Hysteroscopy, endometrial biopsy order has no effect on pain

(HealthDay)—The order of successive office hysteroscopy and endometrial biopsy for evaluation of abnormal uterine bleeding does not impact the global pain perception or time required, according to a study published online Aug. 4 in Obstetrics & Gynecology.

Papri Sarkar, M.D., from the University of South Florida in Tampa, and colleagues evaluated the effect of order of procedures—hysteroscopy first (40 subjects) or endometrial biopsy first (38 subjects)—on patients' pain scores.

The researchers observed no difference in global pain perception (P = 0.57) between the groups. The groups were also similar with respect to procedure duration (P = 0.32) and endometrial sample adequacy (78.9 versus 75.7 percent; P = 0.74). For patients with hysteroscopy first, there was better endometrial visualization (P < 0.001) based on the hysteroscopic images: excellent (50 percent, versus 7.9 percent in endometrial biopsy first), good (20 versus 34.2 percent), and fair (22.5 versus 44.7 percent). Patients with endometrial biopsy first required fewer endometrial biopsy attempts to obtain adequate tissue sample (two versus one; P < 0.001).

"[For] patients having successive office hysteroscopy and endometrial biopsy for evaluation of abnormal uterine bleeding, the global pain perception and time required are independent of the order in which procedures are performed," the authors write. "Performing hysteroscopy first ensures better image, whereas biopsy first yields adequate tissue sample with fewer attempts."

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