11. Before we decide if we should investigate a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and, we have not found any signs that something went wrong in how the Trust managed Ms K’s polyp.
12. Ms K understands her US scan in September 2020 showed she had an endometrial polyp, and that on 27 October, the consultant gynaecologist referred her for removal of this. She says on 19 July 2021 when she went for treatment a different gynaecologist did the procedure. She understands they did a hysteroscopy and biopsy instead and treated her for a fibroid. She thinks this was the wrong treatment and she experienced significant bleeding afterwards. She later had surgery on 23 September, and she says this confirmed she had an endometrial polyp. She thinks the Trust should have treated this sooner and if it did, she would not have had the blood loss.
13. The NICE guideline says consultants should offer a hysteroscopy to women with heavy menstrual bleeding if their history suggests submucosal fibroids (a fibroid that grows from the muscle wall into the cavity of your womb), polyps or endometrial differences, because they have symptoms such as ongoing bleeding between periods.
14. Mrs K had a background history of heavy periods when her GP referred her to a gynaecologist at the Trust. The US scan suggested a polyp. Because of this, the NICE guidance is relevant.
15. On 27 October 2020, the consultant gynaecologist referred Ms K for a hysteroscopy to investigate and see if the polyp could be removed. This is in line with the NICE guidance. Ms K had a hysteroscopy as planned on 19 July 2021. In a hysteroscopy, the doctor passes a telescope with a light and camera at the end into the womb. The images are sent to a monitor so they can see inside the womb.
16. The notes from the hysteroscopy show the gynaecologist decided this was a large fibroid (larger than 2.5cm). We know from later notes that it was not actually a fibroid. We asked our adviser if the gynaecologist got something wrong when they looked at the images of Ms K’s womb. Our adviser said it can sometimes be difficult to distinguish between a normal endometrial polyp and a fibroid, especially in an outpatient hysteroscopy setting. The difference is in what the lesion is made up of. Also, when lesions are large, as this one was, they are more likely to be fibroids. This explains why the gynaecologist thought the lesion was a fibroid.
17. The NHS webpage says hysteroscopy is used to remove both fibroids and polyps, and the procedure may be done under general anaesthetic if the person is having treatment. Our adviser said whether the lesion was a fibroid or polyp, it was right for the gynaecologist to book Ms K for a general anaesthetic hysteroscopy procedure due to its size (bigger than 2.5cm). This is what happened on 23 September 2021. During that operation, the Trust found that the lesion was a polyp and removed it.
18. We understand Ms K experienced heavy bleeding after the outpatient hysteroscopy which led to a blood transfusion, a swollen lymph and discolouration on her arm. This was clearly a very difficult time for her. Our adviser said it is possible that an outpatient hysteroscopy can trigger heavy vaginal bleeding, but it is unlikely. We know Ms K had a history of heavy bleeding, and we think it is more likely that she experienced an episode of this.
19. When we weigh up the evidence, there are no signs the Trust should have done something different. Even if it had correctly identified a polyp instead of a fibroid on 19 July 2021, it would have planned exactly the same treatment. Ms K would still have needed a hysteroscopy procedure under general anaesthetic to remove it.
20. We note the Trust has apologised that it was not clear to Ms K what procedure she was going to have on 19 July 2021. We are pleased to see it recognised its poor communication around this.
21. We are satisfied the Trust did not do anything seriously wrong. We think the Trust acted in line with the NICE and NHS guidance. We recognise the distress the confusion around Ms K’s diagnosis and treatment caused her. It seems the Trust followed the right assessment and management in removing her polyp. We hope this reassures her.