NHS hysteroscopy after post-menopausal bleeding: pain concerns and sedation options?

[Changedforsafety]

I’ve had a little bleeding post menopause and have been referred on the 2 week appt protocol for a TV scan and Hysteroscopy . I’m not especially worried and the bleeding has since stopped. But GP confirmed best practice to check out and also sent for blood tests which have come back normal.
I’ve read the hysteroscopy leaflet and a few articles about the process, notably a campaign group advocating better treatment and BBC news articles both which describe the process as being horribly painful . I just can’t do it. My last two coils have gone awol and removal and reinsertion has been absolutely horrific , with me being sick and nearly passing out.
I’m aware that they will rebook if I say I can’t manage with gas and air/ local but are the NHS sympathetic / am I being a big wuss.

I had it done under GA. You're not being a wuss at all.

I had mine done under GA and don't regret it for a second. I was an NHS patient and was offered a range of options from nothing to GA, and everything in between. Very glad I took the GA.

BTW - be prepared for a fair bit of bleeding if they do a biopsy. I thought it would just be a bit of staining, but it was like a full on period. It was checked and deemed to be normal, but certainly a surprise to me.

My GP told me that while a hysteroscopy by definition is just a ‘looking’ procedure, the vast majority of the time samples are taken. I only waited an additional week to have it under sedation.

Absolutely not a wuss for going for the GA option. Luckily for me, my consultant said it was entirely my choice, but also GA advisable as both my DCs were born via CS.
It’s great that there are women who genuinely don’t find the procedure painful, but there are plenty who talk about a level of pain that’s “horrific” and who passed out due to it. You should choose whatever you think will suit you.

Again thank you all so much for sharing your experiences and opinions - really helps a lot x

You mention the leaflet, is that the RCOG one?

Unfortunately most women don't know if they're going to find it intolerable until the procedure starts.
I have PTSD from my experience 6 years ago. It's pure misogyny. Dismissing women's pain especially if we've given birth.
Compared to my experience in endoscopy at the same hospital, the moment I expressed pain during my endoscopy they pulled the camera out and rebooked me for it with a GA.

anaesthetist pov... the gynaecologists are very much more aware of when it's likely to be unachievable under just local/entonox than they perhaps were historically, and will refer for anaesthetic input. If you do decline to proceed in clinic (which is absolutely fine to do), the anaesthetist will discuss which is the safest/most sensible way to achieve doing - both GA or spinal/saddle block are options, depending a bit on medical history etc.

@fluffythecat1 It is bizarre that it takes hours for the cervix to thin naturally during childbirth, but for this procedure they use a device to open the cervix by several cms within a few minutes and expect it all to be fine

that is scaremongering nonsense. The cervix is not dilated by 'several cms' to do a hysteroscopy.

Deffo GA.
I had one privately under GA and was on the ceiling afterwards with the pain. Can't imagine having one without 😱

You won't wait that long on a 2-week pathway

I feel bad because it’s the 2W pathway and they’ve been super quick to see me but I’ll just have to wait and take chance it won’t be too long .
tbh I could well do without a GA because I live alone and will have to rely on someone to bring me back , but I cannot face enduring the procedure without some sort of anaesthetic.

Agree with @ramonaquimby when I requested a GA after I’d had my ultrasound and it was clear something needed further investigation, it added about 7-10 days to my wait for a hysteroscopy.

@Changedforsafety can you ring them and say that you need it using GA, rather than having to have a first appointment and then go back on another day?

During your hysteroscopy, a thin tube with a small camera inside is inserted into your vagina, passed through your cervix and into your womb.
The above from NHS website.
How was this tube and then a device to remove a polyp passed through my cervix then?

Please look up Campaign Against Painful Hysteroscopy on Facebook and Instagram. The leaflets are just lies.

I would recommend this as well - iron clad knickers at any appointment because they try to talk you into it and hide the medieval instruments under a cloth.

I went to the appt planning to refused the procedure and asked for a general. No problem and it was scheduled as a day case. Did not have to wait very long at all.

Don’t feel bad. I am still so traumatised by a hysteroscopy 15 years ago that I avoid smear tests.

I had one some years ago and was not offered any pain relief, so glad to see that this is generally not the case any more. I was told beforehand by a female doctor that it might be a bit uncomfortable it was horrendous and I complained to her afterwards. Would never do it again without adequate pain relief

the scope is usually somewhere between 0.5- just-under-1cm diameter. If a biopsy is indicated then it's taken via instruments passed through that scope.

Get the GP to add “will only consent to hysteroscopy under GA” to the referral notes. At least then they will know, but I think it’s unlikely the will book you for GA without a consultation appointment.

If you are post menopausal, the cervix is tightly shut and a thin plastic tube can be treated like a battering ram as the doctor tries to insert it. I’ve had one that was quick and painless and another where I was upside down and screaming for an hour as the doctor was unable to get the tube/camera in. I wasn’t even offered local anaesthetic. A third one, and I asked for local anaesthetic, it was so much better and quick. But if they offer you a GA, take it.

I have my legs crossed reading this. It sounds horrific and unless we stamp our feet and refuse to be gaslit they can all go home with their medieval instruments under their arms and practise on themselves!

I was due to have a TVS followed by hysteroscopy if necessary. Am post meno and in my late 60s so things are a bit atrophied down there, but nothing that bothers me too much either. I had spotting, so being the good woman that I am I got it seen to immediately. At the consultants I refused a hysteroscopy without sedation or GA. She looked at me sideways and raised an eyebrow, with the usual spiel of " most women tolerate it very well". How I didn't tell her to fuck off to the far side of fuck I don't know, but I was so angry, and insisted on GA.

So in the end and quite quickly (scary....) she decided to go straight for a Hysteroscopy D+C under general. OK that's fine. While on the table, it was suddenly changed to a full transcervical resection + polyp removal. So I got the lot done in one go. Much better..... I had a difficult recovery due to bleeding.

I am still mad as hell with aftercare though. I had metres of gauze packing in the vag due to bleeding. OMG she came around and yanked all that out without a bit of pain relief or lubrication. I screamed with the pain. Medieval fucking torture. I will be complaining. Am awaiting pathology so am in another worry phase until then and I hope I don't punch that surgeon in the face. And of course I am worried about the diagnosis.

Funny isn't it that all colonoscopies are done with sedation if you want, but hysteroscopy is not. Colonoscopies are for both sexes, Hysteroscopies are for women only. Go figure.

Sorry for the long essay. I am so traumatised that I want to shout at the indignity and unfairness of my treatment. Oh yes, there were two males in the ward while I was dripping blood and I had to pass their beds to get to the loo. Unbelievable, but was explained as shortage of beds. The men were moved after a few hours. Awful awful awful. Sorry I'm in a bad place.

@amdel so sorry