A prospective evaluation of pain and acceptability during outpatient flexible hysteroscopy and endometrial biopsy

Objective To compare the pain of outpatient flexible hysteroscopy and endometrial sampling in women who have abnormal uterine bleeding. Design A prospective cohort study. Setting A minimal access gynaecological training unit within a district general hospital in north-east England. Subjects 100 women referred consecutively for assessment of abnormal uterine bleeding. Main outcome measures Pain experienced with hysteroscopy and endometrial biopsy, as assessed by visual analogue score, and patient acceptability assessed by questionnaire. Results Endometrial biopsy was found to be the most painful part of the assessment and was significantly more painful than either hysteroscopy or insertion of the speculum. (P < 0.0001). The overall success of outpatient hysteroscopy in this series was 93%. On an intention-to-treat basis, procedure acceptability was 92% and only 9% of women required additional oral analgesia following the procedures. Of the women, 51% found the experience of outpatient hysteroscopy less painful than a cervical smear. Conclusion Outpatient flexible hysteroscopy is a viable first-line investigation for abnormal uterine bleeding. Endometrial biopsy should be used selectively.