OFFICE HYSTEROSCOPY AND PAIN: OUR EXPERIENCE Espejo Catena, M.R.* Martínez Payá, M.J. Cruz Simón, J.L. Rubio Valverde, A. Ramos Sanvalero, A. Naranjo de la Puerta, F.G. Hospital de La Ribera. Alzira. Valencia. Spain
OFFICE HYSTEROSCOPY AND PAIN: OUR
EXPERIENCE
Espejo Catena, M.R.*Martínez Payá, M.J.
Cruz Simón, J.L.Rubio Valverde, A.
Ramos Sanvalero, A.Naranjo de la Puerta, F.G.
Hospital de La Ribera. Alzira. Valencia. Spain
STUDY OBJECTIVE
To evaluate the level of pelvic pain in outpatient diagnostic hysteroscopy and the influence of menopause, nulliparity or the menstrual cycle phase.
MATERIAL AND METHODS
Prospective study, performed from January to June, 2004 246 patients referred for diagnostic office hysteroscopy Technical procedure performed by a means of a 4 mm traditional optic Hamou I Storz with a 5 mm thick outer diagnostic sheath Level of pain rated according to a 0-10 visual analogue scale (0= no pain; 1-3=mild pain; 4-7= moderate pain; 8-10= severe pain)
MATERIAL AND METHODS
Patient characteristics
Mean age (years) 50.5+ 11.6 Nulliparous (%) 18.7% Menopause (%) 48.8% Ages from menopause (years) 9.9+8.7 Proliferative phase (%) 33.3% Secretory phase (%) 66.7% Pharmacological preparation 24%
MATERIAL AND METHODS
Hysteroscopy indications
64%7%
13%
14% 2%
Ultrasound indications
Infertility
Abnormal uterinebleeding
Post-menopausalbleeding
Miscellaneousindications
MATERIAL AND METHODS
Hamou I hysteroscope
MATERIAL AND METHODS
Visual analogue scale
MATERIAL AND METHODS
STATISTICAL ANALYSIS Student’s t test X2-test p< 0.05 considered statistically
significant.
RESULTS
The mean+SD pain score was 4.5+2.9.
Mean SD T Student Menopause 4.6 2.9 No menopause 4.3 3.0
p=0.497
Follicular phase 4.5 3.1 Secretory phase 4.2 2.9
p=0.573
Nulliparous 5.2 3.1 Multiparous 4.2 2.9
p=0.037
RESULTS
Pelvic pain divided into four classes according to the VAS. A comparison between post menopausal and pre menopausal women (X2 p=0.742)
0
5
10
15
20
25
30
35
%value
No pain Mild Moderate Severe
Post menopausal
Pre menopausal
RESULTS
Pelvic pain divided into four classes according to the VAS. A comparison between multiparous and nulliparous women (X2 p=0.287)
0
5
10
15
20
25
30
35
40
% value
No pain Mild Moderate Severe
Multiparous
Nulliparous
CONCLUSION
The level of pain experienced by our patients during office hysteroscopy
was mild-moderate with no differences between the groups studied excepting nulliparous
women
M.R. Espejo-Catena, M.D.Department of Obstetrics and Gynaecology