Association Between Menstrual Pain and Procedural Pain During Office Hysteroscopy: A 10-Year Cohort Study.

Background: Office hysteroscopy (OH) is the standard diagnostic method for evaluating intrauterine and endocervical pathology, yet the fear of procedural pain remains a major barrier to patient acceptance. This study examined whether menstrual pain can be used as a clinical reference to anticipate OH procedural pain and explored other predictors of procedural discomfort. Methods: A historical cohort study was conducted among women undergoing OH for abnormal uterine bleeding or postmenopausal bleeding at a tertiary referral hospital between 2014 and 2024. All procedures were performed by a single experienced hysteroscopist using a 4.9-mm vaginoscopic technique with preprocedural acetaminophen. Menstrual pain and OH procedural pain were assessed using a 0-10 visual analogue scale (VAS). Demographic and clinical variables were extracted from medical records. Associations with OH pain were evaluated using Mann-Whitney Results: A total of 488 women were included (median age: 45 years and median BMI: 24.5 kg/m Conclusion: OH was generally well tolerated, with pain typically lower than menstrual pain. Although menstrual pain, parity, and age explained only a modest proportion of pain variability, menstrual pain history offers a simple and patient-centered way to help clinicians set realistic expectations about procedural discomfort.