Hi Katejo - firstly I still find it unbelievable that a biopsy is being suggested for what appears to be a normal uterus lining as THIN as 4.5 mm
. The whole point of the scans was to determine the thickness of the uterus and if any abnormaliities could be detected which would then indicate whether a biopsy is advised.
In your position - there is no way I would have a general anaesthetic for a procedure that to me seems questionnable at this point - with the risks involved in that.
This has come up before - have a look at this recent thread:
https://www.menopausematters.co.uk/forum/index.php/topic,45272.msg728642.html#msg728642On it I posted a paper abstract which someone sent to me - where investigation was carried out into the cancer risks for women with different endometrial thickness with or without bleeding (not on HRT). I will reproduce it again here. Even though you are taking HRT which would imply greater tolerance of endometrial thickness, you are in the bracket for extremely low risk of cancer.
"How thick is too thick? When endometrial thickness should prompt biopsy in postmenopausal women without vaginal bleeding" (Bindman et al 2004)
Abstract
OBJECTIVE:
Transvaginal sonography (TVS) is routinely performed as part of a pelvic sonogram in postmenopausal women, and images of the endometrium are frequently obtained. In women without vaginal bleeding, the threshold separating normal from abnormally thickened endometrium is not known. The aim of this study was to determine an endometrial thickness threshold that should prompt biopsy in a postmenopausal woman without vaginal bleeding.
METHODS:
This was a theoretical cohort of postmenopausal women aged 50 years and older who were not receiving hormone therapy. We determined the risk of cancer for a postmenopausal woman with vaginal bleeding when the endometrial thickness measures > 5 mm, and then determined the endometrial thickness in a woman without vaginal bleeding that would be associated with the same risk of cancer. We used published and unpublished data to determine the sensitivity and specificity of TVS, the incidence of endometrial cancer, the percentage of women symptomatic with vaginal bleeding, and the percentage of cancer that occurs in women without vaginal bleeding. Ranges for each estimate were included in a sensitivity analysis to determine the impact of each estimate on the overall results.
RESULTS:
In a postmenopausal woman with vaginal bleeding, the risk of cancer is approximately 7.3% if her endometrium is thick (> 5 mm) and < 0.07% if her endometrium is thin (< or = 5 mm). An 11-mm threshold yields a similar separation between those who are at high risk and those who are at low risk for endometrial cancer. In postmenopausal women without vaginal bleeding, the risk of cancer is approximately 6.7% if the endometrium is thick (> 11 mm) and 0.002% if the endometrium is thin (< or = 11 mm). The estimated risk of cancer was sensitive to the percentage of cancer cases that were estimated to occur in women without vaginal bleeding. For the base case we estimated that 15% of cancers occur in women without vaginal bleeding. When we changed the estimate to project that only 5% of cancers occur in women without vaginal bleeding, the projected risk of cancer with a thick measurement was only 2.2%, whereas when we estimated that 20% of endometrial cancers occur in women without bleeding, the projected risk of cancer with a thick measurement was 8.9%. As a woman's age increases, her risk of cancer increases at each endometrial thickness measurement. For example, using the 11 mm threshold, the risk of cancer associated with a thick endometrium increases from 4.1% at age 50 years to 9.3% at age 79 years. Varying the other estimates used in the decision analysis within plausible ranges had no substantial effect on the results.
CONCLUSIONS:
In a postmenopausal woman without vaginal bleeding, if the endometrium measures > 11 mm a biopsy should be considered as the risk of cancer is 6.7%, whereas if the endometrium measures < or = 11 mm a biopsy is not needed as the risk of cancer is extremely low. Regarding sedation or GA - I had a hysteroscopy with biopsy a few years ago (due to thickened lining - expected on cyclical HRT, + an area of abnormality - turned out to be small fibroid) and opted to go to the main city hospital rather than the smaller local one which would only do the procedure under GA. Having never had one of these quite honestly the prospect of that terrified me as I felt it completely unnecessary for a minor procedure.
I was advised in the leaflet to take two paracetamol and two ibuprofen an hour before my appointment time. When I got there I asked about local anaesthetic or sedation and they said they don't usually advise it as the procedure is so quick (15 mins) and I had taken the painkillers.
So in my case it was absolutely fine - no problem - however I've had several children so not sure if that makes a difference?
If I wanted something and was worried, and sedation was on offer - I would take that over the GA. My husband today has had what would also be an extremely painful men's procedure - more invasive and an operation rather than like a hysteroscopy - and was given heavy sedation (through cannula in hand) - I think it's benzodiazepenes (sp?) - and was fine when I picked him up. He was vaguely aware when it was happening. Somewhat painful afterwards but he's on painkillers.
If you have to have the procedure that's what I would opt for - sedation and painkillers but must stress as I've never had a GA I don't want one unless aboslutely necessary ie an actual operation rather than a comparatively very minor investigative procedure!
Re the endosocopy - I've never had one of these either but I would definitely have sedation - that seems to me far more invasive and scary than camera through cervix - but we each have our own fears and worries, and therefore needs....
All the best and hope this helps
Hurdity x
Author
Topic: sedation v GA for hysteroscopy? (Read 3411 times)