Outpatient Hysteroscopy in Management of Peri & Postmenopausal Women

Hysteroscopy is the gold standard for the assessment of uterine cavity in cases of ab-normal uterine bleeding, infertility, recurrent spontaneous pregnancy losses and other suspicious pathologies involving the uterine cavity. Outpatient also known as office or ambulatory hysteroscopy makes the procedure more acceptable for patients and it can also be used as a treatment modality in submucosal myomas, polyps, retained products, and removal of lost intrauterine devices. These indications are commonly seen amongst peri and post-menopausal women.
Current study was aimed at comparing the level of pain and discomfort experienced by the patients and to investigate the factors contributing towards that pain and the hysteroscopic outcomes of postmenopausal and perimenopausal women undergoing hysteroscopy in the outpatient hysteroscopy clinic at the Colombo South Teaching Hospital. Another objective was to identify the incidence of post-menopausal and heavy menstrual bleeding. Further-more, this study was conducted to investigate the usage of speculum during hysteroscopy and to identify the incidence of usage of speculum for above mentioned two women groups. This study also aimed to compare the level of pain and discomfort experienced while obtaining biopsy with the age of the women.
67.9% of the perimenopausal women had a pain score less than 2 and more than 60.7% of postmenopausal women had a pain score less than 2 and hence majority were willing to recommend the procedure to other people. There was no correlation of pain with past obstetric history or parity. Endometrial polyps were the most common abnormal outcome among perimenopausal group while it was atrophic endometrium among postmenopausal group. Outpatient hysteroscopy is well tolerated and accepted among both perimenopausal and postmenopausal women in local setting.