Why have I been sent to the rapid access clinic?
Your doctor has referred you to the gynaecology rapid access clinic (RAC) to investigate abnormal bleeding.
The majority of women referred to the clinic do not have a serious problem but, occasionally, these symptoms can be a sign of cancer and this is why you are being seen quickly.
Do I need to do anything to prepare for clinic?
You can eat and drink as normal and take all of your regular medications. Please bring with you a list of medications, allergies and details of any past or current health problems.
The clinic is often busy and if you need multiple tests, then you may be in the hospital for a few hours. For this reason, we recommend that you bring a drink and a small snack with you.
Some women who come to clinic need a hysteroscopy (see below). If this is the case, it can help if you have taken simple painkillers, such as paracetamol and/or ibuprofen (please read the instructions on the packet), one to two hours before your appointment.
Who will see me at the clinic?
You will meet a number of people at the clinic including a consultant or registrar doctor, nurses, a sonographer (person who performs scans), student nurses and doctors and, sometimes, a research nurse.
Our team consists of males and females but there will be a female nurse with you at all times during an internal examination.
What happens at the clinic?
When you arrive at the clinic, you will be seen by a nurse who will ask some simple questions about yourself and take some measurements, including your height and weight.
You will then speak to a doctor who will ask about your symptoms and your general health. Please bring with you a list of any medications and previous health conditions or surgeries.
Most women will go on to have an ultrasound scan of the pelvis. The scan uses high frequency sound waves (at a pitch that is too high to be heard by the human ear) to produce a moving black and white picture displayed on a monitor. Sometimes, scans can be done by putting a probe on to the abdomen but for scans of the pelvis, we recommend an internal scan, where the probe is placed into the vagina. You will be given privacy and asked to undress from below the waist and you will be given a gown to wear to keep you covered throughout the examination. The probe will be gently inserted into the lower part of the vagina and you may be aware of pressure.
The scan usually takes about 15 minutes. It will examine the shape and size of the uterus (womb), measure the thickness of the endometrium (lining of the womb) and the shape and size of the ovaries.
After the scan, the doctor or senior nurse may examine you. This may involve an internal (vaginal) examination.
Will I need a biopsy?
If the endometrium (lining of the womb) is thickened, then a biopsy from the endometrium may be needed. This can often be done in the clinic on the same day. This is done by passing a small straw-like tube into the uterus (womb) to collect some cells. Or we may offer you a hysteroscopy.
What is a hysteroscopy?
A hysteroscopy is an examination on the inside of the womb using a very small telescope and camera. A hysteroscopy is useful as it allows the doctors and nurses to look closely throughout the womb. Biopsies can be taken and small treatments for the cause of the bleeding can often be performed at the same time. Anyone who has a hysteroscopy needs to sign a consent form. Your nurse or doctor will explain the procedure in full and discuss the possible side effects.
We will ask you to lie on the bed and put your legs into stirrups. Local anaesthetic can be used to make the cervix (neck of the womb) numb to make the procedure more comfortable. Once the anaesthetic has taken effect, the hysteroscope is gently passed through the cervix into the womb. It is attached to a small camera so that pictures appear on the screen. During the procedure, there is a continuous flow of fluid through the hysteroscope to create a clear view. After the examination, the hysteroscope is removed quickly and easily. The doctor will often take a small biopsy (a pinch of tissue) from the womb and if a polyp (growth of tissue) is seen, this can often be removed at the same time.
The procedure can be uncomfortable and women may use some Entonox (‘gas and air’) to help with discomfort. The procedure can be stopped at any time. You will have a nurse with you throughout the procedure.
What to expect after a hysteroscopy?
As the local anaesthetic wears off, there may be some abdominal or pelvic pain and simple painkillers may be needed. Following a local anaesthetic, women usually feel ready to go home after a short rest in the clinic.
Once you are home, you can take your usual pain relief if you need it Many women feel able to return to normal activities or work the day after the procedure. Others may need to take one or two days off.
To help avoid the risk of infection, avoid tampons or intercourse for at least one week after a hysteroscopy.
Most women experience no medical problems after a hysteroscopy. The hospital or GP should be contacted immediately if any of the following symptoms develop as they may be a sign of an infection or a complication:
- Persistent heavy bleeding
- Pain that persists for more than 48 hours
- Swollen abdomen or general abdominal pain
- High temperature or fever
Please contact your GP who will be able to help in most cases. If, however, you cannot reach your GP, staff at the Women’s Health Unit or our Gynaecology Ward may be able to offer advice over the telephone.
Women’s Health Unit (8.30am to 5pm): 0191 282 0140
Ward 40 (24 hours): 0191 282 5640
Will I need more tests?
For many women, a scan and an examination are all that is needed and they can go home, with reassurance and advice, back to the care of their GP.
For some patients, however, extra scans (sometimes a CT scan) or additional biopsies are needed and you will have to return for another appointment for these. Your doctor will explain this to you. A computerised tomography (CT) scan uses X-rays and a computer to create detailed images of the inside of the body.
What happens after the appointment?
You will be able to go home after the appointment. Many women, even following a biopsy, will be able to drive but some women will choose to arrange for transport with a friend or family member.
If you think that you need an ambulance or hospital transport, please arrange this through your GP.
When will I get the results?
Test results (from extra scans and biopsies) typically take four weeks to be reported to your doctor. Your doctor will write to you with the results quickly after this.
What should I do if I have not heard about my results?
Typically, you will receive the results within four weeks of the clinic. If you have not received a letter or phone call from us within this time frame, please contact us.
Call our secretarial team on: 0191 282 5031
- Miss Rachel O’Donnell’s secretary Option 6
- Mr Tony Chalhoub’s secretary Option 3
- Miss Michelle Russell’s secretary Option 4
Research
At the RVI, we have a large research team and often work with Newcastle University. All of our consultant team are actively involved in research and may discuss the possibility of you getting involved in research at any of our clinics.
Whilst we are very grateful for those who choose to participate, this is not essential and please feel free to say no. This will not affect your care.
What if I cannot attend my appointment?
If you are unable to attend your appointment, please call the secretary at your GP surgery for your appointment to be rescheduled.
Alternatively please call:
The hospital appointment line 0191 282 4444
Concerns or complaints
If you have any suggestions or concerns, please make these known to a member of the team in the clinic or by letter to the hospital. We welcome suggestions to help improve our services.
Patient Advice and Liaison Service (PALS)
The PALS service aims to advise and support patients, families and carers and can help to deal with matters quickly on your behalf. This service is based at the Royal Victoria Infirmary Hospital.
Telephone: 0800 032 02 02
Text: 0781 550 0015
Email: northoftynepals@nhct.nhs.uk
