"Need to review hysteroscopy information fact sheet"

I was referred to gynaecology at RUH Bath for a polyp to be removed and a biopsy taken.

At pre op appointment I had a failed biopsy as the consultant discovered I had a very small cervical opening and was not able to proceed. I did discuss that I had never had children before and about the procedure. Was told to take Paracetamol and Ibuprofen before coming in and the procedure would be under a local injection. I discussed my unusual bicornare uterus which is all in my medical notes. I was reassured if I took the Paracetamol and Ibuprofen before hysteroscopy it would be all over in 15 to 20 minutes. I was concerned as they had not been able to stretch my cervix regarding pain, but was reassured and given an information leaflet about the hysteroscopy.  I was not offered at any point this procedure under general anaesthetic, though they had experienced difficulty with my small cervix and aware I have a bicornate womb, plus expressed concern re pain.

The leaflet did not cover these things either or risk of vasovagal attack or that I could request a general anaesthetic either. Nothing was mentioned on the leaflet regarding how many women experience severe pain with this. I was told I would get mild period pain , bleeding after and be ok for work.

My hysteroscopy was running 25 min late. I tried to explain regarding my bicornate womb and issues with small cervix also that I'd taken 2 paracetamol and 2 naproxen 250mg before the hysteroscopy but as it ran later the effectiveness of these was not so good.

My hysteroscopy was extremely painful, I felt the injection to the cervix and soon the polyps were found, 2 of them in same area. The first 10 to 15 mins pain was equivalent of period pain which after having every day for 2 years was no surprise to me, I thought I had got used to the constant period pain.  But nothing prepared me for the pain of the instruments thrashing around inside the smallest side of my bicornate womb. I was offered to stop if needed but decided now just to get through though the pain was far too much. At this point I was offered gas and air which I took, never tried before but found it offered no pain relief , just made the room spin around very fast, the lights seemed to dim and I felt very nauseum and faint.

After about 45 mins the consultant had taken both polyps out but on counting up was only able to find one. Told me I would likely pass this afterwards when having a wee. I was barely conscious at this point and not reassured.

Feeing very nauseous with room still spinning I was encouraged to sit up put on my knickers with a pad and get dressed.  I was so dizzy and nauseous was unable to reach to put my own boots on. Was in so much pain around my stomach I couldn't do the zip up on my skirt at all. Ended up being pushed onto a recovery bed for 30 mins, offered a hot drink and biscuit which I couldn't manage. I was shaking so much my partner told me I had gone very pale and the nurse with me seemed concerned . I discussed with the nurse I get menstrual migraines so would have taken my prescribed anti nausea med if been advised beforehand, though was not given this advice on facts heel or in clinic. Nurse told me this would have helped me.

As soon as I forced down the hot drink was told I could go home. I was not able to walk without my partner supporting me and was very weak and shaky on my legs. I asked when my biopsy results would be known on leaving the gynaecological department and was assured by the consultant I would hear within 2 weeks. I went straight to bed with anti sickness medication and more paracetamol and naoroxen.

Next day I had a menstrual migraine, bled profusely which did not help my anaemia and was nauseous for the next 3 days, hardly eating anything. The pain lasted for 3 weeks. I still have gynae pain now and then experienced bacterial vaginosis.  

I would really have liked to have been offered a general anaesthetic for this procedure with my risk factors with pain and anaemia. I felt so unwell with gas and air and am a severe asthmatic which was very unpleasant experience as I felt unable to breathe with gas and air and was told to carry on with it though was making me feel worse and did nothing for my pain. The paracetamol and naproxen were totally ineffective for pain too for my procedure. 

I feel the Royal United Hospital Bath gynaecological team need to review and update their information fact sheet on hystreroscopy to include patients can request general anaesthetic for hysteroscopy. Also, add types of patient who may experience more pain eg women not gone through childbirth, women with cervix or womb deformities, and mention this in pre op to discuss option of general anaesthetic and increased pain with these underlying factors. At no point was my BP checked whereas I would have been monitored much more carefully under general anaesthetic. I don't feel I should have been told to expect mild period pain when it was extreme pain 10/10 level and faint at the end of the procedure.

Staff attitude