Hysteroscopy Action: letter sent to Women’s Minister (7 November 2022)

Summary

In this letter, campaign group Hysteroscopy Action, have written to Women’s Minister, Maria Caulfield, to raise its concerns about the levels of pain and trauma experienced by many women undergoing outpatient hysteroscopy procedures.

The letter, which has over 20 signatories, including Helen Hughes, Chief Executive of the Patient Safety Learning charity.

It calls for more theatre space for women to have procedures under general anaesthetic as well as offering women the choice of intravenous sedation. 

Related reading

• Horror as women are facing major medical procedures without anaesthetic, warn experts
• Guidance for outpatient hysteroscopy: Consultation Response (Patient Safety Learning)
• Patient experiences shared with us in our community thread
• Pain during ambulatory hysteroscopy: A presentation by Richard Harrison (3 minute video)
• 2020: Raising awareness about painful hysteroscopies (8 minute video)
• Pain-free day surgery? Evaluating pain and pain assessment during hysteroscopy
• Ministers respond to concerns about painful hysteroscopies: Northern Ireland, Scotland and Wales

Read the letter to Maria Caulfield in full below.

Content

7 November 2022

Dear Minister

WOMEN’S ENDOSCOPY - HYSTEROSCOPY

We are writing in support of the patient-led Hysteroscopy Action – also known as the Campaign Against Painful Hysteroscopy - to ask you to urgently commission more day-surgery theatre space and set up safely monitored IV sedation with analgesia for women’s endoscopy (hysteroscopy).  

Our call comes following research by the Royal College of Obstetricians and Gynaecologists showing 1 in 3 women having outpatient hysteroscopy experience severe pain.

Lack of NHS day-surgery theatre space & sedation services means thousands of women every year are obliged to suffer excruciating pain while awake. This has been highlighted in numerous NHS audits. (Ref.1)

A statement on the Royal College of Obstetricians & Gynaecologists website - 2018 - instructs gynaecologists to give women the choice of being awake or asleep for quick day case surgery. (Ref. 2)  

However, last year the NHS launched a new programme called Getting it Right First Time. GIRFT has set a target driven by the British Association of Day Surgery for the NHS to do 90 percent diagnostic and 50 per cent operative womb endoscopies without general anaesthetic or sedation. (Ref. 3)

This cost-saving measure when applied to ablation of the womb lining is estimated to save £1,000 pounds per patient. (Ref. 4) 

The Health Service Journal in March 2020 analysed Hysteroscopy Action’s survey and found 240 women who reported not being given a choice to have general anaesthesia or sedation. (Ref. 5) A GIRFT webinar of July 2021 advocating day-case hysterectomy describes hysteroscopy as one of the ‘low-hanging fruits’ that has already been picked off, moved to and now only done in outpatients. (Ref. 6) 

Women are routinely having womb endoscopy in NHS outpatients with no sedation – just ibuprofen from home and ‘distraction technique’. 

In a pioneering, on-line dis-satisfaction survey Hysteroscopy Action has collected 3,000+ accounts of brutal, barbaric pain, fainting and trauma during outpatient hysteroscopy. (Ref. 7) 

Many gynaecologists are not informing patients of the 1 in 3 risk of severe pain if they have hysteroscopy awake.

Women are misled to believe the procedure is a bit like a smear test - mildly uncomfortable to moderately painful. For 1 in 3 women this is not the case and the procedure is agonising. In some cases women are left traumatised, distrustful of doctors, unable to have sex or afraid of further procedures. Hysteroscopy Action is counselling hundreds of patients with PTSD, who for various medical reasons – e.g. no vaginal delivery, previous cervical surgery – were never candidates for hysteroscopy awake. 

Hysteroscopy involves a rigid knitting needle-like rod with a tiny camera and surgical tools passed through the cervix into the womb. The procedure ranges from diagnostic hysteroscopy with biopsy to detect cancer to operative removal of polyps and small fibroids. 

We the undersigned are calling for women to have informed consent and choice about whether and what type of anaesthesia or sedation they want.

Baroness Shaista Gohir

Charlotte Kneer MBE, DL 

Helen Hughes, Chief Executive, Patient Safety Learning

The women’s health charity the Wellbeing of Women

Elaine Falkner, Chair Campaign Against Painful Hysteroscopy

CAPH committee members

References

1. https://www.patientsafetylearning.org/blog/guidance-for-outpatient-hysteroscopy-consultation-response

[7] RCOG, Good Practice Paper: Pain relief and informed decision-making for outpatient hysteroscopy and procedures, February-March 2022. https://s3-eu-west-1.amazonaws.com/ddme-psl/gpp-standards-in-outpatient-hysteroscopy-draft-peer-review.pdf “One third of women reported pain scores of 7–10 out of 10.”

2. https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/hysteroscopy-best-practice-in-outpatient-green-top-guideline-no-59/

The British Society for Gynaecological Endoscopy published this statement in December 2018:

"Diagnostic hysteroscopy is a commonly performed investigation; it is safe and of short duration. Most women are able to have the procedure in an outpatient setting, with or without local anaesthesia, and find it convenient and acceptable. However, it is important that women are offered, from the outset, the choice of having the procedure performed as a day case procedure under general or regional anaesthetic. Some centres are also able to offer a conscious sedation service in a safe and monitored environment. It is important that the procedure is stopped if a woman finds the outpatient experience too painful for it to be continued. This may be at the request of the patient or nursing staff in attendance, or at the discretion of the clinician performing the investigation."

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6. A GIRFT webinar of July 2021 describes hysteroscopy as one of the ‘low-hanging fruits’ that has already been picked off, moved to and now only done in outpatients.  

7. www.hysteroscopyaction.org.uk