Northumbria Healthcare NHS Foundation Trust

4. Miss N complains about aspects of the care and treatment provided by the Trust in January 2025. Specifically, she complains: • She was referred for symptoms of severe abdominal pain, an ovarian mass, a swollen abdomen and changes in her periods, however the consultant only treated her for heavy periods • She was not offered any anaesthesia for a hysteroscopy procedure • The consultant did not inform the nurse carrying out the hysteroscopy that she finds internal examinations traumatic

5. Miss N explains she is a survivor of sexual assault, as such the care and treatment she received from the Trust retraumatised her and adversely affected her mental health. She explains she sought private counselling as a result of her mental health. Miss N tells us she is unable to undergo transvaginal ultrasounds as they are traumatic to her, and she worries about her future health as a result.

6. Miss N also explains the Consultant’s failure to address the remaining referral concerns has left her in ongoing pain and persistent bloating for the past 12 months.

7. By bringing this complaint to us, Miss N seeks evidence of service improvements, an apology from the Trust, and a financial remedy.

8. Miss N’s GP referred her to a consultant at the Trust in December 2024 for the consultant’s opinion, advice or possible review of Miss N.

9. Miss N presented with vague lower abdominal pain, feeling of early satiety (feeling full after eating only a small amount of food), and occasional urinary urgency. She also presented with change in her period and a heavy period flow.

10. The Trust carried out a hysteroscopy procedure in January 2025 after reviewing Miss N.

Unaddressed symptoms

14. Before we decide if we should conduct a detailed investigation of 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 have not found any indications that something has gone wrong.

15. Miss N says the consultant only treated her heavy periods, despite her GP referring her for severe lower abdominal pain, an ovarian mass, abdominal swelling, and changes to her periods.

16. Within the Trust’s complaint response, it said the consultant wanted to carry out further investigations to better understand the cause of Miss N’s pain before considering other possible causes.

17. NICE guideline 88 says clinicians should offer outpatient hysteroscopy to women with heavy menstrual bleeding, if their history suggests submucosal fibroids, polyps, or endometrial pathology.

18. The medical records show Miss N presented with vague lower abdominal pain, early satiety, and occasional urinary urgency. They also show her periods had become much shorter and heavier than before. The medical records indicate Miss N has several fibroids, a thickened endometrium and previously had an ovarian cyst.

19. The records also confirm the Trust carried out a hysteroscopy and offered to insert a Mirena coil. However, Miss N declined the Mirena coil because of her previous experience of sexual assault. A hysteroscopy is a test to look inside a woman's womb, using a thin tube with a small camera inside it. A Mirena coil can help make periods lighter and less painful. A thickened endometrium is when the lining of the womb is thicker than expected.

20. Our adviser explained that the within the referral, the GP appeared mainly concerned about the heavy menstrual bleeding and thickened endometrium. They told us these symptoms can sometimes indicate cancer and therefore require urgent investigation.

21. We can see the Trust triaged the GP’s referral to the abnormal uterine bleeding clinic. After considering this with our clinical adviser, we are satisfied this indicates the Trust took Miss N’s heavy menstrual bleeding and thickened endometrium into account when it received the referral.

22. We understand it is a requirement for clinicians to do hysteroscopy to rule out any possibility of a tumour if a patient presents with thickened endometrium associated with heavy menstrual bleeding. We therefore consider there are indications the Trust acted in line with NICE guideline 88 when it decided to investigate the heavy periods by arranging an outpatient hysteroscopy for Miss N.

23. We can see the consultant offered Miss N Mirena Coil treatment and confirmed the GP could provide Miss N with hormonal therapy and mefenamic acid. Our adviser confirmed these treatments can help to reduce pain. We can also see the consultant suggested that if there was no improvement to Miss N’s symptoms with the suggested measures, she should be referred back, and further options could be discussed. For these reasons, we consider there are indications the consultant addressed the pain concerns raised in the GP’s referral.

24. Overall, we have found no indication of failings by the Trust with regards to the way Miss N was reviewed, and we will not investigate this matter any further.

25. We appreciate the impact the experience has had on Miss N and hope we can bring her some reassurance that there are no indications of failings in the care and treatment she received from the Trust in January 2025.

Anaesthesia

26. Miss N complains the Trust did not offer her any anaesthesia prior to the hysteroscopy procedure.

27. In its response to the complaint, the Trust confirmed it gave Miss N a leaflet covering outpatient hysteroscopy (OPH) and hysteroscopic procedures(HP). The Trust also explained clinicians do not routinely use local anaesthetic during hysteroscopy procedures. It said staff should tell patients they can pause or stop the procedure if it becomes too painful or uncomfortable. The Trust further explained patients should be told they can have the full hysteroscopy procedure under general anaesthetic if they cannot tolerate it.

28. The RCOG green-top guidelines number 59 says the following:

• All gynaecology departments should provide a dedicated outpatient hysteroscopy service to aid care of women and people with abnormal uterine bleeding, reproductive problems, and insertion/retrieval of intrauterine devices.

• Written information should be provided to the woman prior to their appointment. This should include details about the procedure, the benefits and risks, advice regarding pre-operative analgesia, as well as alternative options for care and contact details for the hysteroscopy unit.

• Women should be made aware of other settings and modes of anaesthesia for hysteroscopy

29. In line with the RCOG green-top guidelines number 59, the Trust was required to make Miss N aware of other settings and modes of anaesthesia for hysteroscopy by providing a leaflet/information covering OPH and HP.

30. We have reviewed the leaflet provided to Miss N. We can see this provides advice about what type of pain to expect, and when to take pain relief. It also gives advice on stopping the procedure if it becomes too painful, and mentions the alternative, which is having the procedure under general anaesthesia

31. Our adviser explained Miss N’s age and the fact that she has never dilated by giving birth indicates she will tend to have a tightly closed cervix making it potentially more uncomfortable to have a hysteroscopy. We appreciate, for these reasons, Miss N’s hysteroscopy procedure might have been more uncomfortable, and we are sorry to hear about this experience.

32. Overall, we consider there are indications Trust acted in line with the RCOG green-top guideline 59 when it provided Miss N with the leaflet/information covering OPH and HP as this gave information and advice about what to expect and what her options were for pain relief.

33. We have not found any indication of failings by the Trust, and we will not take any further action on this matter.

Patient History

34. Miss N complains the consultant did not inform the nurses carrying out the hysteroscopy that she finds internal examinations traumatic.

35. Within the Trust response it said information was passed on to the nurses so that they could provide Miss N with support. The nurses who were involved in the procedure provided statements explaining they were made aware of Miss N’s past traumatic experience.

36. We have reviewed the medical records and nurses’ statements with our adviser. We consider the records provide an indication that the Trust shared relevant information with the nurses to make them aware of Miss N’s history, and that the procedure may be traumatic for her.

37. We consider this is in line with the GMC’s Good Medical Practice, which says clinicians should promptly share all relevant information about patients with others involved in their care as required (point 65a).

38. For this reason, we have not found any indication of failings by the Trust in relation to sharing this information, and we will not take any further action on this matter.

39. We hope we have clearly explained our view of what happened and why we consider the Trust acted in line with relevant guidelines. We appreciate the impact this experience has had on Miss N and wish her the best of health for the future.

1. We have carefully considered Miss N’s complaint about the Trust. We are sorry to hear how her mental wellbeing was affected following the care and treatment she received from the Trust in relation to her gynaecological symptoms.

2. Having looked at Miss N’s complaint, we have decided not to consider it any further. This is because we have not seen an indication anything went wrong. This means from the evidence we have considered it appears the Trust provided appropriate care and treatment to Miss N.

3. We understand why this complaint is important to Miss N and we will explain our decision in more detail below. We hope our explanation provides her with reassurance about how carefully we have considered her complaint before reaching our decision.