Why have I been sent to the rapid access clinic?
There are many reasons that women are referred but common symptoms, which prompt referral, include unusual bleeding patterns, symptoms of a swelling in the pelvis (pain, pressure, swelling) or an abnormal area of the vulva. The aim of the clinic is to exclude cancer as a cause for your symptoms.
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
Before your first appointment
We aim to make sure that every woman gets all of the tests that you need in the shortest time. This sometimes means that you will be offered a scan ahead of your first appointment. This might be an ultrasound scan or a CT scan.
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 consultant or resident doctor, nurses, physician associates, sonographers (person who performs scans), student nurses and student doctors. Sometimes you will meet 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 or clinician who will ask about your symptoms and your general health.
Most women will go on to have an ultrasound scan of the pelvis, if this has not been done already. 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 onto 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 clinician may examine you. This may involve an internal (vaginal) examination.
Will I need a biopsy?
The team may recommend a biopsy of the endometrium (lining of the womb), the cervix, the vagina or the vulva skin depending upon the area that is abnormal.
Biopsies are usually done in the clinic on the same day and we will offer pain relief which can include local anaesthetic, gas and air (Entonox) or Penthrox. These options will be disused in detail with you but the alternative of a general anaesthetic will be considered where needed. This cannot be offered the same day.
Will I need a cervical screening (‘smear’) test?
Women in the Uk are advised to have a ‘smear test’ every 3-5 years (depending upon your age). You are typically sent an invite from the GP when your test is due. A smear test requires an internal examination with a speculum so that a small brush can be used to sweep over the cervix (neck of the womb) to test for HPV virus. If the HPV virus is detected then the cells are examined under the microscope to check for possible precancer changes. If your cervical screening test is due then this can often be taken in the clinic.
What is a hysteroscopy?
Some patients require a hysteroscopy and, whilst we aim to do as many tests as possible on the same day, some patients will be given a second appointment for this.
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. A small biopsy (a pinch of tissue) from the womb is often taken 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.
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
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 decline. This will not affect your care.
What if I cannot attend my appointment?
If you are unable to attend your appointment, please let are secretarial team know. This may result in delays to your appointment and diagnosis.
Concerns or complaints
Patient Advice and Liaison Service (PALS)
Should 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.
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: [email protected]
Useful websites
If you would like further information about health conditions and treatment options, you may wish to have a look at the NHS website at www.nhs.uk
If you would like to find accessibility information for our hospitals, please visit www.accessable.co.uk
