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[laszla]

Ladies, I'm to have a hysteroscopy on Thursday for thickened endometrium so I did a little search on here for experiences (I am highly anxious, have a low pain threshold and retroverted uterus).

Just reading a few of these has alarmed me to the point of wanting to cancel but am trying to keep my head and realise that it's not crystal clear to me whether some of these ladies who had very painful experiences had a local anaesthetic or not.

Can anyone help with feedback on experiences of hysteroscopy with local anaesthetic which is what I have been offered (general is also an option but at the moment I'm down for a local).
The posts I've looked at date from the last couple of years - is it possible that those patients had hysteroscopies with no anaesthetic at all?
Thanks

[Doodle]

Hi laszla, I would definitely advise you to take the anaesthetic. I had a hysteroscopy a couple of months ago and was only advised to take 2 ibuprofen an hour before the procedure. It was a very unpleasant experience indeed. I wasn’t even offered any anaesthetic beforehand at all. Not even a sedative. I’ve had many procedures done in the past, but the hysteroscopy is one that imho should NOT be done without proper sedation or anaesthetic. I had a gastroscopy done a few weeks later (camera down throat), and opted for light sedation with this procedure and it was a breeze compared to the hysteroscopy (with nothing at all). I don’t believe anybody should be put through any invasive procedure without the option of sedation/anaesthetic.

Good luck on Thursday. I’m sure you will be fine. It’s all over pretty quickly and even though my experience wasn’t the best, I’m glad I went ahead with it. Go for the anaesthetic, and don’t let them talk you out of it. Because it’s likely they will try to.

[Pandabear]

They don’t routinely offer anaesthetic.  When I asked for anaesthetic they offered to numb the cervix area only which I accepted but didn’t feel that this was much overall help. 

Definitely 100% take the local anaesthetic because yes they do this procedure with no anaesthetic atall.



 

[laszla]

Thanks Doodle for your testimony, I wouldn't dream of doing it with no anaesthetic and they've offered it without my having to ask luckily.

I panicked on reading a few posts with bad experiences as it never occurred to me that no anaesthesia would be given which I assume was the case in those instances.
I would also be great to hear from anyone who's had it with local a.

p.s Doodle I found gastroscopy unbearable!

[laszla]

Thanks Panda, I'll def take the local and if I hear from anyone who's had it with a local but still found it painful I'd even consider a general anaesthetic.

[suzysunday]

I had to have one 3 years ago.  I was petrified when I read up on it and I have really bad anxiety.  The local anaesthetic didn't fill me with confidence.  After research I asked for a general anaesthetic, which hadn't been offered but they let me have one no problem.   I know it was the right decision.  I didn't have to stay overnight as I had someone to take me home and stay with me for 24 hours.  I know I couldn't have coped otherwise.  Everyone is different.  Don't be afraid to ask for what you want, it's your body.  If you have a general it'll probably have to be rearranged, pre op stuff, but honestly I'm so glad I did it that way. 

[laszla]

Thanks Suzy, I agree entirely that we should be able to decide, I was appalled to learn over the last hour or so that even locals are not usually offered! Glad the GA was right for you: I won't rule it out though for me GA brings its own, different brand of worry

[shoppingqueen]

Hi laszla

Strangely, this was pretty much my post a couple of weeks ago. I was down for the same procedure plus biopsy. I was, like you, terrified and posted here. Same issue as I have thickening at 5mm. I was terrified and have a very very low pain threshold. I used to pass out with period pains!
I called before and asked for the GA but they pushed me just to go for the appointment and see and if I couldn’t manage would put me down for a general. I’m not being cynical- or maybe I am- but let’s be honest, it’s cheaper and quicker for them to do without. I agree with a couple of other posters here that any uterine procedure should be done under GA as a matter of course.
Most of my replies were reassuring, although one did scare the living daylights out of me and made me 10 times worse. I wish she’d not posted.
So, when I got there last Wednesday after a sleepless night and awful tummy ache (psychosomatic?), the lovely nurse talked me through and said she was less concerned as my lining was only 1mm over and there was only a small fibroid on the scan. She could see I was beside myself (crying!) and I think was happy to
Let me go and to rescan in a few months, but my doctor had been vigilant and I didn’t want to let her down if that makes sense.
She said she could do the hyst and biopsy, or just the biopsy. I went for this as I had at least got there and have already been worried about uterine cancer so she did a local and I had gas and air. Not pleasant and I felt sore after but I’d had an unpleasant time with a coil fit and it was no worse than that. Trust me, I’ve a VERY low pain threshold.
We agreed if I needed the hyst then I’ll be on the list for a GA.
I would say go to the appointment and see how you are in there. If it’s too overwhelming ask to be put in the list.
Afterwards, I too had that belief like other ladies here that internal investigations such as this should automatically be done under general. The emotional distress and anxiety itself is too much and we shouldn’t have to to get ourselves into a state for this.
Let us know how you get on tomorrow. Remember they can’t do it without your consent and YOU CAN request a general. They can’t refuse.
Prior to the appointment, the secretary had pretty much said this to me but to go to the appointment first. I think they believe most will push through and get on with it. But you don’t have to and request a general.
My discomfort went the next day, by the way.
Thinking of you. Do what feels right for you. Xx

[Wrensong]

Hello laszla, I've had hysteroscopy with biopsy on 3 occasions.  First in my late 30s under general, but with laparoscopy & D&C carried out at same time & no lesser option for pain relief/sedation was offered.

2nd in my 40s with local anaesthetic & light sedation.  This was by far the easiest of the three for me.  I was conscious throughout, but relaxed & able to follow what was happening on the monitor.   I didn't experience any pain, but as this one was carried out before peri began the access route will still have been relatively robust.

I don't get on well with general anaesthetic, so was very pleased to avoid it for that 2nd hysteroscopy.

My last was in mid-50s (postmenopause), without any sedation or pain relief other than the recommended 2 paracetamol an hour before.  Though it was over quickly, I did find it uncomfortable (like intense period cramps), so would not recommend this option & you've sensibly already ruled that out.  That said, it was undertaken at a time when I had poor absorption from my systemic HRT, so with low oestradiol levels (around 100) & inadequately treated VA, a combination that won't have helped comfort.  I'm also a small woman, never had kids & cervical smears that were a doddle in fertile years had also become increasingly difficult.

I don't think they should routinely perform hysteroscopy on postmenopausal women without any form of anaesthetic (none was on offer for that last procedure) & I believe there was a campaign a few years ago to make it mandatory for women to be given choices on level of sedation & pain relief.  It was obvious the lovely middle aged nurses were also not comfortable that patients at that hospital were no longer given any say in the matter. 

I do remember posts though from some members a few years ago who had no problems with hysteroscopy without any pain relief or sedation at all.

If you feel you'd like to go along & let them attempt to do it under local so you avoid the GA you'd rather not have, then this seems a good approach.  I'd tell the staff beforehand you are anxious, as we all are, as it's in their interests as well as yours that you are as relaxed & comfortable as possible.  They will do all they can to put you at ease & likely tell you you can ask them to stop at any time.  You can also ask them beforehand what your options are if you feel you don't want to continue.

I hope it goes well for you.  Whatever you decide it is a quick procedure & after the 2 that involved hysteroscopy alone I was back to normal with no discomfort the next day.
Wx

[laszla]

Thanks so much Shoppingqueen and Wrensong for your reports.

Shopping, my lining is nearly 12mm - where I go they consider up to about 10mm acceptable if on HRT, unless the scan is done right after the bleed in which case the threshold is lower. I'm glad it went ok for you in the end, I agree that probably the best thing is to play it by ear and I won't have any qualms about changing my mind or stopping if it's unbearable.

Wrensong, very good to hear about the differences in your three experiences. Like you I am very slight, have poor oestrogen absorption and have never given birth! OTOH I don't have VA problems as take industrial quantities of Ovestin and Yes. So I am hoping having a local will make it most similar to your second experience (though I'm mid 50s so perhaps wishful thinking!).

I will definitely be very forthcoming about my anxiety and hopefully be in a fit state to explain to them that while of course the mechanics such as thickened endometrium need to be checked, this has to be balanced with my ropey mental state which is the main reason I went onto HRT in the first place.

I also found out this week that despite having taken double or more the estrogel this year compared to the three previous years, my osteopenia has now turned into osteoporosis according to the Dexa. So that hasn't done my confidence or mood much good.

[shoppingqueen]

You’re welcome Laszla

Please let us know how you get on tomorrow. Wrensong’s post is reassuring and I’ll take this on board as well if I have to go back for the hyst! I’m slight too and had my one child by emergency C Section. When I had my coil fitted the skilled GP was unable to do it and I ended up having to go to a  gynae who also struggled.
I mentioned to the nurse last week and she said she could see why as I have a a very small cervix. Also in my fifties.

The nurse did question my referral at the 5mm as I’m on HRT so it makes sense now you’ve mentioned what yours are at, but it was my doctor who wants to rule things out as I’ve not been well this last year. It’s good to get checked though, isn’t it?

Is this the first time you’ve been scanned and referred? It’s good you’re being checked too.

I’m so glad you have a plan now and will be sending positive thoughts tomorrow x

[Kathleen]

Hello laszla

I am another woman who was not told about any pain relief before my procedure! I agree that it is much easier for the medics to just press on and get the appointments through as quickly as possible. When I was in the waiting room I saw other women swallow painkillers and I later found out why lol.

If I have to have another Hysteroscopy I will insist on pain relief. I realise that some ladies find that the whole thing is only mildly uncomfortable... lucky them.

Do let us know how you get on tomorrow and it will be interesting to learn the type of sedation that they offer you.

Take care.

K.

[laszla]

Thanks so much shoppingqueen, this will be my first hysteroscopy and biopsy, I've had TV scans and smears which I've always hated but obviously I need to remind myself that they're not doing this to torture me but as a means to a very medically justified end!
I'll let you know how I get on (or don't as the case may be).

Thanks Kathleen, how awful not to be told about let alone offered any pain relief! I've been offered a local anaesthetic which means an injection  and told to take painkillers beforehand.

I'm not entirely clear as to the extent of the numbing power of the local anaesthetic though. In other cases, eg dentistry, local pretty much means you don't feel any pain but who knows...

No sedation offered in the blurb they've sent though perhaps I'll ask if anything's on offer when I'm there though I'll probably take a betablocker which I rarely take but might be just the ticket in this case for nerves.
I'll report back in any case.

[Wrensong]

Oh laszla, how disappointing about the osteoporosis & how unfair if your oestrogen dose has been enough to thicken your endometrium to that extent yet inadequate to prevent the osteopenia progressing.  Do you know what your oestradiol levels have been on the increased gel dose this year & have you had any advice about next step for your bones?

Great for tomorrow's procedure that you don't have VA.  That you'll be having local anaesthetic I hope will make it comfortable for you, as my 2nd hysteroscopy was.  Sending all good vibes.

Shoppingqueen, at my last scan my lining was 6mm immediately after a withdrawal bleed, yet to my surprise & relief both gynae & GP considered that OK for someone on HRT & I was not required to have another hysteroscopy.  At my scan the previous year my lining was only 1-2mm (also on HRT) but I was told at that one that 4mm was the cut off.  Different hospitals seem to have different guidelines, but if there is any doubt I think it's best to have it sampled for peace of mind.
Wx

[laszla]

Oh laszla, how disappointing about the osteoporosis & how unfair if your oestrogen dose has been enough to thicken your endometrium to that extent yet inadequate to prevent the osteopenia progressing.  Do you know what your oestradiol levels have been on the increased gel dose this year & have you had any advice about next step for your bones?

Wrensong I know - talk about targeted treatment: thin my bones and thicken my endometrium in one fell swoop!! Though to be fair, I'm not yet positive that thickened endometrium is direct result of oestrogel as there is a possibility a polyp is there -I had a large polyp in 2016 well before starting HRT. This is what we're hoping the damn hysteroscopy will clarify.
My serum estradiol levels went up to the 300s on the 4-5 pumps (had been in the upper 100s on 2 pumps) but the specialist said I should be aiming for 400-800 to target my main problem areas which are anxiety and thin bones. He's waiting for hysteroscopy result before moving to a Plan B for my bones but has mentioned the possibility of an implant and I'll probably go for that as well as move to take progesterone continuously.
L x