Misoprostol versus uterine straightening by bladder distension for pain relief in postmenopausal patients undergoing diagnostic office hysteroscopy: a randomised controlled non-inferiority trial

Objective: To compare the effectiveness of misoprostol with uterine straightening by bladder distension in minimising the pain experienced by postmenopausal patients during diagnostic office hysteroscopy. Study design: Seventy-six postmenopausal patients were randomly allocated in a 1:1 ratio to the misoprostol group or to the bladder distension group. Patients in the misoprostol group were instructed to insert two misoprostol tablets (400 mu g) in the vagina 12 h before office hysteroscopy. Patients in the bladder distension group were instructed to drink one litre of water and to avoid urination during a period of 2 h before office hysteroscopy. The severity of pain experienced by the patients during and at 30 min after the procedure was measured using a 100-mm visual analogue scale (VAS). The ease of passing the hysteroscope through the cervical canal was assessed by the hysteroscopists using a 100-mm VAS. Results: The passage of the hysteroscope through the cervical canal was easier in the misoprostol group [60.37 +/- 15.78 vs. 50.05 +/- 19.88, p = 0.015]. The mean VAS pain score during the procedure was significantly lower in the misoprostol group [39.47 +/- 13.96 vs. 50.18 +/- 15.44, p = 0.002]. The mean VAS pain score 30 min post-procedure was comparable between both groups [11.82 +/- 3.71 vs. 12.61 +/- 4.06, p = 0.379]. Conclusion: Vaginal misoprostol is more effective than uterine straightening by bladder distension in relieving the pain experienced by postmenopausal patients during office hysteroscopy. (C) 2016 Elsevier Ireland Ltd. All rights reserved.