Dysmenorrhea is associated with a higher incidence of pain after diagnostic hysteroscopy or treatment

Purpose: The purpose of this study was to evaluate whether dysmenorrhea could predict the occurrence of pain perceived after diagnostic hysteroscopy or treatment.

Methods: 58 women undergoing diagnostic hysteroscopy or treatment were divided into two groups: patients with dysmenorrhea (Group A) and patients without dysmenorrhea (Group B). Patients underwent routine monitoring after the administration of 7.5 µg of sufentanil by intravenous injection. Propofol infusion was initiated by using a target-controlled infusion pump with concentration initially set at 2 µg/mL in order to maintain a bispectral index monitor (BIS) of 60 to 80. Remifentanil was administered as continuous infusion at 0.05 µg/kg per minute. The total dose of propofol and remifentanil utilized during the procedure was calculated.

Results: There were no differences in the characteristics of patients in either group. Multivariate analysis revealed that the presence of dysmenorrhea was significantly correlated with pain (P < 0.05) following the procedure.

Conclusion: Dysmenorrhea is associated with a higher incidence of pain after diagnostic hysteroscopy.

Dysmenorrhea; Diagnostic hysteroscopy; Pain

[1] Sutton C. Hysteroscopic surgery. Best Practice & Research: Clinical Obstetrics & Gynaecology. 2006; 20: 105-137.

[2] Giannella L, Mfuta K, Cerami LB, Boselli F. Does uterine position affect pain intensity during outpatient diagnostic hysteroscopy? Clinical and Experimental Obstetrics & Gynecology. 2019; 46: 787-791.

[3] Pellicano M, Guida M, Zullo F, Lavitola G, Cirillo D, Nappi C. Carbon dioxide versus normal saline as a uterine distension medium for diagnostic vaginoscopic hysteroscopy in infertile patients: a prospective, randomized, multicenter study. Fertility and Sterility. 2003; 79: 418-421.

[4] Rullo S, Sorrenti G, Marziali M, Ermini B, Sesti F, Piccione E. Office hysteroscopy: comparison of 2.7- and 4-mm hysteroscopes for acceptability, feasibility and diagnostic accuracy. The Journal of Reproductive Medicine. 2005; 50: 45-48.

[5] Floris S, Piras B, Orrù M, Silvetti E, Tusconi A, Melis F, et al. Efficacy of intravenous tramadol treatment for reducing pain during office diagnostic hysteroscopy. Fertility and Sterility. 2007; 87: 147-151.

[6] Unfried G, Wieser F, Albrecht A, Kaider A, Nagele F. Flexible versus rigid endoscopes for outpatient hysteroscopy: a prospective randomized clinical trial. Human Reproduction. 2001; 16: 168-171.

[7] Garbin O, Kutnahorsky R, Göllner JL, Vayssiere C. Vaginoscopic versus conventional approaches to outpatient diagnostic hysteroscopy: a two-centre randomized prospective study. Human Reproduction (Oxford, England). 2007; 21: 2996-3000.

[8] El-Mazny A, Abou-Salem N. A double-blind randomized controlled trial of vaginal misoprostol for cervical priming before outpatient hysteroscopy. Fertility and Sterility. 2011; 96: 962-965.

[9] de Carvalho Schettini JA, Ramos de Amorim MM, Ribeiro Costa AA, Albuquerque Neto LC. Pain evaluation in outpatients undergoing diagnostic anesthesia-free hysteroscopy in a teaching hospital: a cohort study. Journal of Minimally Invasive Gynecology. 2007; 14: 729-735.

[10] de Carvalho Schettini JA, Ramos de Amorim MM, Ribeiro Costa AA, Albuquerque Neto LC. Pain evaluation in outpatients undergoing diagnostic anesthesia-free hysteroscopy in a teaching hospital: a cohort study. Journal of Minimally Invasive Gynecology. 2007; 14: 729-735.

[11] de Freitas Fonseca M, Sessa FV, Resende JAD, Guerra CGS, Andrade CM, Crispi CP. Identifying predictors of unacceptable pain at office hysteroscopy. Journal of Minimally Invasive Gynecology. 2014; 21: 586-591.

[12] Chudnoff S, Einstein M, Levie M. Paracervical block efficacy in office hysteroscopic sterilization: a randomized controlled trial. Obstetrics and Gynecology. 2010; 115: 26-34.

[13] Hassan L, Gannon MJ. Anaesthesia and analgesia for ambulatory hysteroscopic surgery. Best Practice & Research: Clinical Obstetrics & Gynaecology. 2006; 19: 681-691.

[14] Kapila A, Glass PS, Jacobs JR, Muir KT, Hermann DJ, Shiraishi M, et al. Measured context-sensitive half-times of remifentanil and alfentanil. Anesthesiology. 1995; 83: 968-975.

[15] Dilger JA, Sprung J, Maurer W, Tetzlaff J. Remifentanil provides better analgesia than alfentanil during breast biopsy surgery under monitored anesthesia care. Canadian Journal of Anesthesia. 2004; 51: 20-24.

[16] de Carvalho Schettini JA, Ramos de Amorim MM, Ribeiro Costa AA, Albuquerque Neto LC. Pain evaluation in outpatients undergoing diagnostic anesthesia-free hysteroscopy in a teaching hospital: a cohort study. Journal of Minimally Invasive Gynecology. 2007; 14: 729-735.

[17] Rosow CE. An overview of remifentanil. Anesthesia & Analgesia. 1999; 89: 1.

[18] Servin F, Desmonts JM, Watkins WD. Remifentanil as an analgesic adjunct in local/regional anesthesia and in monitored anesthesia care. Anesthesia & Analgesia. 1999; 89: 28.

[19] Gold M, Watkins W Sung Y, Yarmush J, Chung F, Uy N, et al. Remifentanil versus remifentanil/midazolam for ambulatory surgery during monitored anesthesia care. Anesthesiology. 1997; 87: 51-57.