Abstract

Objective: Outpatient hysteroscopy (OPH) is increasingly used as the first line investigation for perimenopausal and postmenopausal women with abnormal uterine bleeding. With high success and good pathology detection rates it has the advantage of allowing investigation and management of patients within a one-stop clinic set-up, resulting in high patient acceptability. Failure rates are low, however the main limitation is patient intolerance secondary to pain. Difficulties are thought to be for encountered in nulliparous or postmenopausal women though the evidence is sparse. The aim of this study was to assess which patient factors have an impact on the success of OPH. Design: Prospective observational study Material and methods: The study was carried out from September 2012 to March 2013 in the outpatient hysteroscopy clinic at John Radcliffe Hospital, Oxford. All 96 patients in this series had their OPH performed by the same operator, using only a complete vaginoscopic approach. We used binary logistic regression to analyse which factors had an effect. Results: No significant correlation was found between age and menopausal status. Our study suggested that parity by itself is not predictive but it did find a statistically significant link between previous mode vaginal mode of delivery and successful OPH (p-value=0.001). Conclusions: This paper enhances our understanding of relevant patient factors, which will be useful in facilitating more patient specific counselling. It should also ideally encourage further studies into strategies to improve the success rate of this invaluable diagnostic and therapeutic modality.

Highlights

  • Outpatient diagnostic hysteroscopy is increasingly used as the first line investigation for perimenopausal women with abnormal uterine bleeding [1,2].It has a high success rate and a good pathology detection rate, with little morbidity [3,4,5]

  • Our study suggested that parity by itself is not predictive but it did find a statistically significant link between previous mode vaginal mode of delivery and successful Outpatient hysteroscopy (OPH) (p-value=0.001)

  • This paper enhances our understanding of relevant patient factors, which will be useful in facilitating more patient specific counselling

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Summary

Introduction

Outpatient diagnostic hysteroscopy is increasingly used as the first line investigation for perimenopausal women with abnormal uterine bleeding [1,2] It has a high success rate and a good pathology detection rate, with little morbidity [3,4,5]. It has the advantage of allowing investigation and management of patients within a one-stop clinic set-up and has high patient acceptability and satisfaction. Difficulties are thought to be encountered if patients are nulliparous or postmenopausal though the evidence for this is sparse [8]

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