Anxiety and Pain in Patients Undergoing Pipelle Endometrial Biopsy: A Prospective Study [11F]

INTRODUCTION: Pipelle biopsy is a minimally invasive endometrial sampling procedure, important for early diagnosis of endometrial pathology and treatment planning. While generally well tolerated, some women experience considerable pain. The prospective study reported here provides a first critical test of the hypothesis that heightened anxiety may contribute to the risk of severe pain in women undergoing Pipelle biopsy. METHODS: Pain and anxiety levels immediately prior to, during, and after the Pipelle biopsy were assessed (0-10 numeric rating) in a sample (n=113) of consecutively recruited women undergoing outpatient Pipelle biopsies in a tertiary care facility. Personal and clinical data were extracted from medical records and from surveys administered to providers. Multivariable logistic regression models and generalized estimating equations examined associations between severe (≥7) pain and anxiety prior to, during, and after the biopsy. RESULTS: Severe pain was reported by 9%, 43%, and 13% of participants prior to, during and after the procedure (respectively), while severe anxiety was reported by 30%, 38% and 12%. Pain was significantly associated with anxiety levels at all times assessed. Adjusting for covariates (e.g., age, BMI, biopsy indication), the odds of severe pain prior to, during, and after biopsy were 5.9, 2.3, and 11.0 times higher (respectively) for patients with severe anxiety prior to the procedure. CONCLUSION: The strong relationships between anxiety prior to Pipelle biopsy and patients’ experiences of severe pain associated with the procedure suggest that interventions aimed at reducing anxiety might substantially improve the patient experience of this widely-used procedure for endometrial biopsy.