Feasibility and pain control in outpatient hysteroscopy in postmenopausal women: A randomized trial

Giorgio Giorda, Carlo Scarabelli, Silvia Franceschi, Elio Campagnutta

Research output: Contribution to journalArticlepeer-review


Background. Three methods of diagnostic hysteroscopy have been tested for both women's compliance and feasibility of procedures in postmenopause. Methods. Three hundred and sixty-two postmenopausal women were enrolled in a three-arm study: 5 mm diagnostic sheath (Group 1, 119 women), 5 mm sheath with paracervical block (Group 2, 121 women), and 3.5 mm sheath (Group 3, 121 women). CO2 was the distention medium. Both feasibility of hysteroscopy (procedures failed due to stenosis or incomplete distention of cavity) and discomfort of women have been recorded. Pain perception has been measured on a visual numerical rating scale. Statistical analysis was performed by t-test for unpaired samples and chi-square test. Results. Paracervical block was per se painful in 18.2% and bleeding from injection site occurred in 38.8%. Hysteroscopy failure due to stenosis occurred in 9%, 10% and 0.4% of the three groups respectively (p <0.01). Intolerable pain was reported by 17% of women in Group 1, 6% in Group 2 (p <0.05) and in none of Group 3 (p <0.01). Pain score improved from Group 1 to Group 3 (p <0.01). Hysteroscopy was incomplete because of gas leakage in 1.7% of both Group 1 and 2 and in 13.2% of Group 3 (p <0.01). Conclusions. Pain perception in postmenopausal women was reduced when paracervical block was used, but discomfort was even less with the narrow sheath hysteroscope. The narrow sheath will expose to a high percentage of inconclusive procedures but it can be overcome by changing to the large sheath hysteroscope without affecting patient pain perception.

Original languageEnglish
Pages (from-to)593-597
Number of pages5
JournalActa Obstetricia et Gynecologica Scandinavica
Issue number7
Publication statusPublished - 2000


  • Narrow/large sheath hysteroscopes
  • Outpatient hysteroscopy
  • Pain control
  • Paracervical block
  • Postmenopausal women

ASJC Scopus subject areas

  • Obstetrics and Gynaecology


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