been put on the waiting list for a hysteroscopy and I requested an anaesthetic and have been offered a local anaesthetic which I am happy about.

I previously had a biopsy taken without anaesthetic and it was agony, I had a second one when my cervix was numbed to remove abnormal cells and didn't feel it at all.

I'm undecided about anaesthetic if I need a hysteroscopy. I have delivered vaginally, am usually fine in smears and have had two mirena coils inserted and removed with only discomfort, biopsy yesterday without anaesthetic was unpleasant but not agonising. But you never can tell.

I just don't know what to do now. The stress of what might be wrong is making me ill and I don't want to delay any results/ treatment. I've a horrible feeling that if I refuse to have one without GA,they'll put me on a long waiting list and I can't cope with the uncertainty much longer.
I wish I'd asked questions at my scan,but I didn't know if I could,as when I've had them previously,the staff refused to answer questions. They didn't say anything about what they could see,other than ask if I'd ever had a C-section (no). I don't know why they'd ask that when I'd already told them about abdominal surgeries when they asked when I first went in.
I suppose I'll have to see what they say on Saturday at my appointment and try and gauge whether I let them try without proper pain relief. Honestly,the whole situation is stressful enough without the added worry of having a failed, potentially agonizing procedure.

I had a hysteroscopy and biopsy 10 days ago with anaesthetic spray and gas and air. I have a tilted uterus. I was almost hysterical on arrival due to a really bad Mirena fitting previously. I’ve never had children. I had to insist they got the gas and air and spray (which they did, but I had to ask for it). I had a really good team and I’d communicated my worries beforehand and they agreed to stop and refer me for a GA at any point.

Hit the gas and air hard - them going in was fine. The biopsy and removal of a polyp was uncomfortable but ok. I was even happy enough for them to try a Mirena again whilst I’m on the waiting list for uterine ablation with a GA, and that was ok too. Had 30 mins to let the gas and air wear off, walked to the car, drove 2 miles home, took Nurofen and spent the weekend in bed with a book and chocolate. Wasn’t half as bad as I thought.

To be honest, the person doing your scans was probably a sonographer and not able to talk to you about the hysteroscopies. I think all you can do at your gynae appointment, if they recommend one, ask if it is possible to have GA and how long you would have to wait, then you will be better placed to make a decision. They may be able to offer local anaesthetic or gas and air or similar. The waiting is awful though, I had my second scan today, with a sonographer and all she would say was that she was sending the images back to the gynae consultant. As they took a biopsy it might be a while before I hear anything.

My old consultant said she usually advised a general with a tilted womb etc, her reasoning was it was guaranteed to be done rather try and fail and have to wait for another appointment.

Thank youPauliesWalnuts that very reassuring to know. If they do suggest a hysteroscopy, I think I'll give it a try,but like you,insist that there is local anaesthetic and gas and air available to hand. I've remembered that we might have some co - codamol lurking about,so will take that before hand too,if I can find it.
ExtraDisorganised that's what they said to me.I asked what would happen next and they said they'd write to my GP and give the scans to the Gynaecologist to review. Only afterwards I read a fed threads on here where the sonographers were pointing things out to their patient,ie that they could see a polyp ect,and wondered if I missed a chance to ask questions/ find out a bit more about what might be wrong. I hope you hear soon,the waiting is dreadful.
Seagullsanddsausagerolls that's comforting to know,I'm happy for them to have a look and see what they think about it being successful it means I get speedy,pain free treatment. Thank you.
Thank you all,I don't have anyone in real life to really talk to about this and how worried I am. DH is a rock but scoffed at the idea that they'd do a painful, surgical procedure with only paracetamol ,I told him to look it up and that women are expected to cope with levels of pain and discomfort that men wouldn't stand for. Sounding off here really helps.

Good luck tomorrow @Feckedupbundle

Thank you,my appointment was 9.30 and I was seen on time. I had my suspicions that they'd want to try and do a hysteroscopy there and then,so I'd taken 2x 30mg co codamol and hour before,but it was still a shock to walk into the room and see the chair all set up waiting. I was so anxious that I could barely answer her questions,and started to cry. The scan showed my endometrium was 2mm thicker than they'd expect in a woman of my age.The nurses had no idea that I hadn't been told by my GP that this would happen,and that I'd not received any information from the hospital about it. They were absolutely lovely, apologised and explained that I should have been informed and that if I wanted to opt for a GA, I was able to request one and it would be another week. I couldn't stand the anxiety any longer,so said to try there and then,I told them that I had a tilted womb and she said it might make it more difficult,but I opted to go ahead as she said that she'd be able to tell me there and then what she could see.
I was offered gas and air and I was huffing on that before she even started,I'd read that co codamol and gas &air has a sedative effect,so I self sedated!
It was surprisingly unpainful,she took a biopsy with my permission, although she said that from what she could see,she had no concerns. I felt a mild period like cramp when she did it,and that was it. I didn't feel the camera,the speculum or any of anything else,apart from cold water.
I'm glad it's over and done with, although apparently I have a 5.5cm ovarian cyst that I knew nothing about,so I've got to have a blood test to check that that is nothing sinister, although from the scan she doesn't think it's anything to worry about. She said the bleeding is possibly due to me not being very far into the menopause yet. Bloody hell,I'm 56,I've had periods since I was 11! I will have a follow up scan in 3 months to see if the cyst has grown,as it could start to get painful and may need removing if it has.
It honestly was the best it could have gone,the nurses were lovely,answered all my questions,reassured me and were so considerate. One even popped out to tell DH,who was waiting anxiously outside,that it was all over and that I was fine. Bless them,they said I'd done very well,considering it'd been dropped on me with notice and my history of painful smears,tilted womb ect.
This was Leicester General Planned Care centre,which I think only opened last year.
I know that everyone's experience is different,but just wanted to share mine,as I had all the contraindications for it not being able to be done at all,or severe pain if it was. In all honestly,as I told them,the swabs that the GP took hurt far more than the hysteroscopy did.

You could also ask for sedation if you don’t want a GA. I prepped in advance as my hospital will minimise women’s feelings and tell them an ibuprofen beforehand will be sufficient. I read all reviews of consultant and hospital where I was booked in. I then rang my GP, who is brilliant (a young man too), and explained I was worried I wouldn’t cope so could I have some diazepam and he prescribed a one off dose and told me to take it an hour before appointment.

If I hadn’t had that I’m pretty sure I wouldn’t have managed. It was just like a weird dream.

Sorry - I’ve just seen that you’ve been this morning. Thank you for letting us know about your experience. Some hospitals don’t seem to even offer gas and air, I’m glad you were looked after.

To put your mind at rest, my consultant said that sometimes post meno bleeding is the ovaries having a last hurrah - they churn out whatever hormones are left and it can cause the bleed. My bleed lasted four weeks and caused a massive worry as my family has history of endo cancer. Longest wait of my life as I couldn’t get in to speak to GP and then they got me to consultant apt in days.

I hope you get your results quickly. Try and rest and be gentle with yourself (be kind to yourself physically and mentally for a good few days).

I’m glad it went well, I (cautiously) think mine might be a last hoorah thing as well, I’m nearly 58 but have not had a period since I was early 40s due to having mirena coils and haven’t really had any menopause symptoms but have a family history of late menopause. My last mirena was taken out a fortnight ago and was 10 years old so should have run out of hormones but might have had a lingering effect so I am hoping it was that and late meno combined. I had four days proper bleeding from a few days after it came out which surely must have been hormonal. Had to steal pads from my DD.

Oh, my NHS app has just pinged while I was typing. Biopsy normal! Endometrium only slightly thicker than expected. If I have any further bleeding to let them know and they will do hysteroscopy under general. Well that’s a relief.

I have to say this service has been excellent. I contacted my GP on 6th Jan, saw them for the coil removal a week later, booked into gynae immediately for this week, seen on Monday, scan repeated at another clinic on Weds, results today.

I hope you get your results quickly too @Feckedupbundle

Really glad all went well @Feckedupbundle. With the right team doing the procedure it makes all the difference.

Glad it went well!

Thank you everyone.ExtraDisorganised that's great news that the biopsy was clear,very quick result too!
Ironically,I had no bleeding or pain after the biopsy,just a bit of period type pain yesterday

I had a follow up text survey,asking about my experience,so I gave them chapter and verse about the nurses being fantastic,but the hospital 's communication being appalling. I'm wondering if I ought to make a separate complaint via PALS,as if I hadn't read up on the procedure here,I wouldn't have taken pain relief in advance,AND there was no aftercare information given,other than seek help if in bad pain or bleeding,if I hadn't researched it myself,I'd have got in the bath yesterday,to ease the cramps.I don't think it's good enough not to inform patients of what to expect. It's a shame,as my treatment has been very fast and exemplary apart from that.

This is why i stopped HRT and wont take it anymore. I bled on it so they wanted to send me for an operation without anasthetic otherwise known as a hysteroscopy. Stopped HRT back on 18th September Havent bled since. Havent given birth.

NHS need to make a choice............offer GA as a given.
OR

accept that the ££££ saved by not offering this will have to be ploughed into treating older women who havent taken HRT for all the ailments that HRT can prevent!

I had a hysteroscopy yesterday under GA and had polypectomy, biopsies and D&C, think I had a fibroid removed too. I wouldn't have it done without a GA. Everyone was so lovely and I was very well looked after. I don't have any pain and only minor bleeding. Consultant gynae was very happy with everything and I have to wait for the results which she thinks will be fine.

I’ve had a hystoscopy under spinal (not GA, but completely numb from waist down) for similar reasons with a tilted womb. Was one of the easiest procedures I’ve ever had - and I’ve had many; I’ve got a lot of complex health issues. All okay and was able to go back on HRT afterwards. It took me a while to find the right HRT so I didn’t have constant bleeding - I have lupus and addisons and all sorts so heavy bleeding is an issue. I take the mini pill and have the evorel conti patches. Works well for me. I’m glad I had the hystoscopy as I know I don’t have anything sinister going on. The spinal was great as I didn’t need a general but felt nothing at all.