IMR Press / CEOG / Volume 44 / Issue 4 / DOI: 10.12891/ceog3247.2017

Clinical and Experimental Obstetrics & Gynecology (CEOG) is published by IMR Press from Volume 46 Issue 1 (2019). Previous articles were published by another publisher on a subscription basis, and they are hosted by IMR Press on imrpress.com as a courtesy and upon agreement with S.O.G.

Open Access Original Research
Comparison of office hysteroscopy and dilatation & curettage regarding patient comfort, efficacy and quality of life in patients suffering from menorrhagia: prospective randomized study
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1 Zeynep Kamil, Zeynep Kamil Educational and Research Hospital Obstetric and Gynaecology Department, Istanbul, Turkey
2 Istanbul University, Istanbul Medical Faculty Department of Obstetrics and Gynecology, Istanbul, Turkey
3 Süleymaniye Training and Research Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey
4 Istanbul University, Istanbul School of Medicine, Department of Obstetrics and Gynecology, Istanbul, Turkey
Clin. Exp. Obstet. Gynecol. 2017, 44(4), 599–604; https://doi.org/10.12891/ceog3247.2017
Published: 10 August 2017
Abstract
Objective: Endometrial sampling is essential to exclude carcinoma and confirm the benign nature of abnormal uterine bleeding. Methods include endometrial biopsy, office hysteroscopy, and dilatation and curettage (D&C). The aim of this study was to evaluate the diagnostic efficacy of office hysteroscopy and D&C in patients suffering from menorrhagia, and to compare the tolerability and the outcome of the two procedures. Materials and Methods: Forty patients suffering from menorrhagia and willing to participate were included in this prospective study and randomized to office hysteroscopy (n=20) and D&C groups (n=20). Quality of life was evaluated using the Menorrhagia- Impact-Questionnaire (MIQ) before and three months after the procedure. Visual analogue scale (VAS) was used to evaluate the pain felt during the procedure. Primary outcomes were patient-reported improvement in menorrhagia and effect on quality of life. Secondary outcomes were objective improvement in the complete-blood-count, tolerability and complications of the procedure, and pathology results. Results: There was a significant difference in the mean VAS results for pain in the office hysteroscopy and D&C groups (p = 0.00). In the MIQ domains, there was a significant improvement in the perception of blood loss in both groups, which was more significant in the office hysteroscopy group when compared to the D&C group. There was a significant improvement in the limitations in work inside/outside home, limitations in physical and social activities in the office hysteroscopy group, and the differences were significant when compared with the D&C group. In the assessment of change in blood loss, the difference between the two groups after the procedure was significant. Twenty patients (100%) in the office hysteroscopy group and 19 patients (95%) in the D&C group suggested that this was a remarkable and important change. Two patients in each group had insufficient tissue for diagnosis. Eight patients in the office hysteroscopy group whereas three patients in the D&C group had endometrial polyps. In one patient in the D&C group, pathology result was submucous leiomyoma. Conclusion: There was a significant patient-reported improvement in menorrhagia and positive effect on quality of life after office hysteroscopy when compared to D&C. Pain was significantly less in the office hysteroscopy when compared to D&C even in patients with lower number of deliveries. Office hysteroscopy was superior to D&C in the diagnosis of intracavitary pathologies.
Keywords
Menorrhagia
Office hysteroscopy
Dilatation and curettage
Quality of life
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