Comparison of office hysteroscopy and dilatation & curettage regarding patient comfort, efficacy and quality of life in patients suffering from menorrhagia: prospective randomized study

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.