12. Before we decide if we should do a detailed investigation of a complaint, we look at whether there are signs the organisation got something wrong. We do this by comparing what should have happened with what did happen. We have done this and have not seen any signs that something has gone wrong.
Menstrual problems and hysterectomy
13. Mr R says the consultant told him the severe bleeding and pain he experienced during menstruation were normal. We appreciate Mr R’s concern as he was later diagnosed with polycystic ovaries and endometriosis. These are disorders that can cause menstrual problems.
14. Mr R says the consultant would not help him get a hysterectomy because he is transgender.
15. We appreciate Mr R wants a hysterectomy because it is dangerous for him to get pregnant with the other health conditions he has. He also says he does not want children. Mr R says he is disabled and does not want to pass on any genetic health problems. He says he does not have the energy to raise children with his illnesses.
16. The Trust says Mr R was not referred to the consultant to investigate painful periods or to discuss having a hysterectomy. It says Mr R had been referred to the Trust’s urogynaecology department. Urogynaecology focuses on urinary incontinence and pelvic floor disorders.
17. The Trust says for this reason, the consultant was not able to advise him but did take specialist advice and asked Mr R’s GP to refer him to gender services. The Trust says one of the reasons gender services were best placed to advise him about having a hysterectomy was due to his transitioning and hormone changes he was going through.
18. We looked at Mr R’s medical records. These show the reason for the appointment with the consultant on 30 November 2021 was a follow-up to a bladder procedure he had earlier in the year.
19. We can see from the records, the consultant noted Mr R wanted to talk about his painful, heavy periods. They also note discussions about a hysterectomy. The consultant went on to discuss Mr R's request for a hysterectomy with a colleague who specialises in gender reassignment.
20. The consultant followed up the appointment with a letter to Mr R’s GP. In the letter, the consultant recommends tranexamic acid for Mr R’s heavy periods which is medication used to reduce bleeding. The consultant also asks the GP to refer Mr R to a gender reassignment clinic to discuss a hysterectomy.
21. We can see Mr R has had a long, frustrating experience trying to get a hysterectomy. We are sorry to hear of the pain and distress he experienced with having such heavy periods. We cannot link these experiences to the actions of the Trust’s consultant. Mr R was not referred to the consultant to consider these issues.
22. GMC guidance says when medical professionals assess, diagnose or treat patients they must:
• ‘adequately assess the patient’s conditions, taking account of their history (including the symptoms and psychological, spiritual, social and cultural factors), their views and values; where necessary, examine the patient • promptly provide or arrange suitable advice, investigations or treatment where necessary • refer a patient to another practitioner when this serves the patient’s needs.’
23. When Mr R raised these issues with the consultant, they had a duty to consider his medical picture fully. We appreciate Mr R felt the consultant did not listen to his concerns or take them seriously. We are sorry he was left feeling dismissed. The consultant noted Mr R’s concerns in his records, they took advice from a specialist colleague and made recommendations to the GP. For these reasons, we consider the consultant acted in line with the above guidance and did what they could in the circumstances. We have not seen signs that something went wrong.
Contraceptive coil
24. Mr R says on 30 November 2021 the consultant prescribed a Jaydess coil. This is a hormonal contraceptive inserted into the womb. Mr R says he did not want the coil as different kinds of coil in the past had caused terrible side effects including migraines. He says he told the consultant this, but they prescribed one anyway.
25. Mr R says he had the coil fitted at a sexual health clinic (the Clinic) in February 2022. He says he could only keep the coil in for a couple of months because of the side effects he had. Mr R says the consultant should never have prescribed this. He says it was wrong given his diagnosed chronic migraines.
26. In its complaint response the Trust says it recommended a Jaydess coil because it has a lower level of hormones and is less likely to trigger migraines compared with other coils.
27. The records show that one of the Trust’s professors recommended the Jaydess coil on 9 March 2021, because they thought it may help with the heavy bleeding Mr R had been experiencing.
28. Mr R had an appointment with a nurse on 24 May 2021. The clinic letter says Mr R told the nurse he decided he does not want the coil because he read it is not suitable for people who experience migraines. The nurse wrote that further investigations for his bladder problems were to continue, with the understanding that he does not want a coil.
29. Mr R had his final appointment with the Trust’s consultant on 30 November 2021. The consultant wrote that Mr R did not want to consider hormonal treatment. The consultant recommended medication instead to help with his heavy flow and cramping.
30. As we have different accounts of what happened in the final consultation, we asked the Trust to tell us if it prescribed the coil. We also asked Mr R whether he had any information to support his version of events.
31. The Trust said it did not prescribe a Jaydess coil as Mr R had declined this option more than once. This is supported by what the consultant wrote.
32. Mr R requested his medical records from the Clinic. He hoped they would show he attended with his own prescribed coil. We have checked the records. We cannot see any record of the Clinic inserting a coil after Mr R’s appointment at the Trust at the end of 2021.
33. We are in a difficult situation as the accounts of Mr R and the Trust are different. We have carefully considered all the evidence we have from both sides. We appreciate Mr R remembers the Trust consultant giving him the prescription.
34. There is no record of the prescription in Mr R’s medical records. The records state several times that he did not want a coil or any hormonal contraceptive. We recognise it could be the case that the prescription was not recorded by mistake. We must also consider there is no record in the Clinic records either.
35. For these reasons we have decided it is most likely that the Trust did not prescribe a Jaydess coil. We are sorry to hear of the side effects Mr R experienced. We cannot link this to the actions of the Trust. As we have not seen signs that something went wrong, we will not take further action on Mr R’s complaint.
36. We thank Mr R for bringing his complaint to us.