Hysteroscopic findings in women with menorrhagia.

STUDY OBJECTIVE: To describe the hysteroscopic findings in patients complaining of menorrhagia to establish any significant association between menorrhagia and benign/malignant intrauterine disorders. DESIGN: Prospective cohort study (Canadian Task Force classification II). SETTING: University La Sapienza, Rome, Italy. PATIENTS: One hundred eighteen premenopausal women undergoing office hysteroscopy for menorrhagia (group A) and 344 premenopausal patients undergoing office hysteroscopy for other indications (noncyclic abnormal uterine bleeding, infertility, ultrasonographic abnormalities, etc) (group B). INTERVENTIONS: Office hysteroscopy. MEASUREMENT AND MAIN RESULTS: Data on the prevalence of hysteroscopic findings (cervical polyps, endometrial polyps, submucous myomas, low-grade hyperplasia and high-grade hyperplasia/endometrial carcinoma) were compared between group A and group B. The total prevalence, as well as the prevalence of type 0 and type I myomas (totally or >50% intracavitary, respectively), and the mean number per patients with submucous myomas was significantly higher in group A compared with group B (p = .0001, p = .024, and p = .017, respectively). Multivariable logistic regression analysis showed a statistically significant association between age (odds ratio 4.15, 95% confidence interval 1.55-11.1 in the 40- to 49-year age group), presence of submucous myomas (odds ratio 2.76, 95% confidence interval 1.52-5.00), and menorrhagia. CONCLUSIONS: Menorrhagia seems to be associated with aging, the presence and number of submucous myomas, and with the degree of their intracavitary development.

Office hysteroscopy and compliance: mini-hysteroscopy versus traditional hysteroscopy in a randomized trial.

BACKGROUND: Diagnostic hysteroscopy has not yet been generally accepted as a well-tolerated office procedure. The aim of our study was to verify compliance, side-effects and haemodynamic variations when a mini-hysteroscope is used. METHODS: A prospective randomized trial on office hysteroscopy was performed by comparing the use of a traditional 5 mm hysteroscope (group A) and of a 3.3 mm mini-hysteroscope (group B). Two patient groups (A and B), each comprising 100 cases, were formed on the basis of a randomized computer-generated list. RESULTS: A marked reduction in the mean (+/- SD) pelvic pain score during office hysteroscopy was seen in group B (2.3 +/- 2.1) as compared with group A (4.6 +/- 2.2) (P < 0.0001, Mann-Whitney test). This result was also confirmed when using an alternative approach: four classes of pelvic pain at the visual analogue score (VAS). A significant reduction was observed in the incidence of moderate and severe pelvic pain in group B at the end of the examination (P = 0.001) and 5-10 min later (P < 0.05). CONCLUSIONS: The use of mini-hysteroscopes (3.3 mm with diagnostic sheath) lowers considerably the level of pelvic pain the patients feel: it is halved in comparison with traditional calibre hysteroscopes (2.3 +/- 2.1, on a 0-10 VAS). Furthermore the outpatient hysteroscopy failure rate is less than half (2%) with the mini-hysteroscope compared with the traditional 5 mm hysteroscope (5%). As for side-effects and haemodynamic parameters, no differences were observed except for an increase (P < 0.05) in bradycardia in group B. The advantage of this technique is self-evident, if the patients' compliance is taken into account: in many cases the introduction or withdrawal of the vaginal speculum was reported as the greatest discomfort.

Suppression of pelvic pain during hysteroscopy with a transcutaneous electrical nerve stimulation device.

OBJECTIVE: To evaluate the effectiveness of transcutaneous electrical nerve stimulation (TENS) as a pain control method during office hysteroscopy. DESIGN: A prospective, randomized study. SETTING: Centre for Minimally Invasive Surgery, Department of Gynecological Science and Perinatology, "La Sapienza" University, Rome, Italy. PATIENT(S): One hundred forty-two patients undergoing office hysteroscopy. INTERVENTION(S): Application of a TENS device on the patient's abdomen before and during office hysteroscopy. MAIN OUTCOME MEASURES: The level of pain experienced by the patients was assessed using a 10 cm visual analog scale; the side effects and changes in the hemodynamic parameters were evaluated. RESULT(S): The patients treated with TENS during hysteroscopy (group A, n = 71) were compared with a control group (group B, n = 71) on whom the TENS device was not used. The women in the TENS group experienced a significantly lower level of pain during hysteroscopy. No differences in side effects were observed between both group. CONCLUSION(S): TENS is a simple, efficient, and safe method of relieve pain during office hysteroscopy.

Pelvic pain, low blood pressure, and hemolysis after outpatient hysteroscopy in a patient with glucose-6-phosphate dehydrogenase deficiency.

OBJECTIVE: To report hemolytic crisis in a woman with glucose-6-phosphate dehydrogenase (G6PD) deficiency who underwent diagnostic hysteroscopy using endoscopic instruments sterilized in gluteraldehyde and phenol disinfectant. DESIGN: Case report. SETTING: Surgical unit of a university hospital. PATIENT(S): A 53 year-old woman with endometrial thickening on ultrasonography. INTERVENTION(S): Diagnostic hysteroscopy. MAIN OUTCOME MEASURES: Laboratory tests. RESULT(S): The patient experienced abdominal pain and acute hypotension 10 minutes after diagnostic hysteroscopy. We attributed this event to the exposure of her genital mucosa caused by the hysteroscopic chemical disinfectant. CONCLUSION(S): Chemical sterilization of endoscopes can cause clinical manifestations in people with G6PD deficiency, a common enzyme abnormality. The phenol content in some chemical disinfectants for endoscopic instruments can also cause hemolytic crisis.