Comparative analysis of pain outcomes in operative versus diagnostic hysteroscopy: the role of menopausal status

Year 2024, EARLY ONLINE, 1 - 7

Vahit Özkol , Teymur Bornaun

https://doi.org/10.18621/eurj.1523930

Abstract

Objectives: The study investigates the differential pain outcomes associated with operative and diagnostic hysteroscopy, with a focus on the influence of menopausal status on pain perception. This research aims to refine pain management strategies tailored to patient demographics in gynecological practices.

Methods: A total of 200 patients undergoing hysteroscopy were systematically evaluated. Pain intensity was assessed using the Visual Analog Scale (VAS). The study distinguished between operative and diagnostic procedures, with particular attention to the effect of menopausal status on pain scores. Compliance with CONSORT guidelines was ensured, and relevant clinical trial registration numbers were included.

Results: Pain scores did not significantly differ between operative and diagnostic hysteroscopies, suggesting that the invasiveness of the procedure might not directly correlate with pain perception. However, menopausal women reported significantly higher pain scores, indicating a possible increased sensitivity or decreased pain tolerance related to hormonal changes.

Conclusions: The results affirm that existing pain management protocols effectively mitigate discomfort across different hysteroscopic procedures. Nonetheless, the distinct pain profiles of menopausal women warrant the development of customized pain management strategies. Enhancing analgesic approaches for this subgroup could improve patient care and outcomes in gynecological settings.

Keywords

Hysteroscopy, pain perception, menopause, visual analog scale, patient outcomes, gynecological surgery

References

• 1. Aas-Eng MK, Langebrekke A, Hudelist G. Complications in operative hysteroscopy - is prevention possible? Acta Obstet Gynecol Scand. 2017;96(12):1399-1403. doi: 10.1111/aogs.13209.
• 2. Al-Fozan H, Firwana B, Al Kadri H, Hassan S, Tulandi T. Preoperative ripening of the cervix before operative hysteroscopy. Cochrane Database Syst Rev. 2015;2015(4):CD005998. doi: 10.1002/14651858.CD005998.pub2.
• 3. Almeida ZM, Pontes R, Costa Hde L. [Evaluation of pain in diagnostic hysteroscopy by vaginoscopy using normal saline at body temperature as distension medium: a randomized controlled trial]. Rev Bras Ginecol Obstet. 2008;30(1):25-30. doi: 10.1590/s0100-72032008000100005. [Article in Portuguese]
• 4. De Angelis C, Santoro G, Re ME, Nofroni I. Office hysteroscopy and compliance: mini-hysteroscopy versus traditional hysteroscopy in a randomized trial. Hum Reprod. 2003;18(11):2441-2445. doi: 10.1093/humrep/deg463.
• 5. Bosteels J, Weyers S, Kasius J, Broekmans FJ, Mol BW, D'Hooghe TM. Anti-adhesion therapy following operative hysteroscopy for treatment of female subfertility. Cochrane Database Syst Rev. 2015;(11):CD011110. doi: 10.1002/14651858.CD011110.pub2.
• 6. Centini G, Troia L, Lazzeri L, Petraglia F, Luisi S. Modern operative hysteroscopy. Minerva Ginecol. 2016;68(2):126-132.
• 7. Campo R, Molinas CR, Rombauts L, et al. Prospective multicentre randomized controlled trial to evaluate factors influencing the success rate of office diagnostic hysteroscopy. Hum Reprod. 2005;20(1):258-263. doi: 10.1093/humrep/deh559.
• 8. Carta G, Palermo P, Marinangeli F, et al. Waiting time and pain during office hysteroscopy. J Minim Invasive Gynecol. 2012;19(3):360-364. doi: 10.1016/j.jmig.2012.01.017.
• 9. Buzzaccarini G, Alonso Pacheco L, Vitagliano A, et al. Pain Management during Office Hysteroscopy: An Evidence-Based Approach. Medicina (Kaunas). 2022;58(8):1132. doi: 10.3390/medicina58081132.
• 10. Cicinelli E. Hysteroscopy without anesthesia: review of recent literature. J Minim Invasive Gynecol. 2010;17(6):703-708. doi: 10.1016/j.jmig.2010.07.003.
• 11. Clark TJ, Voit D, Gupta JK, Hyde C, Song F, Khan KS. Accuracy of hysteroscopy in the diagnosis of endometrial cancer and hyperplasia: a systematic quantitative review. JAMA. 20022;288(13):1610-1621. doi: 10.1001/jama.288.13.1610.
• 12. Cooper NA, Smith P, Khan KS, Clark TJ. Vaginoscopic approach to outpatient hysteroscopy: a systematic review of the effect on pain. BJOG. 2010;117(5):532-539. doi: 10.1111/j.1471-0528.2010.02503.x.
• 13. Daniilidis A, Pantelis A, Dinas K, et al. Indications of diagnostic hysteroscopy, a brief review of the literature. Gynecol Surg. 2012;9(1):23-28. doi: 10.1007/s10397-011-0695-3.
• 14. de Campos BF, Benetti-Pinto CL, Yela DA. Nurse support for pain and anxiety control in women undergoing diagnostic hysteroscopy: a randomized clinical trial. Menopause. 2023;30(9):927-932. doi: 10.1097/GME.0000000000002226.
• 15. de Carvalho Schettini JA, Ramos de Amorim MM, Ribeiro Costa AA, Albuquerque Neto LC. Pain evaluation in outpatients undergoing diagnostic anesthesia-free hysteroscopy in a teaching hospital: a cohort study. J Minim Invasive Gynecol. 2007;14(6):729-735. doi: 10.1016/j.jmig.2007.05.009.
• 16. De Silva PM, Stevenson H, Smith PP, Clark TJ. Pain and Operative Technologies Used in Office Hysteroscopy: A Systematic Review of Randomized Controlled Trials. J Minim Invasive Gynecol. 2021;28(10):1699-1711. doi: 10.1016/j.jmig.2021.05.018.
• 17. Donnez J, editor. Atlas of operative laparoscopy and hysteroscopy. CRC Press; 2007.
• 18. Emanuel MH. New developments in hysteroscopy. Best Pract Res Clin Obstet Gynaecol. 2013;27(3):421-429. doi: 10.1016/j.bpobgyn.2012.11.005.
• 19. Fouks Y, Kern G, Cohen A, et al. A virtual reality system for pain and anxiety management during outpatient hysteroscopy-A randomized control trial. Eur J Pain. 2022;26(3):600-609. doi: 10.1002/ejp.1882.
• 20. Genovese F, D’Urso G, Di Guardo F, et al. Failed diagnostic hysteroscopy: Analysis of 62 cases. Eur J Obstet Gynecol Reprod Biol. 2020;245:193-197. doi: 10.1016/j.ejogrb.2019.10.031.
• 21. Ghamry NK, Samy A, Abdelhakim AM, et al. Evaluation and ranking of different interventions for pain relief during outpatient hysteroscopy: A systematic review and network meta-analysis. J Obstet Gynaecol Res. 2020;46(6):807-827. doi: 10.1111/jog.14221.
• 22. Giorda G, Scarabelli C, Franceschi S, Campagnutta E. Feasibility and pain control in outpatient hysteroscopy in postmenopausal women: a randomized trial. Acta Obstet Gynecol Scand. 2000;79(7):593-597.
• 23. Guida M, Pellicano M, Zullo F, et al. Outpatient operative hysteroscopy with bipolar electrode: a prospective multicentre randomized study between local anaesthesia and conscious sedation. Hum Reprod. 2003;18(4):840-843. doi: 10.1093/humrep/deg075.
• 24. Guraslan H, Senturk MB, Dogan K, et al. Diagnostic office hysteroscopy; why is it still painful procedure despite the surgical experience and mini-hysteroscope? J Obstet Gynaecol Res. 2022;48(6):1418-1425. doi: 10.1111/jog.15219.
• 25. Harrison R, Kuteesa W, Kapila A, et al. Pain-free day surgery? Evaluating pain and pain assessment during hysteroscopy. Br J Anaesth. 2020;125(6):e468-e470. doi: 10.1016/j.bja.2020.08.015.