Your Referral to the Gynaecology Rapid Access Clinic

You have been given this leaflet because your GP or hospital doctor has referred you to our Gynaecology Rapid Access Clinic. It explains what the Gynaecology Rapid Access Clinic is and what to expect at your appointment.

What is the Gynaecology Rapid Access Clinic?

This is the clinic where you will be seen within 2 weeks of being referred. This clinic is for women who have symptoms that need urgent assessment and investigation.

These symptoms may include:

• Vaginal bleeding after the menopause.
• Prolonged bleeding or bleeding in between periods or bleeding after sex.
• Lump or itching on the entrance to the vagina (vulva).
• Abdominal swelling or feeling a lump in the abdomen.
• Abnormal appearance of the cervix or severely abnormal cervical smear test.

The Rapid Access Clinic is also used to provide advice about test results carried out by your GP or hospital clinician, or to provide advice about genetic screening for gynaecological cancer.

It is very important that you attend this clinic appointment as in some cases (but not the majority) there is a concern that you may have some form of cancer.

Where do I need to go?

• Women’s Outpatient Department, University Hospital of Hartlepool.
• Blue Zone, Main Out-patient Department, University Hospital of North Tees.

Your clinic letter will advise you of the exact location for your appointment.

What happens at your appointment?

During your appointment, the Doctor or Nurse will talk to you about your symptoms and which tests and investigations you might need. The tests and investigations you may need will depend on your symptoms, therefore please allow at least 2 hours for your visit. You may have several tests at one appointment so you don’t have to come in more than once.

These tests often give reassurance, or may allow a quick diagnosis and treatment. We would advise you to take simple pain relief such as paracetamol or ibuprofen 1 to 2 hours before your appointment. This is to help reduce any crampy ‘period’ type of pain that you may experience during any procedures.

Any procedures or investigations will be discussed with you in detail before they begin.

Please note that there are both male and female members of the team. If you would prefer a female team member, please let us know as soon as possible, as we cannot always accommodate this request on the day.

You are welcome to bring a friend or relative with you to the consultation to give you support in case you feel unwell.

We suggest you bring a list of any medications you are taking, details of any allergies you may have, and any questions for the clinician.

Ultrasound Scan

If you have bleeding symptoms including post-menopausal bleeding or suspected ovarian pathology, you may have an Ultrasound Scan. An Ultrasound Scan uses sound waves to show a picture of your pelvic organs. It is used to assess womb (uterus) size, the thickness of the lining of the womb cavity (endometrium), the ovaries and surrounding structures.

You may need to have different types of scan.

For an abdominal scan, the probe is placed on the tummy and requires a full bladder.

For a transvaginal scan, a specially designed rounded probe is placed inside the vagina.

You may receive an appointment for an Ultrasound Scan before your clinic appointment.

Hysteroscopy and Endometrial Biopsy

Depending on your bleeding symptoms and Ultrasound Scan result, you may require an outpatient endometrial biopsy. This may be combined with a procedure called hysteroscopy.

A hysteroscopy is an examination of the inside of the womb (uterus). A narrow telescope (called the hysteroscope) is passed through the vagina, along the cervix (neck of the womb) into the uterus.

The womb is made bigger by a continuous flow of saline (salty water) through the hysteroscope to get a better view.

This may make you feel wet, can cause discomfort and cramping. This discomfort should last only a few minutes.

The most common findings are:

• Thickened endometrium – this is the thickening of the lining of the womb cavity.
• Polyps – these are growths of glandular tissue inside your womb cavity, or on the cervix, which are usually benign (not cancerous).
• Fibroids – these are muscular lumps (usually non-cancerous) in the womb wall.

Thickened endometrium will be biopsied. The biopsy (tissue sample) of the lining of the womb is taken by passing a fine plastic tube through the cervix.

Findings such as polyps and fibroids may also be dealt with at the time of your procedure.

This is done by using a procedure called MyoSure^® hysteroscopic polypectomy. This is a procedure to remove small lumps, such as fibroids and polyps, from the inside of the womb (uterus).

Why are polyps or fibroids removed?

Polyps (small grape-like growths) can be associated with:

• Heavy vaginal bleeding.
• Bleeding in-between menstrual periods.
• Postmenopausal bleeding.
• Pre-cancer or cancer changes within the polyp.

Fibroids can also result in heavy menstrual loss.

How is the MyoSure^® procedure carried out?

The MyoSure^® hysteroscopic polypectomy procedure is performed under local anaesthetic and usually takes about 15 to 20 minutes. The procedure is carried out using a hysteroscope.

A slender tube is passed into the womb through the hysteroscope channel, which is used to gently cut away the polyp or fibroid; the tissue is then removed. The hysteroscope and tube are then removed from the vagina.

You may have slight vaginal bleeding afterwards and will need to use a sanitary pad or panty liner for a day or two.

Very occasionally, it is not possible to perform the procedure in clinic. If this is the case, you will be offered the procedure at a later stage under a general anaesthetic.

Vulval Biopsy

If you have a problem with changes to the skin outside of the vaginal entrance (the vulva), a biopsy may be taken.

A small piece of tissue is taken under local anaesthetic. We will use dissolvable stitches to close the skin.

Colposcopy and Cervical Biopsy/Vaginal Biopsy

If you have a problem associated with your cervix, you may require a colposcopic examination. The cervix is closely examined using a magnifying lens (colposcope).

By applying different solutions to the cervix, we are able to detect any abnormalities. We may need to take a small piece of tissue (biopsy) from the cervix.

Local anaesthetic is not usually needed. The procedure generally causes little discomfort. Sometimes we may recommend treatment to the cervix as well.

All tissue samples taken will be sent to the laboratory for detailed microscopic examination.

Blood Test

We may need to take some blood tests to assess possible ovarian diseases or anaemia.

Occasionally we may need to arrange more detailed body scans (CT or MRI Scan).

At the end of your appointment

Following any procedure, you will be given an explanation of what was found, when you will receive any test results and whether you need another appointment.

You may be asked to stay for 10 to 15 minutes to make sure you are well after your colposcopy or hysteroscopy.

A nurse will give you verbal, written advice and discharge information if any tests have been performed. Occasionally we may have to refer you to another medical speciality or hospital, but we will discuss this with you if this is required.

If a surgical procedure is advised, arrangements will be made for your admission date. This may be a day-case procedure but sometimes a longer stay is required. An appointment for a pre-operative assessment will also be arranged.

Often, we are able to reassure patients at the end of this visit, following the examination and tests. If no serious cause for your symptoms are found you will be discharged back to your GP’s care.

Contact Details

If you need to rearrange your appointment, please call our 2 week rule booking service on: 01642 383299

If you have any questions or anxieties in relation to your test or treatment, please contact:

Women’s Outpatients Department – University Hospital of Hartlepool

01429 522865
Opening hours: 8.30am to 5.00pm (Monday to Friday)

Women’s Outpatients Department – University Hospital of North Tees

01642 624212
Opening hours: 8.30am to 5.00pm (Monday to Friday)

Comments, concerns, compliments or complaints

Patient Experience Team (PET)

We are continually trying to improve the services we provide. We want to know what we’re doing well or if there’s anything which we can improve, that’s why the Patient Experience Team (PET) is here to help. Our Team is here to try to resolve your concerns. The office is based at the University Hospital of North Tees if you wish to discuss concerns in person. Our contact details are:

Telephone: 01642 624719
Freephone: 0800 092 0084
Opening hours: Monday to Friday, 9:30am to 4:00pm
Email: [email protected]

Out of hours

Out of hours if you wish to speak to a senior member of Trust staff, please contact the hospital switchboard who will bleep the appropriate person.
Telephone: 01642 617617

Patient, Public and People with Lived Experience

We are looking for patients to share their experiences of healthcare and to join our Involvement Bank. Working with the patients, carers, families and the general population we support in making decisions about their care can lead to better health outcomes, increased patient satisfaction and a better overall experience. We want to listen and work with you in shaping the future of your healthcare services. To find out more about the Involvement Bank go to our website or contact us at:

Website: www.nth.nhs.uk/about/community/people-with-lived-experience
Email: [email protected]

Data protection and use of patient information

The Trust has developed Data Protection policies in accordance with Data Protection Legislation (UK General Data Protection Regulations and Data Protection Act 2018) and the Freedom of Information Act 2000. All of our staff respect these policies and confidentiality is adhered to at all times. If you require further information on how we process your information please see our Privacy Notices.

Telephone: 01642 383551

Email: [email protected]

Leaflet feedback

This leaflet has been produced in partnership with patients and carers. All patient leaflets are regularly reviewed, and any suggestions you have as to how it may be improved are extremely valuable. Please write to the Clinical Governance team at:

Email: [email protected]