Office Hysteroscopy in Postmenopausal Women: A Randomized Trial of Cervical Preparation Strategies

July 9, 2026 updated by: Mohammed Amine HANNACHI, Faculty of Medicine of Tunis

A Four-Arm Prospective Randomized Controlled Trial Comparing Oral Misoprostol, Two Vaginal Estrogen Regimens, and No Cervical Preparation Before Office Hysteroscopy in Postmenopausal Women

The goal of this randomized controlled trial is to evaluate the effectiveness of different cervical preparation strategies before office hysteroscopy in postmenopausal women undergoing evaluation for intrauterine pathology.

The main questions to answer are:

Does cervical preparation improve the success rate of complete office hysteroscopy in postmenopausal women? Which cervical preparation strategy provides better patient tolerance, as assessed by pain intensity during the procedure?

Researchers will compare four cervical preparation protocols (14-day vaginal estrogen, 7-day vaginal estrogen, oral misoprostol, and no cervical preparation) to determine their effects on procedural success, pain, procedure duration, and perioperative complications.

Participants will be randomly assigned to one of the four cervical preparation protocols. They will undergo office hysteroscopy using a vaginoscopic ("no touch") approach without anesthesia. Then, they will have pain assessed using a visual analog scale (VAS) during the procedure. Finally, these informations will be collected: procedural success, procedure duration, bleeding, and perioperative complications.

Study Overview

Status

Recruiting

Conditions

Intervention / Treatment

Study Type

Interventional

Enrollment (Estimated)

120

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Locations

  • Tunisia
    • Tunis Governorate
      • Tunis, Tunis Governorate, Tunisia, 1007

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Child
  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Women with postmenopausal status.
  • Scheduled for office hysteroscopy for the evaluation of suspected intrauterine pathology.
  • Able to understand the study procedures and provide written informed consent.

Exclusion Criteria:

  • Known or suspected hormone-dependent malignancy (e.g., breast or endometrial cancer).
  • Active genital tract infection.
  • Contraindication or known hypersensitivity to misoprostol or vaginal estrogen.
  • Refusal to undergo office hysteroscopy without anesthesia.
  • Active uterine bleeding preventing adequate hysteroscopic visualization on the day of the procedure.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Other: No Cervical Preparation
Participants undergo office hysteroscopy without any cervical preparation.
Other: No Cervical Preparation
No pharmacological cervical preparation is administered before office hysteroscopy.
Experimental: Oral Misoprostol
Participants receive 200 µg of misoprostol administered sublingually 2 hours before office hysteroscopy.
Drug: Misoprostol ( Cytotec) 200 microgram a tablet
Misoprostol 200 µg administered sublingually 2 hours before office hysteroscopy for cervical ripening.
Experimental: 7-Day Vaginal Estrogen
Participants receive 20 µg vaginal estrogen once daily for 7 consecutive days before office hysteroscopy.
Drug: Vaginal Estrogen (7-Day Regimen)
Vaginal estrogen 20 µg administered once daily for 7 consecutive days before office hysteroscopy to facilitate cervical ripening.
Experimental: 14-Day Vaginal Estrogen
Participants receive 20 µg vaginal estrogen once daily for 14 consecutive days before office hysteroscopy.
Drug: Vaginal Estrogen (14-Day Regimen)
Vaginal estrogen 20 µg administered once daily for 14 consecutive days before office hysteroscopy to facilitate cervical ripening.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Successful office hysteroscopy
Time Frame: During the office hysteroscopy procedure
A complete hysteroscopic examination of the uterine cavity.
During the office hysteroscopy procedure
Pain during office hysteroscopy
Time Frame: During the office hysteroscopy procedure. 5 minutes after the procedure. 10 minutes after the procedure.
Patient-reported pain assessed using a 10-cm Visual Analog Scale (VAS) during hysteroscopy, 5 minutes after the procedure and 10 minutes after the procedure. 0 is assigned to no pain & 10 is assigned to the most pain imaginable.
During the office hysteroscopy procedure. 5 minutes after the procedure. 10 minutes after the procedure.

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Procedure-related complications
Time Frame: During the procedure and up to 24 hours after office hysteroscopy
Incidence of complications occurring during or immediately after office hysteroscopy, including cervical laceration, uterine perforation, excessive bleeding, vasovagal reaction, or failure requiring conversion to hysteroscopy under anesthesia.
During the procedure and up to 24 hours after office hysteroscopy
Patient satisfaction with cervical preparation
Time Frame: Immediately after the procedure
Patient satisfaction with the assigned cervical preparation protocol, assessed using a Patient Satisfaction Percentage Scale, a self-reported scale ranging from 0% to 100%, where 0% indicates not satisfied at all and 100% indicates completely satisfied. Higher scores indicate greater patient satisfaction.
Immediately after the procedure
Adverse effects of cervical preparation
Time Frame: From date of randomization up to 14 days
Incidence of adverse effects related to cervical preparation, including abdominal pain, uterine cramping, vaginal bleeding, nausea, vomiting, diarrhea, headache, dizziness, or local vaginal irritation.
From date of randomization up to 14 days

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Faculty of Medicine of Tunis

Investigators

  • Study Chair: KHALED M NEJI, Maternity and neonatology center of Tunis

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

January 2, 2026

Primary Completion (Estimated)

July 30, 2026

Study Completion (Estimated)

August 20, 2026

Study Registration Dates

First Submitted

July 6, 2026

First Submitted That Met QC Criteria

July 9, 2026

First Posted (Actual)

July 13, 2026

Study Record Updates

Last Update Posted (Actual)

July 13, 2026

Last Update Submitted That Met QC Criteria

July 9, 2026

Last Verified

July 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • CERV-PREP-MENO-HSC

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

UNDECIDED

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

product manufactured in and exported from the U.S.

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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