Office Hysteroscopy in Postmenopausal Women: A Randomized Trial of Cervical Preparation Strategies
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.
Studieoversigt
Status
Status
Betingelser
Betingelser
Intervention / Behandling
Intervention / Behandling
Undersøgelsestype
Undersøgelsestype
Tilmelding (Anslået)
Tilmelding
Fase
Fase
- Ikke anvendelig
Kontakter og lokationer
Studiekontakt
Studiekontakt
- Navn: Mohammed Amine Hannachi, Assistant professor
- Telefonnummer: +21699696332
- E-mail: medaminehannachi3@gmail.com
Studiesteder
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Tunis Governorate
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Tunis, Tunis Governorate, Tunesien, 1007
- Rekruttering
- Maternity and neonatology center of Tunis
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Kontakt:
- Khaled Neji, Professor
- Telefonnummer: +21651352742
- E-mail: DRKHALEDNEJI21@GMAIL.COM
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Kontakt:
- Mohammed Amine Hannachi
- Telefonnummer: 99696332
- E-mail: medaminehannachi3@gmail.com
-
-
Deltagelseskriterier
Berettigelseskriterier
Berettigelseskriterier
Aldre berettiget til at studere
- Barn
- Voksen
- Ældre voksen
Tager imod sunde frivillige
Beskrivelse
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.
Studieplan
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Behandling
- Tildeling: Randomiseret
- Interventionel model: Parallel tildeling
- Maskning: Ingen (Åben etiket)
Antal våben
Våben og indgreb
Deltagergruppe / ArmDeltagergruppe / Arm |
Intervention / BehandlingIntervention / Behandling |
|---|---|
|
Andet: No Cervical Preparation
Participants undergo office hysteroscopy without any cervical preparation.
|
No pharmacological cervical preparation is administered before office hysteroscopy.
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Eksperimentel: Oral Misoprostol
Participants receive 200 µg of misoprostol administered sublingually 2 hours before office hysteroscopy.
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Misoprostol 200 µg administered sublingually 2 hours before office hysteroscopy for cervical ripening.
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Eksperimentel: 7-Day Vaginal Estrogen
Participants receive 20 µg vaginal estrogen once daily for 7 consecutive days before office hysteroscopy.
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Vaginal estrogen 20 µg administered once daily for 7 consecutive days before office hysteroscopy to facilitate cervical ripening.
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Eksperimentel: 14-Day Vaginal Estrogen
Participants receive 20 µg vaginal estrogen once daily for 14 consecutive days before office hysteroscopy.
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Vaginal estrogen 20 µg administered once daily for 14 consecutive days before office hysteroscopy to facilitate cervical ripening.
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Hvad måler undersøgelsen?
Primære resultatmål
Primære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
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Successful office hysteroscopy
Tidsramme: During the office hysteroscopy procedure
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A complete hysteroscopic examination of the uterine cavity.
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During the office hysteroscopy procedure
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Pain during office hysteroscopy
Tidsramme: During the office hysteroscopy procedure. 5 minutes after the procedure. 10 minutes after the procedure.
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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.
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During the office hysteroscopy procedure. 5 minutes after the procedure. 10 minutes after the procedure.
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Sekundære resultatmål
Sekundære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
|
Procedure-related complications
Tidsramme: During the procedure and up to 24 hours after office hysteroscopy
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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.
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During the procedure and up to 24 hours after office hysteroscopy
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Patient satisfaction with cervical preparation
Tidsramme: Immediately after the procedure
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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.
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Immediately after the procedure
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Adverse effects of cervical preparation
Tidsramme: From date of randomization up to 14 days
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Incidence of adverse effects related to cervical preparation, including abdominal pain, uterine cramping, vaginal bleeding, nausea, vomiting, diarrhea, headache, dizziness, or local vaginal irritation.
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From date of randomization up to 14 days
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Samarbejdspartnere og efterforskere
Sponsor
Sponsor
Efterforskere
Efterforskere
- Studiestol: KHALED M NEJI, Maternity and neonatology center of Tunis
Publikationer og nyttige links
Generelle publikationer
- Wood MA, Kerrigan KL, Burns MK, Glenn TL, Ludwin A, Christianson MS, Bhagavath B, Lindheim SR. Overcoming the Challenging Cervix: Identification and Techniques to Access the Uterine Cavity. Obstet Gynecol Surv. 2018 Nov;73(11):641-649. doi: 10.1097/OGX.0000000000000614.
- Samy A, Nabil H, Abdelhakim AM, Mahy ME, Abdel-Latif AA, Metwally AA. Pain management during diagnostic office hysteroscopy in postmenopausal women: a randomized study. Climacteric. 2020 Aug;23(4):397-403. doi: 10.1080/13697137.2020.1742685. Epub 2020 Apr 17.
- Sauvan M, Pourcelot AG, Fournet S, Fernandez H, Capmas P. Office hysteroscopy for postmenopausal women: Feasibility and correlation with transvaginal ultrasound. J Gynecol Obstet Hum Reprod. 2018 Dec;47(10):505-510. doi: 10.1016/j.jogoh.2018.08.018. Epub 2018 Sep 5.
- Sorbi F, Fambrini M, Saso S, Lucenteforte E, Lisi F, Piciocchi L, Cioni R, Petraglia F. Office hysteroscopy in pre- and post-menopausal women: a predictive model. Gynecol Endocrinol. 2021 Mar;37(3):206-210. doi: 10.1080/09513590.2020.1864316. Epub 2020 Dec 26.
- Giorda G, Scarabelli C, Franceschi S, Campagnutta E. Feasibility and pain control in outpatient hysteroscopy in postmenopausal women: a randomized trial. Acta Obstet Gynecol Scand. 2000 Jul;79(7):593-7.
- Gorodeski GI. Effects of menopause and estrogen on cervical epithelial permeability. J Clin Endocrinol Metab. 2000 Jul;85(7):2584-95. doi: 10.1210/jcem.85.7.6671.
- Cooper NA, Smith P, Khan KS, Clark TJ. Does cervical preparation before outpatient hysteroscopy reduce women's pain experience? A systematic review. BJOG. 2011 Oct;118(11):1292-301. doi: 10.1111/j.1471-0528.2011.03046.x. Epub 2011 Jul 29.
Datoer for undersøgelser
Studer store datoer
Studiestart (Faktiske)
Studiestart
Primær færdiggørelse (Faktiske)
Primær færdiggørelse
Studieafslutning (Anslået)
Studieafslutning
Datoer for studieregistrering
Først indsendt
Først indsendt
Først indsendt, der opfyldte QC-kriterier
Først indsendt, der opfyldte QC-kriterier
Først opslået (Faktiske)
Først opslået
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Faktiske)
Sidste opdatering sendt
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidst verificeret
Sidst verificeret
Mere information
Begreber relateret til denne undersøgelse
Nøgleord
Yderligere relevante MeSH-vilkår
- Urogenitale sygdomme
- Genitale sygdomme
- Patologiske processer
- Urogenitale sygdomme hos kvinder
- Kvinders urogenitale sygdomme og graviditetskomplikationer
- Livmodersygdomme
- Kønssygdomme, kvindelige
- Blødning
- Livmoderblødning
- Patologiske tilstande, tegn og symptomer
- Metroragi
- Sundhedsvæsenets kvalitet, adgang og evaluering
- Terapeutik
- Fedtsyrer
- Lipider
- Biologiske faktorer
- Evalueringsmekanismer til sundhedsvæsenet
- Sundhedskvalitet
- Prostaglandiner, syntetisk
- Prostaglandiner
- Eicosanoider
- Fedtsyrer, umættet
- Autacoider
- Betændelsesformidlere
- Epidemiologiske undersøgelsesegenskaber
- Prostaglandiner E, syntetisk
- Misoprostol
- Kliniske protokoller
Andre undersøgelses-id-numre
Andre undersøgelses-id-numre
- CERV-PREP-MENO-HSC
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