Comparison of patients' reported pain following office hysteroscopy with and without endometrial biopsy: a prospective study.

Abstract

When performing office based gynecologic procedures, one must provide patients with appropriate counseling on anticipated pain prior to the procedure. The goal of this study was to investigate whether there is any difference in patients' pain perception when office hysteroscopy (OH) is performed alone compared with when it is performed with endometrial biopsy (EMB) for various gynecologic indications. A prospective study was performed of patients undergoing office hysteroscopy alone or in combination with endometrial biopsy between October 2015 and February 2017. Procedures were performed using standard gynecologic techniques. Patients described their post procedural pain using the visual analogue scale from 0-10 and data was compared between groups using SPSS version 24. Group 1 had OH alone (N.=243) and group 2 had OH combined with EMB (N.=80). Patients who underwent both procedures had significantly higher reported median (range) pain scores than those undergoing OH alone (7 [0-10]. vs. 5 [0-10], P=0.004). The patients in-group 2 were significantly older than those in group 1 (42.6±7.6 vs. 36.6±6.5, P<0.0001). The patients in group 2 had higher gravidity (2 vs. 1, P=0.04), were more likely to have a tenaculum used during the procedure (36.3% vs. 21.4%, P=0.01) and were more likely to be diagnosed with uterine fibroids (73% vs. 31%, P<0.0001). After controlling for patients age, gravidity, tenaculum use and diagnosis of fibroids using a multivariable regression model, patients undergoing OH with EMB had a 0.51-unit pain score greater than those that had OH alone; however, this difference was not statistically significant (95% CI: -0.32, 1.33 P=0.23). Patients undergoing both OH and EMB appear to report similar pain scores as those undergoing OH alone after controlling for confounding variables. The presence of fibroids was found to contribute to higher reported pain in the patients having OH in combination with EMB.