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RCOG Good Practice Paper: Pain Relief and Informed Decision-Making for Outpatient Hysteroscopy

7 Feb 2023

The RCOG has published a new Good Practice Paper on Pain Relief and Informed Decision-Making for Outpatient Hysteroscopy. The paper is intended for healthcare professionals and has been published with the aim of optimising patient experience and clinical outcomes.

Hysteroscopy is a common and valuable procedure used to diagnose and treat gynaecological conditions arising in the uterus.

The majority of women and people have an acceptable experience of outpatient hysteroscopy, with pain levels tolerable to them and rapid recovery. However, for some women it is an unpleasant, and even traumatic, experience because of the pain.

A third of patients undergoing an outpatient hysteroscopy report pain levels at seven or above out of 10 however patient acceptability/satisfaction rates are consistently well above 90%, likely reflecting the brevity, safety and convenience of the procedure. The patient acceptability/satisfaction rates also indicate that pain may not be the main factor in their decision making.

To allow women or people to make informed choices it is vital that clear, accurate written and verbal information is provided, at the time of referral, or beforehand and at the procedure appointment. This should support choices including whether the person wants to proceed with a hysteroscopic procedure and if so, preferences for treatment setting, pain control and type of anaesthesia.

For women and people undergoing an outpatient hysteroscopy, it should be explained that it is impossible to fully anaesthetise the uterus with local anaesthetic and that simple analgesics should be taken 60 minutes before their appointment. Units should also identify a team member to act as a patient advocate during the procedure, exclusively dedicated to looking after the woman’s immediate needs and overall wellbeing rather than technical elements of the procedure.

Mrs Geeta Kumar, Vice President of the Royal College of Obstetricians and Gynaecologists, said: “Delivering hysteroscopy procedures in an outpatient setting offers women a quick, convenient and safe option. However, it is vital that women are supported to make informed choices about their care, and that all steps are taken to minimise the risk of a poor experience. To achieve this aim, we encourage clinicians and units offering this common procedure to ensure their practice is aligned with this paper."
  • On Monday 13th February a consultation will be open for the Green Top Guideline on Outpatient Hysteroscopy. The RCOG we be requesting feedback from patients, the public, charities and healthcare professionals. Please keep an eye on our website for more information.
  • For patient information on Outpatient Hysteroscopy please click here.
  • Click here to read the Good Practice Paper No. 16 Pain Relief and Informed Decision-Making for Outpatient Hysteroscopy


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