Introduction Office hysteroscopy provides great predictive value for multiple patients categorized as having infertility, abnormal uterine bleeding (AUB), or missed intra uterine contraceptive device (IUCD); however, pain during procedure is still a hindering problem. Multiple studies were done, but still no clear evidence-based data have been settled. Aim To compare intracervical injection of mepivacaine hydrochloride versus intramuscular injection of NSAIDs before hysteroscopy procedure in office hysteroscopy. Patients and methods This was a single-blind randomized comparative study. Both sample size and randomization were done by a computer program. Patients were classified into two groups: group 1 was subjected to intracervical injection of 5 ml of mepivacaine hydrochloride at position 4 and 8 o’ clock of the vaginal portion of the cervix, at least 15 min before procedure was done, and group 2 received NSAID intramuscular injection 15 min before the procedure. Hysteroscopy was done, and if any abnormality was detected, an intervention was done. A descriptive scale of pain was used, classified as mild, moderate, or severe (assigned by interruption of the procedures). Results There was a statistically significant difference between both groups in the three pain grades. However, there was no statistically significant difference between both groups for vomiting. In spite of number of operative cases being low in both groups, the number in study group was double that of control. However, pain during cervical handling and bleeding were two remarkable annoying factors owing to lengthy procedures and occasional considerable bleeding. Conclusion Intracervical injection of a local anesthetic is an effective method in reducing pain during hysteroscopy but time of procedure should be taken into consideration.