Effect of different doses of sublingual misoprostol on pain experience during office hysteroscopy

Abstract

Office hysteroscopy is considered nowadays as the gold standard investigation in patients with perimenopausal or postmenopausal bleeding, irregular bleeding & infertility patients. Its use as an outpatient procedure erase the need to make it least uncomfortable by preparing the patient using drugs that soften the cervix & allow to introduce the hysteroscope easily. The aim of this study was to evaluate different doses of sublingual misoprostol on pain score & its side effect on the procedure. This prospective study involved 88 women planned for office hysteroscopy were selected randomly and divided into 3 groups, 25 patients received 200 μg misoprostol sublingually one hour before the procedure, 30 patients received 100 μg the same way as the first group and the 3rd group 33 patients did not received misoprostol, after the procedure patients were asked about their pain using pain analogue score pictogram with a score from zero to ten. Results of this study revealed that the main indication of hysteroscopy in this study was with irregular vaginal bleeding 48.9% followed by infertility 22.7%. Main finding was endometrial polyp 59.5%. Pain score was significantly higher in patients who did not receive misoprostol 4.09 compared with those who received (2.36 & 2.13 for the 200 μg & 100 μg groups respectively). No statistical difference was found between the two doses of misoprostol regarding pain score. However, side effects in form of endometrial congestion & poor distention of uterine cavity was more in the 200 μg misoprostol group compared to 100 μg misoprostol group (56% versus13.3% and 8% versus 0% respectively). Conclusion: use of misoprostol 100 μg sublingually one hour before office hysteroscopy decrease pain experienced by patient & minimally affecting the endometrium & visual field.