The BSGE has updated its statement on hysteroscopy, reaffirming the importance of patient choice, informed consent and access to appropriate pain relief.

The updated statement emphasises that women should receive clear information about the different settings and pain-control options available, enabling them to make a fully informed choice based on their individual circumstances, preferences and needs. All units should work towards providing a comprehensive range of analgesia options.

Women undergoing outpatient hysteroscopy should remain in control and must be able to ask for the procedure to be paused or stopped at any time. If the procedure cannot be completed, alternative options should be discussed without the woman feeling pressured to continue.

The statement also highlights the importance of appropriate clinician training and regular audit of hysteroscopy services, including patient experience, pain scores and whether women felt appropriately informed and involved in decisions about their care.

Please read the updated BSGE statement below.

Hysteroscopy is a commonly performed procedure used to diagnose and treat a range of gynaecological conditions. It is generally safe and of short duration. Women requiring hysteroscopy should be made aware of all available pain control options and settings in which the procedure can be performed. Patient choice should be central to the decision-making process, with the expectation that all women are appropriately counselled and that informed consent is key. All available options should be discussed with the woman, enabling her to choose the option that is best suited to her individual circumstances, preferences and needs. Clinicians should be given sufficient time within clinics to undertake this level of counselling and ensure that women have the opportunity to make a fully informed choice.

Some women prefer hysteroscopy as a day-case procedure using intravenous sedation, general or regional anaesthesia. Many choose to have the procedure awake in an outpatient setting and find this convenient and acceptable. All appropriate pain control options should be discussed and may include local anaesthesia injected or instilled into the uterus and/or breathe in analgesic gases (inhalational agents). Some centres may also offer conscious sedation within an appropriately staffed, equipped and monitored outpatient environment. All units should work towards providing a comprehensive range of analgesia options.

Women should be informed before an outpatient hysteroscopy begins that they remain in control and may ask for the procedure to pause or stop at any time. If a woman finds the procedure too painful or distressing to continue, her wishes must be respected and the procedure stopped. The procedure should also be stopped where nursing staff or the clinician considers that continuing would not be in the woman’s best interests. Where an outpatient procedure cannot be completed, alternative options should be discussed without the woman feeling pressured to continue.

The BSGE recommends that clinicians undertaking hysteroscopy have been adequately trained and have a sufficient workload to maintain their competencies. The BSGE also expects clinicians to quality assure both their individual practice and the overall calibre of their hysteroscopic service through regular audit, including monitoring the patient experience, pain scores and whether women felt appropriately informed and involved in decisions about their care.