Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: laszla on December 06, 2022, 08:03:35 PM
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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
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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.
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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.
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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!
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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.
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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.
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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
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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
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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
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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.
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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
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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.
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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 :o 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.
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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
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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
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I see what you mean, 4-5 pumps is a lot of gel to have to find body parts for, especially if you're a small woman. I'm sure you must have tried all transdermal HRT types if implant's the next option, but just in case, have you used Sandrena? More concentrated, so helpful for anyone who can't get what they need from Oestrogel, patches, spray. My DEXA is overdue nearly a year (osteopenia, sorry if I said that already) but there's been too much else going on to want to chase it. They don't call me for them, my Endo has to ask GP to arrange each time. At least your specialist is on the case. Let's hope you can come up with a good plan B together to get you feeling really well & help your bones. Bless you.
Wx
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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
That’s reassuring Wrensong and I’m glad you got the ‘sign off’! Such good news :-)
I’d googled like mad about the cut off and saw so many different mm mentioned! The nurse had the same view that this was a tiny amount over.
None of this is pleasant for us, is it, but it’s good we are being checked. Fully agree x
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shoppingqueen,
None of this is pleasant for us, is it
agreed - HRT can involve commitment & perseverance & all we can do is weigh up whether we feel any negatives are worth it for the benefits for us as individuals.
Thinking of you today laszla & sending all best wishes.
Wx
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Take all teh pain killers and a local. I wasn't offered a local ...it was to say the least painful and left me feeling shaky. . I would insist on one next time..my firend had one and said it was a breeze for her!
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Thank you so much for your further supportive replies which are v helpful on my way to the dreaded appointment. I'll be sure to report back :o
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Well that did not go according to plan but like just about anything was a learning experience so perhaps useful to share.
Got to the hospital, had been expecting that the procedure would be carried out by doctor X who did my scan last week who had told me what hysteroscopy entailed, that local anaesthetic would be given etc.
Instead another doctor I'd never met was there, and when I asked where Doctor X was was told by doctor Y that he does not perform outpatient hysteroscopy. Doc Y phoned Doc X in front of me to ask if he would be coming. When she hung up she said no, he would not and she would carry out the procedure.
This totally threw me because my anxiety needs some degree of certainty and advance warning about what's going to happen and any deviation - when it's something important - scares me. Doctor X never said anything to suggest that he would not perform the procedure and I think they should make these things clear.
Doctor Y, seeing my anxiety, within about 20 seconds said that I should have a general anaesthetic.
I told her that from what Doctor Y had told me that I assumed local anaesthetic would be similar to a local in any other body part, ie you pretty much don't feel any pain or serious discomfort.
She practically scoffed and said that while a local 'takes the edge of slightly', it can still be very unpleasant for some women. Needless to say Doctor X had said none of this - and although in principle I have nothing against male docs, perhaps some things like this can only be truly comprehended and explained by a female doctor.
Anyway, I took her advice, left the hospital feeling bad that I hadn't gone through with it but also relieved that I had heard Doctor Y's more realistic assessment of a local and so was spared the risk of a very difficult experience.
I'm now due to have it with general anaesthetic within the next couple of weeks, scary in a different way but probably the least bad option.
Not happy with this experience and it comes on the back of my having had a first TV scan in August where the sonographer wrote that I should have a 2 week urgent referral because of the endometrial thickness; four months later I still hadn't heard a word from the hospital and had to chase it up with the managers to finally go in again for a follow-up.
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Poor you! I can really relate about your anxiety and how a level of certainty is essential. I always wondered how a local anaesthetic would work with the procedure and suspected it would have minimal effect. I hope things work out and maybe a general anaesthetic is best for you, but understand the anxiety with that, which I experienced also. Keep us posted x
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I’ve had a hysteroscopy with general anaesthetic… it all went fine and I was fine after it. x
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Oh laszla, I'm so sorry it didn't go to plan & was such an unnerving experience. I didn't have pain with my hysteroscopy carried out under local anaesthetic despite what your doctor said last week, except of course, for the initial sting of the injection. But as I said earlier I was a lot younger then & you are now the age I was when I had my last, without anaesthetic or sedation, which was indeed uncomfortable. So this Dr's advice to have GA may be the best course of action for you & I'm impressed she took that decision for your wellbeing rather than try to push ahead as scheduled. It is such a quick procedure you should not be under for long & before you know it it will all be behind you.
:hug: Wx
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Thanks ladies. Suzy, the consultant said that a local anaesthetic is pretty limited but she was of the idea that one's mental state is a strong contributor to the individual perception of pain or discomfort and I think there is some truth to this.
Dotty I think a general is my best option, thanks for the reassurance.
Wrensong thanks, I think this doctor rightly gave a lot of importance to how one's mental state affects one's reaction and on that made basis a good choice for me.
There is a video on youtube on the outpatient experience of hysteroscopy (on the NHS) and I think the comments rather than the video itself are useful for anyone in a similar situation wanting feedback from other women.
Will keep you posted x
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Hi laszla
I’m so sorry you got thrown by the change in doctor on the day and agree that you should (we should) be aware of who is doing it and have continuity. Also, thank goodness doctor Y had the empathy to suggest the general immediately. It makes a lot of sense about our mental state and how we then perceive pain. If we’re already in a state of trauma, it’s going to be harder. I was beside myself when I went in, too, so much so that the nurse commented on it. Likely my tears that gave it away!!
The next day was fine (although I only agreed to the biopsy) as said here so a general is a good plan and it’ll all be done. If I need the hysteroscopy, I’ll be requesting a GA too.
Best wishes xx
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Hi, I have to have this done on Monday for polyp removal/biopsy. Can't say I was looking forward to it but to be honest had come to the conclusion that since my period pains each month are the same as being in labour (and I can only take paracetamol due to kidney disease), for me I don't think the procedure could be more painful than that. I'll ask about local pain relief and I will do what I do each month and close my eyes and breathe through it. I figure that if I'm still and calm, it will be done quicker. Fingers crossed!
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Thanks shoppingqueen, the tears do give it away and I was the same which probably prompted Doc Y to suggest the general!
IceLolly, I would at least ask for local pain relief. I too have very painful monthly cramps with the bleed but I somehow feel that being in pain when you're in a clinical setting, in about the most vulnerable physical position there is, seems worse. All the best with it.
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I'm under gynae for endometrial hyperplasia and have had 2 under general with my third and hopefully last the same. I absolutely refused to have it in clinic. In theatre mid morning and home mid afternoon.
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It's good to hear your endorsement of the general anaesthetic option Jorainbow, thanks
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Hi, I had Histroscopy last month, with local anaesthetic, the local was excruciatingly painful to have, followed by the rest of the procedure which was awful. They managed the biopsy, but I have polyps that need to be removed. I 100% won’t be having that procedure awake ever again.
Problem is, I know what’s coming 2nd time round, now way I’ll be able to “relax” on the bed!!
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Poor you,. Don't put yourself through it again, go for a general anaesthetic x
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Very sorry to hear that uncannylizard and am feeling increasingly grateful that my Doctor Y persuaded me to go for a general.
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An update in case anyone in future gets a hysteroscopy with general anaesthetic and wants some feedback:
I was pretty scared of the anaesthetic as I haven't had one in 40 years when I wasn't such a scaredy cat but I must say it was fine in most respects - zero pain afterwards and obviously during you're totally unconscious.
They discovered a couple of teeny polyps that they whacked out and although won't get biopsy results for a couple of weeks they said endometrium looked fine (bearing in mind I twice had a measurement of over 11mm).
But going on a slight tangent, waking up from the anaesthetic made me realise that I haven't slept properly in years. The total oblivion of being under was actually quite wonderful but the realisation of how shallow my sleep has become was quite depressing.
Also, as if to make up for the lost 30 minutes of consciousness, my mind went into ruminating anxious overdrive after just a couple of hours and I felet slightly hungover. But honestly for me it was the best option as it was a totally pain free experience.
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I am so happy to hear it went well for you laszla. I hope the anxiety lessens. I think when feeling so anxious over something, the anxiety can remain even after the event.
It is horrid not to sleep well. I am sorry you struggle with getting a good sleep.
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Hi, thought I should probably add my experience in...I had a hysteroscopy yesterday with no anaesthetic (local or general). I had probably about 20 seconds of horrible cramping pain while the camera was going through the cervix but apart from that, it was incredibly quick and that pain was immediately gone as soon as the equipment went out. I'd taken co-codamol before so that made me really quite relaxed, which meant I could cope with it. If you can't have or are worried about a general anaesthetic, and have it the way I did, it's 20 seconds of pain x
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Hi, thought I should probably add my experience in...I had a hysteroscopy yesterday with no anaesthetic (local or general). I had probably about 20 seconds of horrible cramping pain while the camera was going through the cervix but apart from that, it was incredibly quick and that pain was immediately gone as soon as the equipment went out. I'd taken co-codamol before so that made me really quite relaxed, which meant I could cope with it. If you can't have or are worried about a general anaesthetic, and have it the way I did, it's 20 seconds of pain x
Thank you for sharing this. I am very happy to know you are feeling okay and it went well.
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Thanks Flossie, the sleep difficulty is tough so I'm going to prioritize trying to improve it.
Glad you did ok icelolly, it's good to hear different feedback.
For me no anaesthetic would have been unthinkable but some women feel the same about general anaesthetic or even the injection of a local
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Great news laszla, I'm glad it's behind you. Thanks for the update, it will be encouraging for others who may be wary of going for the procedure under GA. I so sympathise over the poor sleep - it's the one really troublesome consequence of menopause I've really struggled to crack. I hope you feel better soon.
Hi IceLolly, great to hear your hysteroscopy was straightforward. Experiences vary so much, but yours will also be reassuring to anyone who feels they'd like to try that way. I've had the procedure 3 times under 3 different conditions (general anaesthetic, local anaesthetic with light sedation & no anaesthetic or sedation). I had no say in conditions for the latter & though over quickly, it was carried out when I was several years postmenopause, as a small (size 6 hips :o), childless woman, with inadequately controlled GSM & would not recommend it to anyone in similar circs.
As I posted earlier, the best of the 3 for me was with local anaesthetic & light sedation, though I was still pre-menopause at that time, with a robust access route!
Imo it would be great if all 3 options were always offered, with advice about what to expect from each & which might be best suited to individual circumstances, taking into consideration life stage, whether GSM or other relevant painful conditions are present & any personal concerns or preferences.
Wx
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Thanks Wrensong - I completely agree that all three options should be offered and fully explained - I found the "explaining" side of things very poor at my hospital.
Your small size reminds me that just before they put me under, the anaesthetist told me that if I had been 1 kilo less they would have given me a child's dose which would have been a bit alarming!
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Hi laszla - I've sent you a PM that would have taken this thread off topic. Hope that's OK.
Wx