Is pain better tolerated with mini-hysteroscopy than with conventional device? A systematic review and meta-analysis

Abstract

Hysteroscopy is an indispensable approach in gynecology. Miniaturization may reduce pain allowing office procedures without anesthesia. Our main objective is to determine if modifications in scope diameters have made office hysteroscopy less painful. Studies were sought with key words "hysteroscopy" and "pain" from available online sources. Time frame was from 2000 onward. Thirty-three articles were retrieved for detailed analysis. Prospective randomized trials, studying pain as main outcome in office hysteroscopy expressed in means, confidence intervals and SD, comparing office mini-hysteroscopy to conventional hysteroscopy. Studies or arms within a study where conscientious sedation, anesthesia or non-steroidal drugs were used were excluded. We analyzed data from eight studies (seven RCT) comparing mini-hysteroscopy with conventional scopes, involving a total of twenty-three hundred and twenty-two participants, of which nineteen hundred and eighty-six completed the intervention. A meta-analysis revealed a significant reduction pain score (MD: -3.64; 95% CI -5.16 to -2.12; test for overall effect p<0.00001) and available data support miniaturization decreases pain in outpatient hysteroscopy. Pain in office hysteroscopy is lower with mini-hysteroscopes.