Hysteroscopies, minimally invasive procedures performed on the womb, have become increasingly common in recent years as a diagnostic and treatment tool. In 2021, 71,000 of these procedures took place in England alone. Conditions warranting the procedure include heavy or unexplained bleeding, unexplained infertility, recurrent miscarriage, and removal of fibroids, polyps, or scar tissue. Following clinical evidence in the 2000s and 2010s demonstrating safety and cost-effectiveness, the procedures transitioned from requiring general anesthesia to being performed in outpatient settings, with current NHS targets aiming for 90% of diagnostic and 50% of operative procedures in this setting.
However, patient accounts highlight significant pain during these procedures. Those undergoing hysteroscopies report experiencing intense discomfort despite local anesthetic administration and describe the experience as distressing. One patient described the procedure as “barbaric” and reported feeling assaulted, while another became hysterical upon completion. Healthcare providers sometimes compare the experience to dental work, yet patients report substantially different pain levels than anticipated.
Campaign group Hysteroscopy Action, formed in 2010, has been advocating for systematic change regarding pain management and patient choice. The organization calls for all hysteroscopy patients to receive full informed consent about potential severe pain and access to multiple pain relief options, including local anesthesia, gas and air, conscious sedation, epidural, and general anesthetic where appropriate. The group specifically seeks parity with colonoscopy procedures, noting that half of colonoscopy patients are men and that these procedures offer patients a broader range of pain management choices.
The April Women’s Health Strategy included provisions addressing these concerns, with Action 7 calling for informed consent and pain relief options for hysteroscopy patients. Despite this policy development, implementation remains stalled. Advocacy efforts continue as pain relief availability varies significantly across different regions of the country, with some facilities offering minimal options beyond nursing support.
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