Hysteroscopies, minimally invasive procedures used to examine and treat conditions within the uterus, are frequently performed across the NHS but have generated growing complaints about inadequate pain management. The procedures, which involve inserting a thin surgical instrument through the vagina and cervix into the womb, are classified as routine by the health service. In 2021, approximately 71,000 hysteroscopies were conducted in England alone.
Patients report experiencing severe pain during these examinations despite being told they would feel minimal discomfort. One woman undergoing a fibroid removal procedure described the experience as traumatic, noting that she had received local anesthesia but no adequate waiting period to allow it to take effect before the procedure began. She reported witnessing other patients emerge from their procedures in distress. The shift toward outpatient hysteroscopies without general anesthesia occurred over the 2000s and 2010s following clinical evidence suggesting the procedures were safe when performed in office settings and more cost-effective than operating room procedures. Current NHS targets specify that 90% of diagnostic and 50% of operative hysteroscopies should occur in outpatient settings.
Campaigners with Hysteroscopy Action, a group established in 2010, have advocated for 16 years that patients receive full informed consent about pain risks and access to comprehensive pain relief options, including local anesthesia, conscious sedation, epidural anesthesia, and general anesthesia when needed. They note that pain relief options vary significantly across different NHS facilities and that women are often offered minimal support beyond basic reassurance during procedures. The group has called for parity with colonoscopy procedures, which routinely offer diverse anesthesia options to patients.
A Women’s Health Strategy released in April included provisions for informed consent and pain relief choices for hysteroscopy patients. However, campaign leaders report that no substantive progress has followed the policy announcement. These procedures are used to diagnose and treat multiple conditions, including heavy bleeding, unexplained infertility, recurrent miscarriage, and to remove fibroids, polyps, and scar tissue.
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