Outpatient Hysteroscopy and Ambulatory Gynaecology Clinic - FAQ
Royal Devon and Exeter
NHS Foundation Trust
Patient
Information
Outpatient Hysteroscopy and
Ambulatory Gynaecology
Clinic
Frequently Asked Questions
Reference Number: CW 13 010 002
(version date: October 2015)
This information leaflet describes the gynaecological
procedures that can be performed without a general
anaesthetic. Some examples include telescopic investigations
of the inside of the womb (Hysteroscopy), change of intrauterine
contraceptive devices, removal of womb polyps and fibroids,
treatment of heavy periods and sterilisation.
New techniques ensure these procedures remain comfortable with
either no anaesthetic or a local anaesthetic injection only. There are
advantages in avoiding complications of general anaesthesia, and
allowing a rapid return to normal activities.
Not all procedures or patients may be suitable for a procedure
without a general anaesthetic but you will normally have a choice.
Why is hysteroscopy performed?
Common reasons include painful or heavy periods, abnormal or
unexpected bleeding (e.g. after the menopause) and evaluation of
unusual findings following an ultrasound scan. You should have a
clear understanding of your reason for this surgery.
What are the alternatives to this treatment?
Other less invasive interventions may be appropriate for your
particular condition and will normally have been considered prior
to your procedure. Most of the outpatient procedures can also be
offered under a general anaesthetic in our day case unit.
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What is a hysteroscopy?
Hysteroscopy involves looking at the inside of the uterus (womb)
with a fine telescope that is passed into the vagina and through the
cervix (neck of womb). Clear fluids passed down the hysteroscope
to fill the vagina and then gently stretch the cervix to enable the
passage of the hysteroscope into the womb cavity. The saline
then gently stretches the womb cavity so that it can be viewed.
Once inside the womb a micro-grasping forcep can be passed
down an internal channel of the hysteroscope to allow a sample
(biopsy) to be gathered from the womb lining. The procedure
takes approximately 20 minutes. Sometimes other procedures are
recommended or required; such as removal of polyps (or some
fibroids), removal of contraceptive coils where the threads are no
longer visible, sterilisation (by blocking the tubes with an implant) or
endometrial ablation for heavy periods.
How is local anaesthetic administered?
The smallest hysteroscope (telescope), in the majority of instances,
can be inserted directly into the vagina and through the cervix
with no need for a local anaesthetic injection into the cervix. All
operations can be paused or stopped immediately if you experience
significant discomfort or pain. We may then recommend an injection
of local anaesthetic into the neck of the womb before trying again.
We recommend that you take painkillers before the procedure (see
below) and, if necessary, you can be given more to take afterwards.
Some procedures require local anaesthetic to be injected gently into
the neck of the womb or close by and your doctor will explain this
before going ahead.
Do I need antibiotics?
An antibiotic may occasionally, but not routinely, be offered to you
before the procedure.
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Can I eat and drink before the procedure?
Yes. You can eat and drink as normal but we suggest a light diet
only on the day.
What happens when I come into hospital?
If your doctor has organised for you to have the procedure in this
clinic then you will usually be invited to Clinic 2 (off Wynard Ward) in
the Centre for Women’s Health.
You should be prepared to be in hospital for up to an hour after your
appointment time. Sometimes, a pre-operative visit is arranged a
few days before if other tests are required.
Should I take pain killers before my
appointment?
Your doctor may have given you painkillers to take before your
appointment. If not, we suggest you take Paracetamol 1g (two
standard 500mg tablets) and Ibuprofen 600mg (three standard
200mg tablets) one hour before your appointment time. These are
available at chemists and supermarkets. You should not take either
if you are known to be allergic to them, or should seek medical
advice before taking Ibuprofen if you have stomach ulcers, bad
heartburn or bad asthma.
Do I need an empty bladder?
Most women between the ages of 15 and 55 will be asked to
provide a urine sample for a pregnancy test. Please don’t empty
your bladder before speaking to our staff as your procedure will be
delayed until a negative sample is obtained.
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How is an outpatient operation carried out?
When the time comes for your operation a nurse will bring you to
our procedure room and will stay with you at all times. There is a
private changing room and toilet next to the procedure room. Many
procedures require a patient’s legs to be lifted into footrests to allow
access to the neck of the womb. You will need to remove clothes
below the waist, but will be covered by a sheet and can keep a
loose skirt on to maintain your privacy as much as possible.
Sometimes a speculum instrument is placed inside your vagina to
identify the cervix (neck of the womb) to allow your procedure to go
ahead. Your surgeon will talk to you throughout the procedure which
you can also watch on a computer screen. You can ask questions or
request the team to stop at any time.
When the procedure is finished, your nurse will take you back to the
clinic area and look after you until you are ready to go home.
Will I feel pain or have bleeding?
Most procedures cause some discomfort but not bad pain (similar
to period-pain). We recommend that you take painkillers before
your appointment (above). If you have not had the opportunity
or forgotten to take some then these can be offered to you either
before the procedure begins or afterwards. Any discomfort is usually
short-lived and stops as soon as the telescope is removed from
the womb. Most patients feel able to tolerate some discomfort in
order for the procedure to be completed on the day. You can ask the
doctor to stop at any stage if you do not feel able to carry on. If no
local anaesthetic has been used then the option of injecting some
into the neck of the womb can be offered. Some patients choose
to use “gas and air,” to avoid having a general anaesthetic. Your
doctor will discuss this with you as well as the option of rescheduling
the procedure for another time under a general anaesthetic.
Reassuringly, over 95% of hysteroscopies are able to be completed
in the outpatient clinic setting without needing to be rescheduled.
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Some bleeding is often expected and your surgeon will advise you.
It is advisable to use sanitary towels and not tampons until this
settles.
Heavy bleeding or severe pain is not normal and you will have a
contact number to ring if you have worries or concerns. If necessary,
you may be given some pain killers to take home.
Endometrial ablation under local anaesthetic
This is a procedure to treat heavy, painful periods and can be
performed for many women under local anaesthetic. A separate
leaflet describes this technique. We would perform a hysteroscopy
to check your suitability and to be certain it will not cause undue
discomfort. Before the treatment you should take the painkillers
given by your doctor or as suggested above. You should have
someone at home with you for the remainder of that day. We
recommend that someone brings you and takes you home after
you’re ablation procedure. You need to allow 60 minutes for the
appointment, although the actual ablation part of the procedure is
usually completed within 2 minutes. Our experience in Exeter is
that most women have a pain score of 3 out of 10 (0 being no pain
and 10 being worst pain imagined) during the 2 minute treatment.
This reduces to 1 out of 10 as soon as it is completed. The ablation
can be stopped at any time at your request, although if it is then
the procedure is unlikely to be successful. The most commonly
used ablation technique at present in Exeter is called Novasure
endometrial ablation (see separate leaflet).
You will be offered a hot or cold drink afterwards and cared for
by the nursing staff until you are fit to go home. Most patients go
home within an hour of their procedure. Having avoided a general
anaesthetic most patients are able to return to work the following
day but you may need to take paracetamol / ibuprofen for 24-48
hours if you experience period-like discomfort.
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Removal of endometrial polyps and fibroids?
Endometrial polyps are invariably benign (not cancerous)
overgrowths of the lining of the womb (endometrium) in certain
areas. They can be responsible for bleeding and are often the
reason for a thickened appearance of the endometrium on
ultrasound scan of the womb. Most small polyps can be removed
with fine grasping forceps that are passed down an internal channel
of the hysteroscope when it is inside the womb. Larger polyps may
require the use of a special probe (passed down the same channel)
that cuts the base of the polyp to detach it. It uses heat energy to
do this. Most women feel only minor discomfort with both of these
techniques. Larger polyps are not easy to remove in this way.
Instead we may recommend the use of a morcellator that is passed
down through a slightly wider hysteroscope. The morcellator is a
device that is passed into the womb down an internal channel within
the hysteroscope. Under direct vision the polyp is sucked onto the
device and broken up into small pieces which are sucked out of the
womb into a chamber to allow the pathologist to examine it. The
cervix (neck of womb) has to be gently stretched to accommodate
this telescope and is done so after injecting a small amount of
local anaesthetic. The procedure does not cause more discomfort
than a normal hysteroscopy in most patients. Occasionally a
polyp will be of a size or position in the womb whereby the doctor
will recommend rescheduling for a day case general anaesthetic
removal at another time.
Fibroids are benign overgrowths of the muscle wall of the womb.
Occasionally they grow into the womb cavity stretching the
endometrium (lining of the womb). This may cause abnormal
bleeding or problems with pregnancy. Following assessment by
ultrasound scan your doctor may recommend removing this type
of fibroid having discussed this and other treatment options. If
appropriate it can be removed with a similar morcellator device to
that used for removal of endometrial polyps (see above). In addition
to the small risks of hysteroscopy (see below) there is a possibility
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of absorbing some of the fluid used to distend the womb into the
blood circulation, we would only be concerned if a large volume was
absorbed which is very unlikely (less than 0.1%) as we monitor your
fluid balance very closely during the procedure.
Most polyps and fibroids take only a few minutes to remove once
the device is introduced into the womb. If the fibroid is not able to
be safely removed in this setting then your procedure would be
rescheduled for a day case general anaesthetic on a different day
using a larger resecting hysteroscope.
What happens after my procedure?
Quite often following your procedure we are able to give you
immediate results, however, if biopsies / polyp shave been removed
from the womb then there will be results to follow. Sometimes
results will be sent to you and your GP by post or you will be invited
to come in for an appointment to discuss the findings. The nursing
and medical staff will advise you of any follow up arrangements that
are required.
Can I drive myself in and out of hospital?
This is usually possible however for some operations (such as
endometrial ablation) it is best to ask someone to collect you. Your
doctor will advise you regarding this.
Are there any potential complications?
All operations have a risk of complications, regardless of the
anaesthetic used although major problems are very rare. These
general risks include pelvic infection, unexpected bleeding and
trauma or damage to the cervix or womb and will be explained
to you by your surgeon on the day. A specific complication of
hysteroscopy is perforation (puncture of the womb wall). This does
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not usually cause long term problems. Rarely following perforation
does injury occur to other internal organs such as bowel. In most
cases after perforation no further treatment is required but we may
suggest observing you in hospital overnight and giving antibiotics.
Very rarely if injury is suspected then a laparoscopy (passage of a
telescope through the umbilicus) to view the pelvis and abdomen
under general anaesthetic would be recommended proceeding to a
laparotomy (open operation) only if an injury needed to be repaired.
Please notify your GP, or Wynard Ward if you experience the
following problems:
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Fever or feeling unwell
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Smelly vaginal discharge or heavy bleeding
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Constant nausea or vomiting
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Severe pain
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Inability to empty your bladder or bowels
Please contact Wynard ward on 01392 406512 if you require
urgent attention.
For general questions please contact Clinic 2 (01392 406503) or
specialist nurse pre-assessment (01392 406527) 9am to 5pm.
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