title: Is pain better tolerated with mini-hysteroscopy than with conventional device? A systematic review and meta-analysis : hysteroscopy scope size and pain.
abstract: BACKGROUND
  Hysteroscopy is an indispensable approach in gynecology. Miniaturization may reduce pain allowing office procedures without anesthesia.
  
  
  OBJECTIVE
  Our main objective is to determine if modifications in scope diameters have made office hysteroscopy less painful.
  
  
  METHODS
  Studies were sought with key words "hysteroscopy" and "pain" from available online sources. Time frame was from 2000 onward. Thirty-three articles were retrieved for detailed analysis.
  
  
  METHODS
  Prospective randomized trials, studying pain as main outcome in office hysteroscopy expressed in means, confidence intervals and SD, comparing office mini-hysteroscopy to conventional hysteroscopy. Studies or arms within a study where conscientious sedation, anesthesia or non-steroidal drugs were used were excluded.
  
  
  METHODS
  We analyzed data from eight studies (seven RCT) comparing mini-hysteroscopy with conventional scopes, involving a total of twenty-three hundred and twenty-two participants, of which nineteen hundred and eighty-six completed the intervention.
  
  
  RESULTS
  A meta-analysis revealed a significant reduction pain score (MD: -3.64; 95 % CI -5.16 to -2.12; test for overall effect p < 0.00001) and available data support miniaturization decreases pain in outpatient hysteroscopy.
  
  
  CONCLUSIONS
  Pain in office hysteroscopy is lower with mini-hysteroscopes.
authors.affiliation: Department of Obstetrics and Gynecology, Hospital Centre Tondela-Viseu, Avda. Rei D.Duarte, 3504-509, Viseu, Portugal. antoniosantospaulo@sapo.pt.|Health Sciences Department, University of Aveiro, Aveiro, Portugal. antoniosantospaulo@sapo.pt.
authors.forename: Antonio Augusto Santos
authors.initials: AA
authors.lastname: Paulo
authors.affiliation: Department of Obstetrics and Gynecology, Hospital Centre Tondela-Viseu, Avda. Rei D.Duarte, 3504-509, Viseu, Portugal.
authors.forename: Maria Helena Ruivo
authors.initials: MH
authors.lastname: Solheiro
authors.affiliation: Farmacia Avenida, Mangualde, Portugal.
authors.forename: Carolina Oliveira Santos
authors.initials: CO
authors.lastname: Paulo
mesh_terms: D005260:Female; D006176:Gynecology; D006801:Humans; D020702:Hysteroscopes; D015907:Hysteroscopy / Q000379:methods*; D010146:Pain; D010147:Pain Measurement; D011247:Pregnancy
keywords: Hysteroscopy; Pain; Scope size