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

Abstract

Background: Hysteroscopy is an indispensable approach in gynecology. Miniaturization may reduce pain allowing office procedures without anesthesia.

Objectives: Our main objective is to determine if modifications in scope diameters have made office hysteroscopy less painful.

Search strategy: 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.

Selection criteria: 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.

Data collection and analysis: 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.

Main results: 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.

Conclusions: Pain in office hysteroscopy is lower with mini-hysteroscopes.

Keywords: Hysteroscopy; Pain; Scope size.