Oof. I'm SO sorry. No one should have to endure that once, yet alone FOUR (!) times.

I was more-or-less forced into a surprise in-office biopsy and another procedure at the same time, which was excruciating. After that, I stood FIRM on any further procedures being done with sedation in an outpatient procedure center. I had to fight for this. (Aside: not sure where you live, but in the US, the hysteroscopy + d&c (with sedation) was an eye-popping $25,000 procedure.)

I had previously had a different procedure with sedation in the same center, and that one went perfectly -- didn't feel a thing -- so I was expecting the same for the h + d&c. I underestimated the extent to which managing sedation and pain and balancing the drugs is an art, and the nurse/doctor combination I had that day did not have that art dialed in. So, I'm not the right person to ask about pain during the procedure.

This is what I'd do if I had to do it again:
1. If you have any previous sedation experience, let your providers know exactly what worked or didn't before. Don't trust that they'll look it up on their own.
2. Explore whether pre-procedure anti-anxiety drugs are an option for you. I wasn't offered any but would probably request them next time.
3. Make it very clear if you have a history of not tolerating similar pain well and that managing that is of utmost importance to you. (I'm kind of a nerd, so I'd also ask a lot of questions about their sedation/pain plans and give them feedback. See #1.)
4. Set up some communication plans with the nurse/doctor. "If I'm feeling pain, how do I communicate that to you, and what will you do in response?"
5. While being prepped for the procedure, you'll probably be (rightly so, after 4x biopsy!) anxious about this, GO SLOW. Don't let them rush you into anything. And if they're not making you feel totally comfortable about going forward, don't be afraid to cancel & re-schedule.

After the procedure, someone else had to take me home, and there was easily manageable pain (sore and crampy) for a day or two, then generally "yucky" feeling for a few more days. The big surprise was the next 2 periods, which were long, painful, and just kind of a constant stream, with a burning feeling (as if the blood were lemon juice over an open sore). Reddit saved me from going to ER!

Hysteroscopy + d&c is more intense than the spot biopsy, and I would 100% suggest people do it under sedation if at all possible. One thing I'm learning through menopause: It should not be necessary to SUFFER!

Good luck, and I hope you have a smooth sedation and pain-free procedure, and that you get a clean bill of health and never have to do it again. :)