title: Misoprostol versus uterine straightening by bladder distension for pain relief in postmenopausal patients undergoing diagnostic office hysteroscopy: a randomised controlled non-inferiority trial.
abstract: OBJECTIVE
  To compare the effectiveness of misoprostol with uterine straightening by bladder distension in minimising the pain experienced by postmenopausal patients during diagnostic office hysteroscopy.
  
  
  METHODS
  Seventy-six postmenopausal patients were randomly allocated in a 1:1 ratio to the misoprostol group or to the bladder distension group. Patients in the misoprostol group were instructed to insert two misoprostol tablets (400μg) in the vagina 12h before office hysteroscopy. Patients in the bladder distension group were instructed to drink one litre of water and to avoid urination during a period of 2h before office hysteroscopy. The severity of pain experienced by the patients during and at 30min after the procedure was measured using a 100-mm visual analogue scale (VAS). The ease of passing the hysteroscope through the cervical canal was assessed by the hysteroscopists using a 100-mm VAS.
  
  
  RESULTS
  The passage of the hysteroscope through the cervical canal was easier in the misoprostol group [60.37±15.78 vs. 50.05±19.88, p=0.015]. The mean VAS pain score during the procedure was significantly lower in the misoprostol group [39.47±13.96 vs. 50.18±15.44, p=0.002]. The mean VAS pain score 30min post-procedure was comparable between both groups [11.82±3.71 vs. 12.61±4.06, p=0.379].
  
  
  CONCLUSIONS
  Vaginal misoprostol is more effective than uterine straightening by bladder distension in relieving the pain experienced by postmenopausal patients during office hysteroscopy.
  
  
  BACKGROUND
  Clinicaltrials.gov [NCT02328495]. https://clinicaltrials.gov/ct2/show/NCT02328495.
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt. Electronic address: umfrfouda@yahoo.com.
authors.forename: Usama M
authors.initials: UM
authors.lastname: Fouda
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt. Electronic address: dr.heshamelshaer@hotmail.com.
authors.forename: Hesham S
authors.initials: HS
authors.lastname: Elshaer
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt. Electronic address: kelsetohy@kasralainy.edu.eg.
authors.forename: Khaled A
authors.initials: KA
authors.lastname: Elsetohy
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt. Electronic address: mohamedyoussef1973@gmail.com.
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Youssef
mesh_terms: D000282:Administration, Intravaginal; D000368:Aged; D000698:Analgesia / Q000379:methods*; D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000009:adverse effects* / Q000379:methods; D008875:Middle Aged; D016595:Misoprostol / Q000627:therapeutic use*; D010120:Oxytocics / Q000627:therapeutic use*; D059408:Pain Management / Q000379:methods*; D010149:Postoperative Pain / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology / Q000628:therapy*; D017698:Postmenopause; D012720:Severity of Illness Index; D016896:Treatment Outcome; D001743:Urinary Bladder; D014599:Uterus
chemical_list: D010120:Oxytocics; D016595:Misoprostol
keywords: Bladder distension; Misoprostol; Office hysteroscopy; Pain; Uterine straightening