OFFICE HYSTEROSCOPY AND PAIN: OUR

EXPERIENCE

Espejo Catena, M.R.*Martínez Payá, M.J.

Cruz Simón, J.L.Rubio Valverde, A.

Ramos Sanvalero, A.Naranjo de la Puerta, F.G.

Hospital de La Ribera. Alzira. Valencia. Spain

STUDY OBJECTIVE

To evaluate the level of pelvic pain in outpatient diagnostic hysteroscopy and the influence of menopause, nulliparity or the menstrual cycle phase.

MATERIAL AND METHODS

Prospective study, performed from January to June, 2004 246 patients referred for diagnostic office hysteroscopy Technical procedure performed by a means of a 4 mm traditional optic Hamou I Storz with a 5 mm thick outer diagnostic sheath Level of pain rated according to a 0-10 visual analogue scale (0= no pain; 1-3=mild pain; 4-7= moderate pain; 8-10= severe pain)

MATERIAL AND METHODS

Patient characteristics

Mean age (years) 50.5+ 11.6 Nulliparous (%) 18.7% Menopause (%) 48.8% Ages from menopause (years) 9.9+8.7 Proliferative phase (%) 33.3% Secretory phase (%) 66.7% Pharmacological preparation 24%

MATERIAL AND METHODS

Hysteroscopy indications

64%7%

13%

14% 2%

Ultrasound indications

Infertility

Abnormal uterinebleeding

Post-menopausalbleeding

Miscellaneousindications

MATERIAL AND METHODS

Hamou I hysteroscope

MATERIAL AND METHODS

Visual analogue scale

MATERIAL AND METHODS

STATISTICAL ANALYSIS Student’s t test X2-test p< 0.05 considered statistically

significant.

RESULTS

The mean+SD pain score was 4.5+2.9.

Mean SD T Student Menopause 4.6 2.9 No menopause 4.3 3.0

p=0.497

Follicular phase 4.5 3.1 Secretory phase 4.2 2.9

p=0.573

Nulliparous 5.2 3.1 Multiparous 4.2 2.9

p=0.037

RESULTS

Pelvic pain divided into four classes according to the VAS. A comparison between post menopausal and pre menopausal women (X2 p=0.742)

0

5

10

15

20

25

30

35

%value

No pain Mild Moderate Severe

Post menopausal

Pre menopausal

RESULTS

Pelvic pain divided into four classes according to the VAS. A comparison between multiparous and nulliparous women (X2 p=0.287)

0

5

10

15

20

25

30

35

40

% value

No pain Mild Moderate Severe

Multiparous

Nulliparous

CONCLUSION

The level of pain experienced by our patients during office hysteroscopy

was mild-moderate with no differences between the groups studied excepting nulliparous

women

M.R. Espejo-Catena, M.D.Department of Obstetrics and Gynaecology