Two Week Rule (Rapid Access) Gynaecology Clinic
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What is the gynaecology two week referral (TWR) clinic?
This is a clinic where you will be seen within two weeks of being referred. You will normally be referred to us by a GP or sometimes by another doctor at St George’s.
Who is the clinic for?
The clinic is for women with symptoms needing urgent assessment and investigation, such as:
- abnormal skin changes on the outside of the vagina
- abnormal appearance of the cervix or severely abnormal cervical smear test
- prolonged periods or bleeding in between periods
- bleeding after the menopause
- abdominal swelling or feeling a lump in the abdomen.
Where do I need to go?
Lanesborough Wing, St George’s Hospital.
Your clinic letter will advise you of the exact location for your appointment.
What will happen at the clinic?
We aim to see you and to do any investigations you need in one visit. Sometimes this is not possible and you may have to come back.
There is more than one TWR clinic and we will use the information in your referral letter to decide which clinic is right for you.
- If you have abnormal skin changes on the outside of the vagina, or a suspected abnormality of the cervix, you will come to the colposcopy . A colposcopy is where we take close up pictures of your skin. The doctor may put a solution on your skin before the pictures are taken. The test should not be painful. Sometimes samples of the cervix or vaginal skin (biopsies) will also need to be taken and you may have a local anaesthetic to numb the area first.
- If you have abnormal periods or bleeding after the menopause, you will come to a clinic where we will look at your womb and womb lining.
This can be done by having an ultrasound scan OR an outpatient hysteroscopy at this clinic.
An ultrasound scan is done by passing a small probe into your vagina, to get better images than scanning through your stomach. It will only take a few minutes and shouldn’t be painful. Sometimes samples of your womb lining will also need to be taken. A speculum will be put inside your vagina (like during a smear test) and a fine plastic tube will be passed into your womb to take a sample. This should take about one minute. It may cause some pain (like period pain) but this should only last a few minutes.
An outpatient hysteroscopy is when a very thin camera is passed through your vagina and into your womb. The camera has warm, sterile fluid (saline) coming out of it which will feel wet during the test. The test may cause some discomfort (like period pain) but this should only last a few minutes. You should feel normal when you leave the clinic and be able to carry on with daily activities. Information about Myosure can be found here
We advise women to take some simple pain relief (for example paracetamol or ibuprofen) 30 – 60 minutes before the appointment.
- If you have abdominal swelling or can feel a lump in your stomach, you will come to a clinic where you will have an ultrasound scan. This may be done by passing a small probe into your vagina, or it may be done through your stomach, or it may be done both ways. Blood tests may also be taken at the same visit. Sometimes, if we can’t get a good image with an ultrasound scan, you may need another type of scanning test. Any new scans may need to be booked for another date which will be soon after your first appointment.
How long will I be at the clinic?
Your appointment will probably take around 30 minutes. Clinic staff will be able to give you more information about how long things will take when you come in for your appointment.
What happens next?
The doctor should discuss the results of any scanning tests with you before you leave the clinic and let you know if you need treatment. Treatment may be given on the same day or may need to be given afterwards by your GP. If you have had blood tests or biopsies, we should usually let you and your GP know the results in two or three weeks.
We will also send a report about your clinic visit to you and your GP. Most women should feel normal when they leave the clinic and will be able to carry with daily activities.
If you need to re-arrange your appointment, please call our Two week ruke booking service on 020 8725 1111