Feasibility and pain control in outpatient hysteroscopy in postmenopausal women: a randomized trial

Background. Three methods of diagnostic hysteroscopy have been tested for b oth women's compliance and feasibility of procedures in postmenopause. Methods. Three hundred and sixty-two postmenopausal women were enrolled in a three-arm study: 5 mm diagnostic sheath (Group 1, 119 women), 5 mm sheath with paracervical block (Group 2, 121 women), and 3.5 mm sheath (Group 3, 121 women). CO2 was the distention medium. Both feasibility of hysteroscopy (procedures failed due to stenosis or incomplete distention of cavity) and discomfort of women have been recorded. Pain perception has been measured on a visual numerical rating scale. Statistical analysis was performed by t -test for unpaired samples and chi-square test. Results. Paracervical block was pet se painful in 18.2% and bleeding from i njection site occurred in 38.8%. Hysteroscopy failure due to stenosis occur red in 9%, 10% and 0.4% of the three groups respectively (p<0.01). Intolera ble pain was reported by 17% of women in Group 1, 6% in Group 2 (p<0.05) an d in none of Group 3 (p<0.01). Pain score improved from Group 1 to Group 3 (p<0.01). Hysteroscopy was incomplete because of gas leakage in 1.7% of bot h Group 1 and 2 and in 13.2% of Group 3 (p<0.01). Conclusions. Pain perception in postmenopausal women was reduced when parac ervical block was used, but discomfort was even less with the narrow sheath hysteroscope. The narrow sheath will expose to a high percentage of inconc lusive procedures but it can be overcome by changing to the large sheath hy steroscope without affecting patient pain perception.