Evaluation of office hysteroscopy in pre-menopausal and post-menopausal women: experience with 2,255 cases

Abstract

To assess whether outpatient hysteroscopy without anesthesia confers any advantages over the traditional technique, we conducted a retrospective study. Participants consisted of 2,255 women who were referred to outpatient hysteroscopy at Alexandra Hospital from October 1991 to July 2007. The procedure was done without general or any other form of anesthesia; only in some cases was local anesthetic used. Diagnostic hysteroscopy was performed by means of a 2.7-mm hysteroscope and a 3.2-mm diagnostic sheath. The mean age was 36.37 years, 78.89% were nulliparous, and 94.01% were pre-menopausal. Hysteroscopy was successful in 98.40% of the participants. The morbidity ratio of the procedure was 0.13%. Cervical dilation was required in 10.15%. Local anesthesia was used in 7.36% of the participants. Indications included control of intrauterine cavity (36.49%), repeated failure of IVF infertility (27.45%), abnormal bleeding (4.1%), ultrasound indications (4.64%), amenorrhea (2.4%) oligomenorrhea (1.3%), monitoring of the endometrium because of tamoxifen therapy (1.46%), and a history of abortions (0.86%). Nulligravid women suffer significantly more often from endometrial atrophy and endometrial hyperplasia. The use of a 3.2-mm diameter hysteroscope proves that hysteroscopy without local anesthesia is a safe, well-tolerated method of assessing endometrial functional status in order to choose the most effective therapy.