8182 Does Menopausal Status Impact Pain Perception during in-Office Hysteroscopy? Findings from a Single-Center Study

Abstract

<h3>Study Objective</h3> Hysteroscopy is considered gold standard for investigation of intrauterine pathologies. When performed in-office, patients forego the use of anesthesia and other risks associated with operating room procedures. However, fear of pain during an in-office procedure remains a deterrent factor. Previous studies have suggested that menopause is associated with increased pain during in-office hysteroscopy. The goal of our study is to evaluate the impact of menopausal status on perceived pain level during in-office hysteroscopy at our institution. <h3>Design</h3> We identified women who underwent in-office hysteroscopy using the vaginoscopy "no touch" technique at two university-affiliated clinics at our academic institution. Menopause was defined as 12 months of amenorrhea in the absence of other biological or physiological causes. At the conclusion of the procedure, perceived pain level during the procedure was self-reported on a scale from 0 to 10. <h3>Setting</h3> Hysteroscopies were performed in office procedural rooms equipped with gynecologic beds with stirrups. Patients were positioned in dorsal lithotomy position. <h3>Patients or Participants</h3> A total of 80 women were included, among which 31 patients (38.8%) were postmenopausal and 49 patients (61.3%) were premenopausal. <h3>Interventions</h3> Hysteroscopies were performed without anesthesia, using a rigid 5 mm diagnostic hysteroscope with a 30o optic (Bettocchi KARL STORZ) and normal saline as distention media at gravity. <h3>Measurements and Main Results</h3> Statistical analysis was performed via independent-sample t-test with significance set at 0.05. Average pain level was 2.45 in postmenopausal patients and 2.22 in premenopausal patients. Postmenopausal status was not a statistically significant risk factor for worse pain perception during in-office hysteroscopy (p = 0.67). <h3>Conclusion</h3> Although previous studies have described a correlation between menopausal status and increased severity of pain during in-office hysteroscopy, our study did not reveal similar results. Further studies are necessary to identify risk factors that influence the pain experienced by patients during in-office hysteroscopy to better guide gynecologists when planning diagnostic approaches to intrauterine pathologies.