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[Hurdity]

Hi Tinkerbell

So sorry to hear about your experience.

It needs to be explained to you:

Why you need a skin biopsy ( is this the vulva?)

Why you are having a hysteroscopy?

Why they want to fit a Mirena?

From what you've said there seem to be so many things wrong with all of this.

OK let's just say you do need a hysteroscopy - for good reasons (and I presume they would explain these to you), then you do not need to have a GA. I would point blank refuse this. I said in my earlier post below that I had a hysteroscopy with no anaesthetic at all. Having said that I was given a choice of hospitals to go to - a local town one and a further city one (both 30 mins drive away). The local town one would only do this procedure under GA but the city one would do either. It may be that the consultant at the hospital they want to refer you only carries out this procedure under gA. If so ask to go elsewhere where you can do it without anaesthetic, or LA if you prefer!

Re being tested for lichen sclerosis - I know nothing about this. I presume you have read up on it? However if the only reason they are suggesting this is because you need to use Vagifem for 5 nights per week then again this is rubbish! Previously women were able to use 2 x 25 mcg twice a week and then this was withdrawn to less than half the dose. The gynae has not read the sceintific paper if s/he says it works. What the research showed was that a statistically significant sample of women showed improvement on various indicators ( vaginal ph, epithelial cells - something like that - can't quite remember) - compared to placebo or no treatment. The results did not show a 100% improvment. The research also stated that greater improvement was found with 25 mcg dose than 10 mcg ie it is dose dependent. You are one of those women - as you have read on here there are others.

Several of us on here use local oestrogen ( ie 10 mcg Vagifem twice a week) in addition to systemic oestrogen so we are in effect getting more oestrogen.

You do not need a hysteroscopy initially to look at the thickness of the uterus if they are worried about the lining thickening on the Vagifem (and this is quite unusual anyway - you would have bleeding if this was the case). The lining is usually first tested using ultra-sound scan amd then transvaginal scan if necessary. As far as I know the hysteroscopy is not needed to measure thickness but to look at the surface of the womb lining for abnormalities, especially if the lining has been shown by scan to be thickened, and if irregularities might be seen ( as in my case). Maybe they are concerned about this?

You do not need to go privately for a second opinion but you do need a second opinion. This would not have happened in my area and please don't be pushed into having a GA if you don't need one.

As for the Mirena - what's this supposed to be for?

I've probably repeated myself as I haven't read though my other post and out working in a bit - but hope this is helpful!

Hurdity x

 

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It's the thought that any Surgeon would 'operate' without an initial consultation that bothers me 

[Tinkerbell]

Sorry my previous ramblings are not that clear!

I was referred to consultant gynae by female GP because I was having to use Vagifem more than twice a week. I saw consultant in August who, rather abruptly, told me that I needed a Hysterscopy because I was overusing Vagifem...5x a week and because I am overweight ( I have lost 10lbs  over the summer though)

I asked for a scan first but this has been refused, have been told they are not that reliable.

I have not had any bleeding between periods......last period was March but that was a light one, last proper one was September 2014.

The vulva biopsy is suggested to rule out lichen Sclerous ....I have researched it, and I do not have the symptoms of that! 

Consultant said VA always responds to Vagifem and if it does not, other skin conditions need to be looked at...hence the skin biopsy.

Mirena was suggested to stop womb lining build up due to my over zealous use of Vagifem and because of my weight.

Doctor is happy to refer me to female consultant, as I do not wish to see him again, and I feel uncomfortable seeing a male as well due to something that happened when I was a young adult.

If I am referred to female gynae, do you think she will change the plan he suggested or will she be unable to change it, I am worried by this as the hospital is the same one.

I do not want a GA or Spinal block.....I have found out female gynae runs a one stop Hysterscopy clinic....do you think this means she does it without GA?

I now don't know what to do, I am so fed up and got the impression that female GP won't budge and give me the full HRT I want to try.

[CLKD]

Other problems need to be ruled out I suppose, we shouldn't blame every thing on menopause  .  You are entitled to a Nurse when you see a Consultant/GP ……… I often stood with patients (male and female) if the Nurses were busy  . 

'always responds'  wonder where she read that!  I rarely believe GPs when they begin pulling ideas out of thin air! 

[Hurdity]

Thanks for filling us in on the details Tinkerbell. it is really worrying how treatment differs from area to area.

What I said in my long previous post below about Vagifem still stands. I don't like to disagree with a consultant but it is shown on here that women don't always respond to Vagifem at the dose of 10 mcg twice a week - I mean as I said in earlier post - the research paper shows this!!!! Many women used 25 mcg twice a week in order to stay comfortable. As I also said some women are using 10 mcg twice a week in addition to full HRT - like myself. Your GP did not need to refer you on this basis as she (the GP) does not understand that some women need more than 10 mcg twice a week. There are women on here who have been prescribed double this amount ie using 2 x 10 mcg twice a week or as you say 5 x per week (which is the old dose).

You most certainly do not need a Mirena because you are using Vagifem!!!  That is ridiculous! Endometrial thickening while using Vagifem is very unusual. Some gynaes recommend an annual progestogen challenge just to see if it has thickened - if it has there would be a small withdrawal bleed. If you want to use full HRT though, you could have a Mirena for the progestogen part of HRT and then use a patch or gel oestrogen. This should be your choice though!

You certainly don't need spinal block nor GA for hysteroscopy - if my experience (and others on here) is anything to go by.

There is no reason not to have a scan first to see if there is thickening - I mean there is no evidence of this is there ie thoikening? It's like saying I need to have a hysteroscopy because I use a medium dose oestrogen on a long cycle - which is way more than you are using.

You could find out if the female gynae does the hyseroscopy under LA or none?

From what you've said, you really really should not have to do all of this - and you need to tell your doc this or someone before it goes too far?

Rather than go to see a private gynae, could you write all of this in an e-mail consultation with Dr Currie (costs £25) and see what she says.  Info on the home page of this website. Then take it from there.....

Hope this helps 

Hurdity x

[CLKD]

Good idea 

[Taz2]

Just to say that our local hospital offers GA for hysteroscopy if you feel you need it and you are then a day case patient but NHS advice is that not even a local is needed - as Hurdity says - it all depends on preference I suppose. Some people get too anxious to have the procedure carried out without any form of anaesthetic and others sail through it. http://www.nhs.uk/Conditions/Hysteroscopy/Pages/Theprocedure.aspx

Taz x

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