Hysteroscopy - General or Local Anaesthetic?

[RuzGen]

I had a consultant appointment today for thickened womb lining and a possible cyst or polyp.

Was told I need a hysteroscopy which I'm really quite nervous about.

I'm autistic so possibly more anxious than I should be about it but it's really playing on my mind

I've been offered the option of local or general so wanted to get people's thoughts and experiences.

Currently booked in for general so that they are prepped for either scenario and I can decide later on what to go for (if they booked me for local they wouldn't be prepped for general if I changed my mind on the day)

Consultant said it can cause some "mild discomfort" under local but I've learnt from experience that they tend to under estimate pain.

I'm also quite worried that whatever is going on might have got worse as I've waited a year for this consultant appointment

Any advice or thoughts welcome

Thanks all

Because I've had 3 vaginal births and multiple Mirena coils, the gyne thought I should be fine with hysteroscopy.

It's because I know how distressing and painful I find Mirena insertions that I knew I would not be able to tolerate hysteroscopy while awake. So I insisted on general anaesthetic. I'm glad I did.

I don't recover quickly from GA. I was discharged from hospital about 5h after the procedure was finished (they normally expect to discharge after 2-5h) and needed a couple more days off work because I kept falling asleep.

The most important thing for me was avoiding pain - both physical and emotional. When you're already worried about what they might find, is a wonderful thing to able to sleep through a procedure that is likely to cause physical and emotional pain, and wake up in no distress.

If I need to have another hysteroscopy, I'm willing to consider doing it with a spinal, but I will never agree to being awake or not having full anaesthetisia from the waist down.

General, I was made to think it was a great inconvenience to have one. I wish I had insisted.

Just adding to the data set: two vaginal births, never had any pain with gynae exams (transvaginal ultrasound/smears), had hysteroscopy with biopsy and polyp removal and literally didn’t feel a thing. I was a bit anxious about it because I’d read it could be nasty, but it was 100% pain free for me.

But, as others have said, if you haven’t had a vaginal birth or have a history of finding gynae exams painful, I’d go for general or spinal all the way. There are no rosettes for not having anaesthetic!

I had one last week and had a general and glad I did! When I came round the cramping was bloody awful, but they pumped me full of good drugs and it eased off.

My sister had hers done via local and said it was absolutely awful, the worst thing she’s ever experienced

I had a biopsy done without any anaesthetic done and it was unbelievably painful.

I opted for local for my recent hysterscopy, biopsy and mirena insertion and was fine. I had some slight pain when my cervix was dilated but apart from that I was painfree.

I'm also autistic and get really anxious so I took some prescribed diazepam before the procedure which made a huge difference as I went to shaking with anxiety to managing the procedure fine.

I've had 2 UIDs (got one currently) and had no problem at all with the fitting (or removing). I was really surprised when I heard some people find it agony. I guess everyone is different.

2 vaginal births

@DivorcedMumOfAdults I'm not great with the dentist but that's more because I have a fear of dentists in general

I had one with nothing, I wasn't aware of any other option, however it was fine. Slightly uncomfortable period type pains after but otherwise no discomfort at all.

I wasn’t given or offered anything, just to take two ibuprofen half an hour before. I had no idea some people were having it under GA!

Thank you @Greybeardy. Really appreciate your response.

I asked if the local would be in the cervix and she said yes. There was no mention of spinal.

She asked about my births and the pain relief I had and then said "oh you'll be absolutely fine if you coped with the pain relief you had".

That's all very well but I didn't really have a choice. I also screamed so much both times the midwife had to ask me to stop and I bit DH during the 2nd birth when I had no pain relief 😬.

I'm glad you mentioned converting half way through. The info pack they gave me said if local was too painful they'd have stop and re-book, but it suddenly dawned on me earlier that if they were prepping for a GA anyway that maybe I could start local and switch if it was too much.

I will call on Monday to get more info.

Thank you all for sharing your experiences.

I haven't had GA since I was a child but it tended to make me vomit a lot after.

It will be done in theatre whichever option I go for. It's also highly likely I will need a polyp removal as long as they can find the polyp when they go in.

I was also surprised when the consultant gave me options. I've heard a lot on here about people not being allowed GA despite begging and the procedure being awful. I think that's what has scared me to be honest.

It's mad how people have such different experiences and reactions to gynea procedures! I suppose I will only know how I'll react when I try it. I think if it's an option I'll try local as long as the anaesthetist could administer a GA immediately if needed.

Thank you all 🙂

Just in case anyone doesn't know this, they don't always offer options but you can ask.

I got a phone call to schedule mine and when I asked about pain relief they suggested I take otc painkillers. I asked what the alternatives were and eventually after putting me on hold I was offered GA.

I had no problems with smears when younger (coil was a different story) but it's got worse with age and menopause and I knew they'd be removing fibroids so no thanks.

I’m still teary about the one I had about 5 years ago, horrific, absolutely horrific, shaking, fainted, hysterically crying, the most horrible searing pain.
doctor (male) said yeah, sometimes this happens, probs as you had c sections. Like it was my fucking fault.
went back a week later for a general

Sorry for cross post op, I hadn't seen your latest.
If you haven't had GA since childhood you might be pleasantly surprised.
I hallucinated recovering from GA when I had my appendix removed as a teen but latest one was fine. (Tbh I woke up feeling amazing.)

@nzeire can I ask which bit you found painful? Was it the cervix dilation?

I was told to have GA for my first as I hadn't had a vaginal birth. For my second I asked if I could have GA - they seemed surprised but when I told them I'd had it before they agreed. I googled it before I had the procedure and there are some awful stories of women going through real pain so I am glad I did. Have it done under GA, it's on offer so why put yourself through a potentially painful and emotionally damaging procedure.

I had a hysteroscopy for similar. I was very nervous because of a bad experience two years ago when another gynae tried to remove vaginal polyps with no local anaesthetic and no pain relief.

This experience was very different. Was told to take ibuprofen and paracetamol beforehand, but also took a diazepam - I checked with the gynae department beforehand.

The male gynae was very experienced. He took time to explain everything very clearly, listened to my fears and introduced me to his team. (They were all women.) He suggested inserting a Mirena coil to protect my uterus from cancer. The consent form said that it would only be inserted if appropriate.

I did find the insertion of the speculum uncomfortable, but after that it was plain sailing. He injected a local anaesthetic into the cervix and I didn't feel it at all.

It turned out that there was no polyp. He took what he described as "a more extensive biopsy". I didn't feel a thing.

He announced "That's it all done!" and I was astonished to hear that he'd already inserted the coil.

When I expressed my surprise at the fact that they hysteroscopy was pain free, he smiled and said "I'd be very disappointed if I hurt you with all my years of experience."

ETA I'm 64, have never given birth and I'm on the spectrum.

ask them about it - it isn't always the right thing to do, but it may be an option. I would agree to that as a plan for someone who I'd anticipate being straightforward to anaesthetise, but for someone who might be trickier just doing a GA from the start might be safer. Even if the surgeon hasn't mentioned spinal, it would still be an option if it's an anaesthetic list (and there's no contraindications). Anaesthetist on the day (rather than anyone you're likely to be able to get hold of by phone before the date) will be able to explain the pros & cons of different anaesthetic options for you once they know your medical history etc. Having had vaginal deliveries and IUDs are often good signs that it'd be straightforward - how painful labour was doesn't necessarily mean much - it's more that your cervix will be more 'relaxed' than someone who's never had a baby pass through theirs.

i am likely to need one (scan coming up to confirm) and an already thinking general.

I was always scared of a general but had one last year for something else and I thought it was amazing!

I had one 2 months ago under general after a failed attempt using local. The pain was indescribable and I'm still a bit traumatised from it if I'm completely honest. I went in as a day surgery patient, got there for 11.30 and was home by 6pm. The staff were fantastic. If I had to have it done again, I'd opt for general with no hesitation. I hope it goes well, whatever you decide

I’ve had two - one was uncomfortable but bearable, the second was horrific. I have a pretty high pain threshold, but there are so many variables such as skill of consultant and your particular gynae problem, to name a couple.

I think that if you know you would be able to be assertive enough to ask them to stop and restart/rebook for another one under GA, I’d go for local. If you feel like you might find that hard, go for GA.

Ultimately, I hope the current campaign really keeps pushing the line of giving women the power to advocate for themselves and to know they will be listened to without judgment or pressure. This is where we need to end up, but we aren’t there yet though….

i hope it goes well for you, whatever you choose.

Me too. I was in a terrible state and was in the recovery room for hours. I only went in for an ultrasound and they said 'go down the hall' and then said 'we need to do this, it will take another year if you don't do it today', I'd never even heard of it. I had 4 nurses pinning me down, gas and air, I was screaming, and they didn't stop. I was in so much pain, in the recovery room, I couldnt sit up to take the painkiller they gave me after. I still have no idea how I drove home. I still get very shaky just thinking about it all.

And to top it off, as I thought I would be there an hour, I went over the short term limit in the car park which cost me £25.

For those who've had it done, were you able to return to work the next day or did you need longer off?

I can work from home so wouldn't have to travel anywhere

2 paracetamol before and ibuprofen after- nothing else was suggested. I bled a lot afterwards but would have been fine to go to work the next day.

I had a GA and biopsy. I took 3 days off as I was tender and crampy. That was before WFH was a thing though.

I'd have been OK WFH on day 2 probably.