You might remember that I went for a hysteroscopy examination about six weeks ago. I wrote about it briefly in this blog post and promised to elaborate once I had the results and next steps. I was overwhelmed by the number of comments and emails in response to that post. It’s heartening that so many women were willing to share their own experiences about hysteroscopy and about heavy bleeding which is why I had mine. More of that in a moment.
What Is A Hysteroscopy?
So what is a hysteroscopy? Well there are countless excellent websites that explain what the procedure entails. The “mechanics,” I suppose. It is a procedure that uses a hysteroscope, (a very narrow telescope with a light), to examine the inside of the uterus. It is inserted vaginally, through the cervix and into the womb. The consultant will take biopsies of the endometrium, (lining of the womb), at the same time, if necessary. The hysteroscope sends images to a monitor so the consultant can see. It is usually carried out without anaesthetic although it is sometimes carried out under general anaesthetic.
Why I Had A Hysteroscopy
I needed a hysteroscopy because I’ve had heavy menstrual bleeding, menorrhagia, for several years. The definition of menorrhagia is abnormally heavy or prolonged menstrual bleeding. In my case, this amounts to a bleed which lasts for about ten days within a 24-26 day cycle. I get mild stomach cramps and feel light-headed for five days leading up to the bleed, although these pre-menstrual symptoms require little more than a hot water bottle and a few paracetamol. I don’t get the typical mood swings associated with PMT, however, I do feel excessively emotional and tearful. A quick calculation tells you that for 15 out of every 25 days, I am either pre-menstrual or bleeding. It’s no fun.
The bleeding itself is very heavy. I experience flooding and at times I need to change my bedding three times within a night. I get lower backache, headache and severe stomach cramps. The fear of bleeding all over the place stops me going to the gym and I dread standing up after driving for the same reason. I drive my son to play football several times per week and the journey can take up to two hours depending on location. Some matches are played on pitches that have no toilets nearby. I find myself looking for the nearest supermarket so I can use the ladies loos and get changed if necessary.
This heavy bleeding has had a significant impact on me over the last few years. Physically, I feel, (and look), exhausted for the duration of the bleed. I often feel very light-headed and on a few occasions, I have fainted because of low blood pressure. It interrupts my sleep and it’s painful. I often need to change my underwear and sometimes other clothing several times per day. And none of us need any more washing do we?
Emotionally, I feel unattractive and undesirable. The bleeding stops me from doing things I want to do. It makes me think twice about what I wear- I avoid anything fitted or light-coloured and instead choose looser. brighter clothing, often with a pattern; it’s more forgiving of leaks.
At times, I feel like my life revolves around it and I avoid arranging meetings, nights out and other social events during those times.
However, I’m fortunate to have so many good friends who understand and who help with the football runs if necessary. My partner Ian is patient and kind and my parents are wonderful. I’ve told my teenage children on a need to know basis and they know that if I’m a little quieter than usual, then it’s nothing to worry about.
Options To Help Heavy Bleeding
There is a set of protocols set out by NICE for the treatment/management of menorrhagia which must be carried out in order.
The first option is a hormonal one, i.e. the contraceptive pill or the Mirena coil. The combination pill was contraindicated because of the increased risk of thrombosis associated with me being over forty. Consequently, the first thing I tried was a progesterone-only, (mini) pill. It definitely reduced the incidence and severity of the flooding but I had spotting on every other day of the month. I persevered and gave it two years, hoping that one day it would stop. It didn’t.
The next step was the Mirena coil. I know so many women for whom this has been life-changing. Again, it reduced the severity but I was still bleeding heavily and spotting on more days than not. I can’t be certain, but it seemed to exacerbate my lower back pain and made me feel flat. Not low, or depressed. Just flat. Not my usual upbeat, bubbly self. This time I persevered for 14 months. In the end I made an appointment to see my GP because I was thoroughly fed up. She gave me an internal examination then referred me for an internal ultrasound on my pelvis and uterus. This revealed a few small fibroids and that the Mirena coil was sitting a little low. Shortly afterwards, I chose to have the coil taken out by my GP. It was totally painless and took a matter of seconds.
The next thing I tried was Tranexamic Acid. In simple terms, this encourages clotting so in theory reduces blood flow. (It’s used for severe nosebleeds and following certain surgeries for the same reason). This is a course of tablets which must be taken as soon as the period starts and for up to four days each cycle. It seemed to help reduce flooding for two or three days but after that, I found that I was passing large clots which was painful and really just not very nice. I took advice and tried it for three cycles but the clots were worse than everything else. I was very glad to stop taking it.
My Experience of Hysteroscopy
Because I’d tried every option, the next step was referral to a gynaecologist. At the initial appointment, she took a thorough history and told me that a hysteroscopy will rule out anything sinister and will assess suitability for treatment. It is worth mentioning here that I have always kept up to date with smear tests and they have always been normal. There is no history of uterine, ovarian, bladder, bowel or breast cancer in my family. Because of this, I was never worried about anything serious or life-threatening. The fact that nothing got any worse also reassured me that I must be ok in myself.
I had the hysteroscopy about six weeks ago as an outpatient. The nurse checked my blood pressure and took me to theatre. It was carried out without anaesthetic, so once I’d removed the clothes from my bottom half and put a gown on, I got onto the bed. (Operating table sounds a bit dramatic, but I guess that’s what it was). I had to put my bottom towards the foot of the bed and lie down. My legs were elevated and opened and covered with drapes. The initial part of the hysteroscopy was like having a smear test. Slightly uncomfortable and rather undignified, but nothing more than that.
She took endometrial biopsies and then it become more uncomfortable. I could feel the hysteroscope as it moved and that made me jump a few times. I tried not to tense up and did my best breathe through it. I’m really very tolerant of pain and discomfort; I’m not soft. I gave birth to my two children naturally and with only gas and air. Consequently, I expected this to be a walk in the park! My mum advised me to take some painkillers before I went. I had every intention of doing so but I forgot. It would have taken the edge off the discomfort, so I highly recommend it to others.
I was tearful and actually started to cry during the procedure. It wasn’t because of the discomfort or because I was frightened. I still don’t know why really.
The hysteroscopy took about 25 minutes. There was a lot of bleeding immediately afterwards as I’d expected. I got dressed and waited for a short while before the nurse checked my blood pressure again. It was quite a bit lower than it was pre-op and I felt a bit faint, but not enough to worry me. My friend Sue took me and brought me home. Initially, I thought I’d be perfectly fine to drive myself. There is no way I could have managed that. Not only was I light-headed, I was still weepy, (poor Sue wondered what on earth had happened). I felt shaky and was very pale.
The Week After My Hysteroscopy
Sue left me with a much needed cup of tea, a hot water bottle and firm instructions to take it easy. I’d planned to work that afternoon. After all, I do little more strenuous than sit at a laptop. But, no. I had tummy and backache as well as a headache. My friend Sally came later with flowers and gossip and I felt a little better. By bedtime that night I felt a lot less like crying and I expected to be as good as new by morning.
However, I felt exhausted, achey and just not right. It took a week until I felt normal again. I’m always very emotional but this seemed to be heightened to the nth degree that week too. In my previous blog post about this, another lady commented that her friend was emotional too. And a friend of a friend experienced the same. I know this is only anecdotal evidence, but it’s reassuring to know that it wasn’t just me who cried a river after having a hysteroscopy!
I bled for three weeks afterwards. It wasn’t heavy and there wasn’t any flooding but it was enough to make me slightly concerned. I called the gynae ward and they told me that it isn’t unusual.
The Results and Next Steps
I had my follow-up appointment last week. As expected, the biopsies confirmed that everything is normal. However, and I’m delighted about this, I am on the list for uterine ablation. This is the surgical removal of the endometrial tissue which has an 80% success rate in reducing menorrhagia significantly and entirely in some cases. It’s carried out under general anaesthetic and the literature suggests a recovery time of up to two weeks. I can’t tell you how glad I am. It’s not going to be easy sitting still and because I’m self-employed, it will have a financial impact. But, my goodness, if it reduces the bleeding and its associated symptoms, then I shall be one very happy woman. I’m hoping that it will take place sometime in May.
I can’t praise the NHS enough. My consultant and her team are brilliant as are the GPs I’ve seen throughout. I feel fortunate to live in a country that has such a brilliant system. I also feel very fortunate to know that in a few months from now, I’ll feel like my old self. I’ve got so much to look forward to and I can’t wait for summer.
Ian bought the beautiful roses for me. The gorgeous lingerie and dressing gown that I’m wearing in these photographs were a gift from F&F Clothing. They sent a selection to me and it’s all absolutely beautiful. The colour palette is perfect for spring and includes blush pink and sea green. It’s the first time I’ve had any underwear or nightwear from there and it’s lovely; excellent quality and great value. At £18, the floral dressing gown would make a perfect Easter gift.