OUTPATIENT HYSTEROSCOPY SERVICES JASMINE SUITE

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1 OUTPATIENT HYSTEROSCOPY SERVICES JASMINE SUITE Information Leaflet Your Health. Our Priority.

2 Page 2 of 6 This information is for patients having a hysteroscopy (diagnostic or operative). It explains what the procedure is, why you might need one and any risks involved. What is hysteroscopy and why do I need one? Hysteroscopy is a procedure where a scope (a long, thin tube with a camera at the end) is passed through the cervix (neck of the womb) to investigate the inside of your womb. You might need a hysteroscopy if you have: Heavy or irregular periods Other period problems Postmenopausal bleeding If your ultrasound scan suggested fibroids (non-cancerous lumps of the wall of your womb) or polyps (soft tags of tissue on the surface of the lining of the womb) Coil problems Fertility problems Where will I have the hysteroscopy? Jasmine Suite, located on the 5th floor of the Women s Unit at Stepping Hill Hospital. Before you attend Please eat and drink as normal before you come. Do not skip meals. Pain relief It is advised that you take both 1gm (1000mg) of Paracetamol and 400mg of Ibuprofen orally around 1 hour before your scheduled appointment time, provided you are not allergic to them. This will reduce the pain or discomfort from the procedure. Please record the names of your painkiller and the time they were taken. What to expect When you arrive, you will see the doctor. The doctor will take your medical history. Depending on your symptoms you will be advised a transvaginal scan +/- diagnostic hysteroscopy +/- biopsy. The doctor will explain the procedure that you might need and ask you to sign a consent form. It is very important that you understand the procedure, so please ask questions if there is anything that you are not clear about. If after the diagnostic tests, it is felt that you need treatment then you will require an operative hysteroscopy. This can sometimes be done at the same visit after the diagnostic hysteroscopy or it may need to be done at a subsequent visit. This will be discussed with you and arrangements will be made.

3 Page 3 of 6 What does the procedure involve? The doctor will ask you to lie on an examination couch, in the same position as when you have a smear test. If transvaginal scan is required this will be done first. It involves inserting a narrow ultrasound probe inside the vagina to look at the womb and the pelvic organs and diagnose any abnormality. This will be followed by hysteroscopy. Diagnostic Hysteroscopy for diagnosis The hysteroscopes we use for diagnosis are very fine (2.5mm wide) so most women will not experience any discomfort from them. The hysteroscope is passed through your vagina and the cervix. A speculum may be used to open your vagina and see your cervix. Once inside your womb, saline fluid (salt water) will be passed though the hysteroscope into your womb to expand it. This can give you a crampy period type pain which may last a few minutes. It will help the doctor to see inside your womb on a colour TV monitor. You will also be able to watch the monitor unless you choose not to. A sample of the lining of the womb (biopsy) is usually taken through a fine tube and sent to the laboratory to be examined. This may be uncomfortable but is quick. Operative Hysteroscopy for treatment If a polyp or fibroid is identified and is suitable to be removed in the clinic then the doctor will advise you accordingly. A special hysteroscope called Myosure will be used. As it is slightly larger than the diagnostic hysteroscope, the cervix will need to be dilated (opened up). Local anaesthetic will be injected into the cervix to minimise discomfort. The polyp or fibroid will then be removed. This usually takes about 5-10 minutes. You will be kept fully informed throughout the procedure and any untoward discomfort will be addressed. You will receive a phone call in 3-6 months, to enquire about symptoms / relief. As Myosure is a relatively new procedure long term data on its safety and efficacy is limited. However, available data suggests the risk of complications is small. (2%) A Mirena coil may be advised and can be put in if you wish to treat your heavy periods. Your recovery Your appointment will take approximately 30 minutes for diagnostic procedure and approximately 60 minutes for treatment procedure. You should be able to go home after the procedure. Some women leave immediately, others may need a short time to recover if they experience pain. There is a recovery area with facilities for tea and coffee. If you have any residual discomfort, we can give you stronger pain-killers. It is advised that there is someone with you to drive you back home.

4 Page 4 of 6 Are there any complications or risks? Pain after hysteroscopy is usually very mild and similar to period pain. It is usually controlled with simple painkillers. Bleeding is usually mild and is lighter than a period, settling within few days. It is important to use sanitary towels, not tampons. If bleeding does not settle and is getting worse, you will need to see your doctor. Infection may cause an unpleasant smelly vaginal discharge or persistent bleeding. Infection is uncommon (1 in 100 procedures) and is treated with antibiotics. Vasovagal reaction occurs rarely (1 in 100 procedures) when a hysteroscope is passed through the cervix. This is a feeling of fainting and you may feel sweaty or sick. These symptoms are short lasting and settle once lying flat. It is important to alert us if you are feeling these symptoms. Perforation There is a very small risk (1-10 per 1000) that the instruments used could puncture the wall of the womb with possible damage to any internal structure. This is rare as the entire procedure is viewed on the screen. If it happens, you may need to stay in hospital overnight for close observation. Sometimes you may require a further operation (usually a key-hole) to investigate any damage. Failed procedure (1 in 500), where it is not possible to place the hysteroscope inside the womb. This is rare and your doctor will discuss other options with you. What happens after I go home? It is normal to have some mild cramping or a little bloody discharge like a period for few days after the procedure. If you have a fever, chills or heavy bleeding, contact your GP straight away. To reduce your risk of infection we advise that for one week you avoid: sexual intercourse swimming use of tampons For most women, normal activities can be resumed the day after the procedure. We would advise you to have some pain relief at home such as paracetamol or ibuprofen. When do I get the results of my tests? The doctor will explain the immediate findings at the time. We will contact your GP and yourself with any pending results and treatment plans. You will be told of these arrangements before you leave the Hysteroscopy Clinic. IMPORTANT Hysteroscopy will not be done at the time of your appointment if you are bleeding or if you are pregnant. Please ring the Hysteroscopy Clinic Secretary on to reschedule and for advice. You may be offered a pregnancy test if there is any possibility that you might be pregnant.

5 Page 5 of 6 Questionnaires When you attend our clinic you may be asked to complete a feedback questionnaire so we can continually strive to improve our services based on your feedback. Research and Audit As a part of our ongoing research and audit, we would like to include your medical details and findings from the clinic appointment on a database. This confidential database may be used for the future research and audit projects. Part of this will be looking at the long-term benefit of these specialised ambulatory (one stop) services. This may involve contacting you in the future by postal questionnaire. We hope that you are happy with this but if you have any objections please let the staff know when you attend the clinic. Contact Us If you have any questions or worries about the procedure, please ring , Stepping Hill Hospital switchboard, Monday-Friday 9.00 am 5.00pm) and ask for: Hysteroscopy Clinic Sister - Bleep 1245 Hysteroscopy Sister s Office - Extension 5876 Hysteroscopy Clinic Secretary - Extension 4762

6 Page 6 of 6 If you would like this leaflet in a different format, for example, in large print, or on audiotape, or for people with learning disabilities, please contact: Patient and Customer Services, Poplar Suite, Stepping Hill Hospital. Tel: [email protected]. Our smoke free policy Smoking is not allowed anywhere on our sites. Please read our leaflet 'Policy on Smoke Free NHS Premises' to find out more. Leaflet number MAT130 Publication date October 2015 Review date October 2017 Department Jasmine Suite, Women s Unit Location Stepping Hill Hospital