Preparing for Hysteroscopy

Hysteroscopy is a procedure that a number of us in perimenopause and menopause will undergo - particularly if we're having problematic or post-menopausal bleeding. For some it's a piece of cake, for others its a nightmare. It's really important that the right kind of conversation happen before that procedure. And sometimes making sure that conversation happens properly will fall to us.

There needs to be an open and honest conversation about pain and pain relief with someone from the medical team involved.

That conversation should acknowledge that around a quarter of women experience severe pain. You should be offered choices about pain relief. You should be listened to. You should be invited to consent.

How many women find it painful?

Around 1 in 4 of us find it to be severely painful. Often they are those who haven't been pregnant, but I've talked to women who have had several vaginal births and say that their pain on hysteroscopy was worse. One woman I talked to had two very different experiences and felt that some practitioners were able to do it more gently than others.

Why do it without pain relief?

From the hospital's point of view, it's cheaper and patients are able to give feedback during the procedure. From the patients point of view it's less disruptive. You take less time off work and you don't need to arrange transport too and from the hospital and make sure you have someone with you for the next 24 hours. There's also a greater risk of hospital acquired infection the longer you stay in hospital.

What pain relief is available?

I've talked to women who have been told to 'take a couple of paracetamol' and then screamed through the whole procedure. If you are going to try to manage with over the counter medication, the maximum you could take would be 2 co-codamol and 2 paracetamol and unless you are sensitive to any of those drugs then I'd recommend it just in case.

You can be offered gas and air. For me that wasn't enough - but for some it might be.

You can be given a nerve block into the cervix. The procedure can be done under sedation or general anaesthetic.

What is it about hysteroscopy?

Good question. These conversations seem to happen routinely when colonoscopies are done. I've had two - one under sedation and one with gas and air. Gas and air was a good choice for me. I had a cup of tea and a sandwich and then I drove home. My experience of hysteroscopy under gas and air was of being overwhelmed by pain. Fortunately the gynaecologist involved stopped the procedure and it was done under general anaesthetic. In fact my experience at St Mary's in Manchester was a pretty good example of how it can work well.

Red Flags

If you have a doctor who suggests you 'pop up on the table' while he 'takes a little look' or 'has a wee poke around' and then starts a hysteroscopy you have a problem.

You have someone who not merely patronising. They are minimising the procedure they are doing and denying you a proper conversation and the opportunity to give informed consent. You are also probably in the hands of someone who thinks the pain is 'all in the mind' and if we don't worry we won't feel a thing.

My Advice

Insist on that conversation. Ask them to detail exactly what they are going to do. Ask them about the options for pain relief. Don't give your consent until you are happy that you have some control over the situation. And if necessary, you can withdraw consent part way through. That could well be difficult and uncomfortable. It may ultimately be the least painful option.

And do check out The Campaign for Painful Hysteroscopy.