Menopause Matters Forum
Menopause Discussion => Personal Experiences => Topic started by: Katejo on March 02, 2020, 04:23:25 PM
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My hysteroscopy with local anaesthetic was too painful for them to take a biopsy so I have to go back again even though it looked healthy and they found no polyps.
I thought i would have to have a GA but a consultant told me today that sedation is an option too. Has anyone had it done while sedated? Or is it almost as painful as a local anaesthetic?
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I know it's not quite the same thing Katejo but I was offered either/or for a colonoscopy. The nurse explained to me that the sedation wouldn't prevent the pain but would make me more relaxed. I was so nervous I asked for both, and they gave me both. Hope this helps x
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Me too, for colonoscopy I had sedation. It was horrific. I know we are all different..... But I felt everything and was just a bit out of it. It was 20 years ago and I am still horrified by it!!!
Had an endoscopy..... Had nothing because I couldn't face the sedation.
I know your procedure is different, hopefully someone will have experience of this......
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Hello Katejo
I had a hysteroscopy without any pain relief and it was a bit grim. I'm pretty sure they took biopsies as well.
Before I had the procedure I noticed other women in the waiting room were swallowing tablets and later I realised why. The appointment letter had not mentioned taking pain relief and there was no offer of sedation so I assume the other women had been there before and knew that it was wise to take some painkillers. The nurses told me that one patient had drunk a fair amount of rum during her procedure and she hadn't felt a thing!
I've also had two colonoscopies with sedation and both experiences were pain free. They used a cannula to deliver liquid diazepam and it worked very well and I didn't feel any pain at all.
Hope this helps you in some way.
Take care.
K.
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Sorry, I can't advise but I had a hystoscopy with nothing as I wasn't offered anything! I personally found it extremely painful. I wish I'd taken some painkillers first. It's a period like pain so I assume mefalonic acid would do the trick.
Annoyingly after mine the next consultant couldn't read the first ones notes so they said they needed to do another. Not sodding likely! I had an MRI instead but obviously they can't get biopsies with that. Mine was to see if an ablation was possible with my fibroid. It wasn't and I had a hysterectomy, different hospital and gynocologist. Best decision for me and I haven't looked back. Good luck x
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I've had an endoscopy with sedation and it was really good. The sedative contains a memory blocker so although conscious and able to follow instructions you remember nothing about it.
Taz x
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Katejo, I've had 3 hysteroscopies - the first under GA (but only because they also did laparoscopy & D&C), 2nd with local and sedation. Both of those were done in fertile years so that area was reasonably robust & access easier.
The 3rd was 4 years postmeno with poorly managed VA & as it turns out an atrophied uterus - so there was nothing for them to sample on biopsy. That was without any local or sedation, because the NHS had stopped offering any sort of pain relief or sedation for the procedure by then. I took painkillers beforehand as advised, but felt no relief from them. Like yours, it was shockingly painful & tbh felt barbaric, though over very quickly with few after effects. The nursing staff were very kind & obviously felt bad it had to be done that way.
Of the 3, the least problematic by far was the 2nd with sedation & local - I'd wanted to avoid GA which makes me very sick for a long time afterwards. The anaesthetist was standing by to put me under if need be (those were the days) but I felt no pain. So if this combination is available for you, that might work well.
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I've had an endoscopy with sedation and it was really good. The sedative contains a memory blocker so although conscious and able to follow instructions you remember nothing about it.
Taz x
I had endoscopy without even a local numbing and only had minor discomfort . It was no comparison to the hysteroscopy at all. Having a check fir polyps and fibroids was ok with a local but not when they tried to do a biopsy. I suspect that bring sedated won't be any better than a local (with painkillers).
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Katejo, I've had 3 hysteroscopies - the first under GA (but only because they also did laparoscopy & D&C), 2nd with local and sedation. Both of those were done in fertile years so that area was reasonably robust & access easier.
The 3rd was 4 years postmeno with poorly managed VA & as it turns out an atrophied uterus - so there was nothing for them to sample on biopsy. That was without any local or sedation, because the NHS had stopped offering any sort of pain relief or sedation for the procedure by then. I took painkillers beforehand as advised, but felt no relief from them. Like yours, it was shockingly painful & tbh felt barbaric, though over very quickly with few after effects. The nursing staff were very kind & obviously felt bad it had to be done that way.
Of the 3, the least problematic by far was the 2nd with sedation & local - I'd wanted to avoid GA which makes me very sick for a long time afterwards. The anaesthetist was standing by to put me under if need be (those were the days) but I felt no pain. So if this combination is available for you, that might work well.
I suspect that they won't find anything to biopsy. The nurse thought that a biopsy under GA wouldn't be necessary after they found no polyps or fibroids but a doctor later overruled her. I suspected this and another consultant confirmed my suspicions today. The annoying thing is the long wait to get the biopsy done. I don't even have a date for a pre op appointment yet. I have another appt. at the same hospital on Wednesday and I am going to chase it up.
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Katejo, I don't think they need to see anything suspicious to biopsy - I think they just take a sample of the lining - I'm thinking I remember your hysteroscopy is for postmeno bleeding as mine was? Do chase them up when you go on Weds - a personal appearance often gets results a phone call seemingly can't.
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Katejo, I don't think they need to see anything suspicious to biopsy - I think they just take a sample of the lining - I'm thinking I remember your hysteroscopy is for postmeno bleeding as mine was? Do chase them up when you go on Weds - a personal appearance often gets results a phone call seemingly can't.
Yes it is for post meno bleeding when using Conti patches. I still think that they will have trouble getting a sample fir biopsy as the layer is only 4.5 mm.
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I've had an endoscopy with sedation and it was really good. The sedative contains a memory blocker so although conscious and able to follow instructions you remember nothing about it.
Taz x
I had endoscopy without even a local numbing and only had minor discomfort . It was no comparison to the hysteroscopy at all. Having a check fir polyps and fibroids was ok with a local but not when they tried to do a biopsy. I suspect that bring sedated won't be any better than a local (with painkillers).
By sedation they usually mean you are totally unaware of what's happening. It's like a GA but with none of the GA risks. You don't feel or remember anything. I had it due to a failed second endoscopy. The first one I had with no sedation and no problems. I didn't mean that an endoscopy is anywhere near as painful as a hysteroscopy but merely used it to show my experiences of what 'sedation' meant in my case. It would be worth asking which drug they use?
Taz x
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I've had mirena fitting with no local injection as my gynae said it doesnt stop the pain. Maybe that's why you found it so painful katejo. I havent had hysteroscopy but I assume local injection is the same, although I wouldnt presume the procedure or level of pain is.
I opted for twighlight sedation with colonoscopy . I wasnt told what you were perin about it not stopping pain but in my case it most certainly didnt. I wouldnt have it done again under sedation but of course it's a different procedure.
Everyone is different with sedation. It takes a lot to affect me. . All the other colonoscopy patients were drowsy or sleeping after the twighlight but I felt as though I'd had nothing at all.
Just a thought. Katejo but Im wondering if anyone knows anything about phenegran in this respect.
I say this as I was prescribed 50mg for sleep but I noticed on the info it can be prescribed in that dose undr docs supervision pre surgical procedures as a sort of pre med. Not sure if or how it might be beneficial in this instance. Just throwing it out there.
I hope you get new appt sorted soon. And . Hope it all goes well.
Xx
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Hi Tc
Re the colonoscopy I don't know how much sedation they used it may vary depending where you have it done. I omitted to say the pain relief was gas and air. Like you Tc the sedation had worn off by the end of the procedure. It was a horrible experience, and one I won't be repeating.
I have had a hysteroscopy and that's nowhere near as bad (although uncomfortable), even so Katejo I would advocate for what you want to get you through the procedure x
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I had sedation for gynae procedure and I hated it. It didn't reduce the pain, I just felt drunk and confused. It depends how sensitive you are to pain. I have really high tolerance to pain generally but not in that area - I can't cope with anything down there. Having my second merina fitted was horrendous (the first was fine), so much so when this runs out I won't be having another. (PTSD doesn't help!) So I kind of guess it depends on your tolerance levels and your mental state when it comes to stuff like that.
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I'm due a hysteroscopy & biopsy & will be having a GA not putting my vagina through anymore trauma than is necessary with me needing peeling off of the ceiling.
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Katejo,
I still think that they will have trouble getting a sample fir biopsy as the layer is only 4.5 mm.
Not sure how thick it needs to be, but my biopsy returned mucus only (sorry if tmi) - report said uterus was atrophied - & they didn't suggest repeating for a more meaningful sample. Mine was for postmeno bleeding on Evorel Conti & meno clinic (not where hysteroscopy was done) later suggested the intermittent bleeding was actually due to the atrophy.
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Katejo, I still think that they will have trouble getting a sample fir biopsy as the layer is only 4.5 mm.
Not sure how thick it needs to be, but my biopsy returned mucus only (sorry if tmi) - report said uterus was atrophied - & they didn't suggest repeating for a more meaningful sample. Mine was for postmeno bleeding on Evorel Conti & meno clinic (not where hysteroscopy was done) later suggested the intermittent bleeding was actually due to the atrophy.
Hi Wrensong Yes I remember reading your account of the thin layer/no good sample. I used it as an illustration of the point when I queried the need to have it done. Anyway today I had a much more productive appt. with the meno consultant (apart from the hospital appointments staff cocking it up and giving me a non existent slot at 8am! I had to wait 1.5 hours). I then got the chance to express my confusion at the need to have the hysteroscopy so quickly. I referred to a study which BearG had sent me in which it says that bleeding up to 12 months is common for women who start HRT several years post meno. 92 % have no bleeding beyond 12 months. The consultant knew of the study and said that there is a move to delay the hysteroscopy to 9-12 months but that it hasn't yet been agreed so the NHS 6 months rule still applies.
She doesn't think that they will find a problem but I still have to have it done. I have a pre op appointment on saturday 7th March and then the hysteroscopy date will be about 2-3 weeks later. I need it to be a Monday because it is the only day when I have someone to accompany me home and stay with me.
I haven't had any more bleeding for nearly 2 weeks.
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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 :o. 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#msg728642
On 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
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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 :o. 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#msg728642
On 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
Thanks Hurdity for this but they want to do it because I HAVE had vaginal bleeding. I did try to have it done without GA but with painkillers but it was too painful. In comparison the endoscopy was easy. Just a bit of discomfort and I didn't even have the numbing at all let alone a GA. My cervix is very tight (have never had kids). I have decided to go ahead with it now. A friend has had it to remove polyps and found it ok. It may be that sedation is enough.
I did put the question of the mm thickness to the consultant but she said that, with bleeding present, it must be under 4.5mm to not need a biopsy (even when using HRT). Mine was 5mm. I sensed that she wanted to agree with me but had to apply the rules.
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I had a GA for my hysteroscopy. It was not offered but I found out I could ask for one. I knew I could not cope without one.
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Hi Katejo
I had this procedure for post meno bleed.
I had it done at hospital, it was a bit uncomfortable and the lady who did it said it would be slightly uncomfortable.
She couldn't manage to get to see.
So she said I'd have to go back and have it done under GA.
She said to sit in corridor till I felt ok and asked did I want a drink.
I saw partner coming down the corridor, so walked up to him.
By the time we'd got outside the hospital building, I was doubled up in pain
I literally thought I was going to faint(used to faint at school with period pains). I was to scared to move to get into the car, partner was going to take me back into hospital
I just wanted home! I went straight to bed with 2 paracetamol and hot water bottle. Within hour I was fine. Apart from labour pains, that was the worse pain I've had.
The same with me, I never took paracetamol BEFORE procedure!!
I had private health insurance, so I had it done under GA at Bupa hospital.
I was fine😁 absolutely nothing like without GA.
I felt fine after trying to have it done locally (minimal discomfort) but the actual procedure wasn't helped by the painkillers at all. The first part was ok but my cervix was far too tight (haven't had kids). I now have a pre op appointment for the GA on Saturday.
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Hi Katejo
I had two hysteroscopies last October due to vaginal bleeding.
I had the first hysteroscopy and scan within two days and a polyp was found. I found it very painful, didn't know they were going to even do that and took no painkillers.
A week later had a GA and hysteroscopy and .D&C. Even though I was so scared it was a lot better having a GA.
Hope you are okay Katejo.
Best wishes
Vicky xx
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Hi Katejo
I had two hysteroscopies last October due to vaginal bleeding.
I had the first hysteroscopy and scan within two days and a polyp was found. I found it very painful, didn't know they were going to even do that and took no painkillers.
A week later had a GA and hysteroscopy and .D&C. Even though I was so scared it was a lot better having a GA.
Hope you are okay Katejo.
Best wishes
Vicky xx
Hi Vicky i had the pre op for mine today. I am not too worried about the result though i do want it out of the way. I'd have preferred to wait a little longer to see if I really needed it. I already know that I have no polyps/fibroids and that it looks healthy but still have to have a biopsy. The consultant said this week that she wasn't expecting a problem result.
How did you feel after the GA (several hours afterwards when you were allowed to go home)? The hospital insists that I have to go back by car not train even though there is a direct train line from near the hospital which stops right close to my house! I thought it would be enough for a friend to accompany me home and stay with me. I don't like travelling by car that much and the car journey will be much longer.
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Katejo. I'm glad you have sorted it out now. I do wish you all the best.
aside from my major surgery I've also had GA for minor surgery (neck biopsy) and I definitely wouldnt have wanted to be getting on a train after that as It hadnt worn off enough when i went home two hours later.
Xxx