"Outpatient Hysteroscopy, Pipelle Biopsy & Mirena Insertion"

About: St James's University Hospital / Gynaecology

(as the patient),

Here is my account of today's appointment. I'll also use the same passage to submit to Patient Opinion.

My GP made a referral for a hysteroscopy as a transvaginal ultrasound indicated the presence of a polyp and abnormal endometrial thickness.

After about 8 weeks I made a call to the bookings department as I'd still not been given an appointment at St James' Hospital, Leeds. The administrator said there was a cancellation for two days time which I happily agreed to take. I was provided with no information about the procedure only that I'd be awake and that there was no need to fast (only because I asked).

On arrival to the department I was met by the consultant who briefly explained the procedure and the things that can go wrong eg damage, infection etc and asked whether I'd like to try having a Mirena coil inserted at the end of he procedure. I agreed to this and signed my consent form. I was also asked whether I'd taken any painkillers in preparation. I explained that I hadn't as I wasn't advised to and assumed I'd be offered some to take now. I wasn't and the consultant, although pleasant, seemed more concerned that I'd not eaten breakfast!

The procedure began with irrigating my insides with water as I was bleeding. From the off it proved to be very uncomfortable. The introduction of the scope was extremely painful and was coupled with an intense pressure - it honestly felt as though the scope was going to pierce through the top of my uterus into my stomach. The staff in the room - the Consultant, Staff Nurse

and HCA were all very nice and tried to keep me talking throughout. I was just repeatedly told to relax my legs and my bottom which I found quite difficult considering the pain I was in. I don't remember having the endometrial biopsy as it was all a mix of intense pain and constant, strong period- like cramping. The insertion of the Mirena coil was a breeze after everything else that was done!

At the beginning of December I had a Colposcopy where several cervical biopsies were taken due to an abnormal smear. I thought this was uncomfortable but the Hysteroscopy was by far the worst pain I've had to endure. I've never had children and I'd say that I have a moderate to high pain tolerance so I feel great concern that this procedure is provided to a majority of women minus any sort of pain relief. Surely the risk of damage to the patient should they shift position suddenly is high enough to warrant at least minimal intervention, never mind the mental trauma? My upset doesn't lie with the staff in this instance, but the underlying policy that dictates that this is allowed to happen to women across the country within an NHS that promotes 'patient-centred care'.

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Responses

Response from Leeds Teaching Hospitals

Dear HeatherH,

Thank you for your feedback regarding your experience of our outpatient hysteroscopy service at St James University Hospital. I am pleased to hear that you found the staff members who cared for you on the day friendly and nice. Our gynaecology department strives to offer a patient-centred service. We truly believe that our outpatient hysteroscopy clinic aims to offer such a service so I am sorry to hear that your overall experience was unpleasant.

Ideally, before your hysteroscopy appointment you should have been given verbal and written information about the procedure and your appointment. The written information explains what the procedure involves and gives advice on how to prepare for your appointment including the recommendation to eat as normal and to take pain killers. Due to the short notice of your appointment, the patient information leaflet may not have been sent to you as it would have arrived to you after your appointment. I am sorry that the administrative staff member did not inform you of these points during your phone call. Feedback will be given to ensure that future patients who have short notice appointments are correctly informed. In addition, we plan to put all our gynaecology patient leaflets on Leeds Hospitals NHS trust website so that they are accessible online.

I am sorry that you experienced significant pain during the hysteroscopy procedure. Outpatient hysteroscopy is an established and generally safe procedure that is performed worldwide to investigate women with abnormal vaginal bleeding. There are significant advantages to having a hysteroscopy while awake rather than when asleep (under general anaesthetic) including fewer visits to hospital, shorter stay in hospital (usually 1 hour versus a day), quicker recovery and return to normal daily activities. In addition, certain side effects and complications are less likely if the hysteroscopy is performed while awake. These include perforation (making a hole through the womb), severe bleeding and complications of a general anaesthetic.

Research studies and our experience have shown that most women tolerate outpatient hysteroscopy well. Patient satisfaction is the same as for women having the procedure under general anaesthetic. Unfortunately, significant pain is a recognised risk of the procedure and is experienced in a small percentage of women whether the procedure is performed awake or asleep. We cannot predict, before the procedure, who will experience significant pain and I am sorry that you did. We do have options available for women who experience such pain including using local anaesthetic and the option to stop.

We continue to strive to provide the safest, most effective and patient centred care to all our women. Feedback, like yours, helps us in achieving this goal.