Effectiveness of Office Hysteroscopy on a Patient’s Health-Related Quality of Life (HRQoL): a Prospective Observational Study

Effectiveness of Office Hysteroscopy on a Patient’s Health-Related Quality of Life (HRQoL): a Prospective Observational Study | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL This is a preprint and has not been peer reviewed. Data may be preliminary. 27 January 2026 V1 Latest version Share on Effectiveness of Office Hysteroscopy on a Patient’s Health-Related Quality of Life (HRQoL): a Prospective Observational Study Authors : Teresa Tam [email protected] , Yuanyuan Groves , Haley Primuth , Elliot Levine , and Carlos Fernandez Authors Info & Affiliations https://doi.org/10.22541/au.176953525.57532722/v1 144 views 68 downloads Contents Abstract Supplementary Material Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract Objective: To determine the effect of office hysteroscopy on a patient’s health-related quality of life (HRQoL) pre-hysteroscopy, 2 weeks, and 6–8 weeks post-hysteroscopy using the EuroQoL-5 Dimension-5 Level (EQ-5D-5L) health status questionnaires and EuroQoL visual analogue scale (EQ-VAS). Study Design: Prospective observational study was done between May 30th, 2023 to June 30th, 2024. One hundred and three (103) patients were included and each completed the questionnaires at three different time points. Paired T-test analyses were used to determine statistical significance. Setting: Private practice office setting Participants: Women, aged 18 and older, meeting the inclusion criteria and scheduled to undergo hysteroscopy in the office setting for diagnosis and treatment purposes, were enrolled. The inclusion criteria include abnormal uterine bleeding, heavy menstrual bleeding, postmenopausal bleeding, abnormal pelvic ultrasound with abnormal endometrial thickening, and/or intrauterine lesions. The exclusion criteria included pregnancy, active pelvic infection, confirmed cervical or endometrial cancer. Women who withdrew voluntarily from the study were also excluded. Interventions: All subjects were asked to complete the EuroQoL-5D-5L questionnaire and then rate their overall health on the EQ-VAS scale before office hysteroscopy, 2-weeks post and 6-8 weeks post-hysteroscopy, respectively. Results: Of the 176 patients scheduled, 103 were included in the final analysis. Significant improvements (p<0.05) in HRQoL were observed in mobility, pain/discomfort, anxiety/depression, and overall health (EQ-VAS) scores at 2 weeks and 6-8 weeks post-hysteroscopy. No significant changes were noted in self-care, and improvements in usual activities were significant only at 6-8 weeks. Conclusion: Office hysteroscopy is shown to have positive effects on HRQoL in patients requiring the procedure including significant improvements in post-hysteroscopy pain and discomfort, while also having improvements in anxiety and depression before and after the procedure. Title: Effectiveness of Office Hysteroscopy on a Patient’s Health-Related Quality of Life (HRQoL): a Prospective Observational Study Author List: Teresa Tam a ; Yuanyuan Groves a ; Haley Primuth b ; Elliot M. Levine c ; Carlos Fernandez d Affiliations: 1. Department of Obstetrics and Gynecology, Ascension Saint Joseph Hospital, 2900 North Lake Shore Drive, Chicago, Illinois 60657 2. Department of Obstetrics and Gynecology, Aurora Sinai Medical Center, 945 North 12th Street, Milwaukee, Wisconsin 53233 3. Rosalind Franklin University Chicago Medical School, 3333 North Green Bay Road, North Chicago, Illinois 60064 4. Department of Obstetrics and Gynecology, Advocate Illinois Masonic, 836 West Wellington Avenue, Chicago, Illinois 60657 Corresponding Author: Teresa Tam, MD, FACOG, FACS 331 West Surf Street Suite 902 Chicago, Illinois 60657 773-904-8641 [email protected] Running Title: Office Hysteroscopy and Quality of Life Acknowledgements : No funding was received for this research. No editorial or writing assistance was received. Word count: 2,450 Abstract: Objective: To determine the effect of office hysteroscopy on a patient’s health-related quality of life (HRQoL) pre-hysteroscopy, 2 weeks, and 6–8 weeks post-hysteroscopy using the EuroQoL-5 Dimension-5 Level (EQ-5D-5L) health status questionnaires and EuroQoL visual analogue scale (EQ-VAS). Study Design: Prospective observational study was done between May 30th, 2023 to June 30th, 2024. One hundred and three (103) patients were included and each completed the questionnaires at three different time points. Paired T-test analyses were used to determine statistical significance. Setting: Private practice office setting Participants: Women, aged 18 and older, meeting the inclusion criteria and scheduled to undergo hysteroscopy in the office setting for diagnosis and treatment purposes, were enrolled. The inclusion criteria include abnormal uterine bleeding, heavy menstrual bleeding, postmenopausal bleeding, abnormal pelvic ultrasound with abnormal endometrial thickening, and/or intrauterine lesions. The exclusion criteria included pregnancy, active pelvic infection, confirmed cervical or endometrial cancer. Women who withdrew voluntarily from the study were also excluded. Interventions: All subjects were asked to complete the EuroQoL-5D-5L questionnaire and then rate their overall health on the EQ-VAS scale before office hysteroscopy, 2-weeks post and 6-8 weeks post-hysteroscopy, respectively. Results: Of the 176 patients scheduled, 103 were included in the final analysis. Significant improvements (p<0.05) in HRQoL were observed in mobility, pain/discomfort, anxiety/depression, and overall health (EQ-VAS) scores at 2 weeks and 6-8 weeks post-hysteroscopy. No significant changes were noted in self-care, and improvements in usual activities were significant only at 6-8 weeks. Conclusion: Office hysteroscopy is shown to have positive effects on HRQoL in patients requiring the procedure including significant improvements in post-hysteroscopy pain and discomfort, while also having improvements in anxiety and depression before and after the procedure. Funding: No research funding was provided. List of Keywords: health related quality of life; office hysteroscopy; abnormal uterine bleeding; postmenopausal bleeding; heavy menstrual bleeding; abnormal endometrial thickening. INTRODUCTION Since the 1990s, there has been a rise in the use of office-based hysteroscopy for the diagnosis and management of gynecologic conditions, with up to 15–25% of gynecologists performing these procedures today 1 . Improved technology has led to advancements in minimally invasive procedures, taking what was once done conventionally in an operating room, to an outpatient setting 2 . Office hysteroscopy has proved invaluable in a number of ways. It has demonstrated fast recovery, cost-effectiveness, a ‘see-and-treat’ approach, and removes the need for sedation and its complications 3,4 . It is well-tolerated and safe 5 . By eliminating the need for the operating room, patients and physicians alike have improved convenience and accessibility, leading to prompt access to treatment. However, studies to date have yet to demonstrate whether office hysteroscopy improves health-related quality of life (HRQoL), which is a critical, but often overlooked factor. HRQoL is an important measure of overall health as it takes into account patient-reported outcomes. The EuroQoL 5-dimension 5-level (EQ-5D-5L) questionnaire, including the visual analogue scale (EQ-VAS), is a validated tool that measures HRQoL 6 . Patients score how their current health affects different dimensions of living. They then rate their overall current health on a visual analogue scale, providing a quantitative measure of a patient’s perspective of their health 7 . The goal of this study is to evaluate the effects of office hysteroscopy on patients’ HRQoL using the EQ-5D-5L scale. Understanding how office hysteroscopy impacts these scores can provide practitioners’ valuable insights to improve patient-reported outcomes. Health-related quality of life (HRQoL) is a crucial outcome measure in assessing the impact of office hysteroscopy, as it captures the patient’s subjective experience of their health status, which can significantly influence their overall well-being and satisfaction with treatment outcomes. MATERIALS AND METHODS This is a prospective observational study of private practice patients who required diagnostic hysteroscopy between May 30, 2023 to June 30th, 2024. A sample size of 100 participants provided 80% statistical power to detect a difference in the baseline change of the EQ-5D-5L scale before hysteroscopy, 2 weeks after hysteroscopy, and 6–8 weeks after hysteroscopy. To meet the subject requirement, 120 participants were recruited with an expected 20% dropout rate 8,9 . Oral and written informed consents were obtained from all study participants. Ascension Saint Joseph Hospital in Chicago granted full Institutional Review Board (IRB) approval in 2023. All methods were carried out in accordance with relevant guidelines and regulations. The study population included all women aged 18 and older having met the inclusion criteria and having been scheduled to undergo hysteroscopy in the office for diagnosis and/or treatment purposes. In each case, after a visual assessment was made, an endometrial biopsy or polypectomy was performed. The inclusion criteria were as follows: diagnosis of abnormal uterine bleeding, heavy menses, postmenopausal bleeding, or abnormal pelvic ultrasound assessed with 2-D imaging (e.g. abnormal endometrial thickening or identified intrauterine lesions). Exclusion criteria included: pregnancy, patients who request hysteroscopy in the operating room, active pelvic infection, confirmed cervical cancer, endometrial hyperplasia, atypia or cancer, cognitively impaired, and limited English proficiency (LEP) since consents and questionnaires were performed in English. Women who voluntarily withdrew from the study or did not complete all three sets of questionnaires were also excluded. Patient demographics and clinical characteristics assessed included age, sexual orientation, marital status, employment, ethnicity, tobacco use, and alcohol use (Table 1). The same gynecologic surgeon performed all office hysteroscopies in an identical manner, using the TruClear™ hysteroscopic device to avoid any deviations in operative practice. All patients enrolled in the study completed patient-reported outcomes of EQ-5D-5L health status questionnaires. They also rated their overall health on EQ-VAS at the time of enrollment (at most 4 weeks prior to hysteroscopy), 2 weeks post-hysteroscopy, and 6-8 weeks after hysteroscopy. Patients could complete the questionnaire either in person during their office visit, virtually through telehealth visits, online, or through a phone call. Lower scores (or decrease from baseline) for the EQ-5D-5L for the subscales including mobility, self-care, usual activities, pain/discomfort, and anxiety/depression indicated improvement in HRQoL. Higher scores (or increased from baseline) of the overall health EQ-VAS questionnaire indicated improvement in a patient’s health-related quality of life (HRQoL). Paired T-test analyses were used to assess the primary analysis, which was to determine differences between the baseline EQ-VAS values and those values at 2-weeks and 6–8 weeks post-hysteroscopy, along with each outcome associated with the EQ-5D-5L questionnaire. A power analysis was conducted using G*Power 3.1.9.6 software to determine the required sample size for detecting a clinically meaningful effect in the 5-dimensional EQ-5D-5L and a visual analogue scale (EQ-VAS) score. We employed a two-tailed paired t-test to detect the difference between means of two pairs. Given an alpha error of 0.05, beta error of 0.05, power of 0.95, and an effect size of 0.4, an a priori power analysis was computed resulting in a sample size of 84. Considering an estimated drop-out rate of 20–30%, the final sample size was calculated to be 120 participants. RESULTS Of the 176 patients initially scheduled for office hysteroscopy between May 30, 2023, and June 30, 2024, 53 were excluded for not meeting the inclusion criteria. A total of 123 participants met the criteria and provided consent. However, 20 participants were subsequently excluded: three could not tolerate the procedure, one was diagnosed with cancer, three were diagnosed with hyperplasia/atypia, two withdrew from the study, and 11 did not complete all three sets of questionnaires. In all, a total of 103 patients were included in the study for final analysis (Figure 1). Demographic and clinical characteristics of the 103 participants are listed in Table 1. The mean age was 46.38 years. A majority of the participants (N=84, 82%) identified as heterosexual and were married (N=62, 60%). Most patients were full-time employees (N=66, 64%). Race included White, Black, Asian, Hispanic and multi-racial. Most participants were non-smokers (N=84, 82%) and non-alcohol users or light alcohol drinkers (N=88, 84%). Clinically, 97% of the participants (N=100) had a pelvic ultrasound performed, with 87% (N=90) showing abnormalities. A majority of the pathology was either normal (N=50, 49%) or identified as an endometrial polyp (N=43, 42%). While a third of participants had no past medical history, the remainder had at least one medical condition, including 19% with diagnosed anxiety or depression. Regarding gynecologic conditions, 36% had abnormal or heavy menstrual bleeding, 28% had abnormal uterine bleeding and uterine fibroids, and 22% had postmenopausal bleeding. Among the 103 participants, HRQoL measured by mean EQ-5D-5L scores in the mobility, pain/discomfort, anxiety/depression and overall EQ-VAS scores showed statistically significant improvements (p<0.05) two weeks post-hysteroscopy compared to baseline (see Table 2). These improvements persisted at 6–8 weeks post-hysteroscopy. No difference was seen in self-care scores prior to and post-hysteroscopy. Differences in the dimension of usual activities only showed statistically significant findings when comparing baseline to 6–8 weeks post-hysteroscopy. DISCUSSION Numerous clinical benefits have been identified when comparing in-office hysteroscopy with those performed in the operating room. However, few studies have considered hysteroscopy in the office from a patient’s perspective. This prospective observational study evaluates the impact of office-based hysteroscopy on HRQoL, providing insights into patient-reported outcomes post-procedure. Our findings indicate that in-office hysteroscopy does significantly enhance HRQoL, particularly in reducing pain, discomfort and depression/anxiety. Many patients undergo hysteroscopy due to abnormal or heavy menstrual bleeding. As office hysteroscopy allows for a ‘see-and-treat’ approach, these patients were able to be treated if abnormalities were seen. This aligns with studies that demonstrate treatment for abnormal uterine bleeding improves quality of life 10,11 . One study demonstrated non-inferiority in uterine polyp treatment between office versus inpatient removal of polyps in bleeding outcomes 12 . This helps support that successful treatment for our patients was possible with in-office hysteroscopy, which is likely to have led to improvements in EQ-VAS scores. Furthermore, our study echoes the findings of Bennett, et. al. 13 . Most postmenopausal patients undergo hysteroscopy because of abnormal ultrasound results or postmenopausal bleeding. These must be evaluated as they can be indicative of hyperplasia or cancer. After in-office evaluation, it is likely that the results that patients had reduced anxiety and depression overall, and thus, an improvement in their outlook on HRQoL. Our findings suggest that in postmenopausal patients who can tolerate office procedures, in-office hysteroscopy is a useful option to avoid disrupting their activities of daily life, which is consistent with other studies that demonstrate faster recovery and return to normal activities with office procedures 3 . Regardless of menopausal status, this study reveals that office hysteroscopy significantly improves HRQoL. As prior research shows, office hysteroscopy has multiple clinical advantages, including faster recovery, decreased cost, convenience, and high patient satisfaction 3,14 . Each of these factors impact a patient’s HRQoL in multiple capacities, including socially and financially. For example, office hysteroscopy leads to less time required off work, avoids the need for increased childcare arrangements and less financial strain due to decreased cost. Patients can observe the procedure directly, ask questions during the procedure, and be informed of the findings immediately. These elements that make office hysteroscopy a popular option are further reinforced by our study at the patient level. Multiple studies have also shown that improvement in HRQoL scores has also led to improvement in key objective patient outcomes, including overall mortality and cancer survival in cancer patients 15 . Although the study by Sitlinger and Zafar focused specifically on cancer patients, it is noteworthy to see how a patient’s own perspective on their health can impact objective patient measures. It is also imperative to address pain management for any procedures performed in the office setting, as was accomplished in this current case series 16 . This study has multiple strengths. A sample size large enough to detect statistical power of our findings was used. The use of validated questionnaires like the EQ-5D-5L and EQ-VAS is a significant strength, as these tools have been widely adopted globally for measuring HRQoL, offering robust and reliable data across diverse populations. A single surgeon performed all hysteroscopies, which allowed for consistent technique and methodology. Due to its prospective nature, it allowed for real-time data collection, which minimized recall bias. Although office hysteroscopy does come with risk, we did not require randomization or other experimental manipulations that would impact a person’s ability to get treatment. As our final survey was done 6-8-weeks post-hysteroscopy, we were able to assess the long-term impact of the procedure on quality of life without overlooking the impact post-procedure recovery has on outcomes. This study has a few limitations, including the lack of demographic sub-analyses and potential biases due to participant dropout. Demographic factors may affect how individuals assess outcomes related to quality of life (such as comorbidities, socioeconomic status, psychological factors, etc.), although these can be evaluated in the future to determine if they affect results. Participant dropout introduces bias as those that may have been dissatisfied with the procedure may be more likely to dropout and thus overestimate the procedure’s benefit. Despite these limitations, our study was able to demonstrate the positive influence hysteroscopy performed in the office setting has on HRQoL in patients requiring the procedure. Hysteroscopy, for these patients, was able to be done safely and efficiently in the office, avoiding the need for the operating room, while improving their health-related quality of life. Future research can seek to identify whether improvement in HRQoL measures with office hysteroscopy also improve other objective clinical factors in a patient’s health journey. CONCLUSION Office hysteroscopy has proven to be a valuable tool for gynecologists in assessing, diagnosing and treating various intrauterine pathologies. It improves access and convenience for both patients and physicians, avoids analgesia complications, decreases costs and leads to faster recovery, all while maintaining patient satisfaction and safety. Notably, there has been limited focus on evaluating patient-reported outcomes following office hysteroscopy. Our study is one of the few that addresses this gap by demonstrating that office hysteroscopy positively influences health-related quality of life. A patient’s perception of their health-related quality of life is vital, as it illustrates the broader impact procedures may have on a patient’s day to day life. Health-related quality of life (HRQoL) is a crucial outcome measure in assessing the impact of office hysteroscopy, as it captures the patient’s subjective experience of their health status, which can significantly influence their overall well-being and satisfaction with treatment outcomes. HRQoL measures help evaluate the effectiveness of treatments beyond clinical outcomes, providing insights into how procedures affect patients’ overall health perception. This is particularly important in procedures like office hysteroscopy, where understanding patient-reported outcomes can inform treatment decisions and improve patient-centered care. REFERENCES 1. Salazar C, Isaacson K. Office Operative Hysteroscopy: An Update. J Minim Invasive Gynecol . 2018;25(2):199-208. 2. Bakour SH, Jones SE, O’Donovan P. Ambulatory hysteroscopy: evidence-based guide to diagnosis and therapy. Best Pract Res Clin Obstet Gynaecol. 2006;20(6):953-75. 3. Kremer C, Duffy S, Moroney M. Patient satisfaction with outpatient hysteroscopy versus day case hysteroscopy: randomised controlled trial. BMJ . 2000;320(7230):279-82. 4. Moawad N, Santamaria E, Johnson M, Shuster J. Cost-effectiveness of office hysteroscopy for abnormal uterine bleeding. JSLS . 2014;18(3):e2014.00393. 5. Mairos J, Di Martino P. Office Hysteroscopy: An operative gold standard technique and an important contribution to Patient Safety. Gynecol Surg . 2016:13:111. 6. The EuroQol Group (1990). EuroQol-a new facility for the measurement of health-related quality of life. Health Policy. 16(3):199-208. 7. Jiang R, Janssen MFB, Pickard AS. US population norms for the EQ-5D-5L and comparison of norms from face-to-face and online samples. Qual Life Res . 2021;30(3):803-816. 8. Kohn MA, Senyak J. Sample Size Calculators website . UCSF CTSI. 20 December 2021. Available at https://www.sample-size.net/.Accessed 20 May 2023. 9. Sullivan GM, Feinn R. Using Effect Size-or Why the P Value Is Not Enough. J Grad Med Educ . 2012;4(3):279-82. 10. Perelló J, Pujol P, Pérez M, Artés M, Calaf J. Heavy Menstrual Bleeding-Visual Analog Scale, an Easy-to-Use Tool for Excessive Menstrual Blood Loss That Interferes with Quality-of-Life Screening in Clinical Practice. Womens Health Rep (New Rochelle). 2022;3(1):483-490. 11. National Guideline Alliance (UK). Evidence reviews for management of heavy menstrual bleeding: Heavy menstrual bleeding (update): Evidence review B . London: National Institute for Health and Care Excellence (NICE); 2018 Mar. (NICE Guideline, No. 88.) Available from: https://www.ncbi.nlm.nih.gov/books/NBK569015/ 12. Clark TJ, Middleton LJ, Cooper NA, et al. A randomised controlled trial of Outpatient versus inpatient Polyp Treatment (OPT) for abnormal uterine bleeding. Health Technol Assess . 2015;19(61):1-194. 13. Bennett A, Lepage C, Thavorn K, Fergusson D, Murnaghan O, Coyle D, Singh SS. Effectiveness of Outpatient Versus Operating Room Hysteroscopy for the Diagnosis and Treatment of Uterine Conditions: A Systematic Review and Meta-Analysis. J Obstet Gynaecol Can. 2019 Jul;41(7):930-941. 14. The Use of Hysteroscopy for the Diagnosis and Treatment of Intrauterine Pathology: ACOG Committee Opinion, Number 800. Obstet Gynecol . 2020;135(3):e138-e148. 15. Sitlinger A, Zafar SY. Health-Related Quality of LIfe: The Impact on Morbidity and Mortality. Surg Oncol Clin N Am. 2018;27(4):675-684. 16. American College of Obstetricians and Gynecologists. Pain Management for In-Office Uterine and Cervical Procedures. ACOG Clinical Consensus No. 9. Obstet Gynecol. 2025 Jul; doi: 10.1097/AOG.0000000000005911. Disclosure of Interests: Dr. Tam is a consultant for Medtronic. The rest of the authors have no relevant interests to disclose. Contribution to Authorship: TT was involved in research conception, data collection, manuscript writing, editing, and approval. YG and HP were involved in data collection and analysis. EL and CF were involved in manuscript review and editing. Details of Ethics Approval: The study received IRB review and approval from the Ascension Healthcare Human Research Protection Program on May 25, 2023. IRB ID: RIL20230023 Figure and Table Legends: Figure 1. Flowchart of office schedule review of 103 total study participants. This figure illustrates the process of identifying patients for office hysteroscopy, excluding those who did not meet inclusion criteria, and including patients who completed all three questionnaires. Table 1. Demographic and clinical characteristics of participants. Variables are presented as n (%). Key characteristics include age, sexual orientation, marital status, employment, ethnicity, and lifestyle factors (tobacco use, alcohol use). Table 2. EQ-5D-5L Dimensions and EQ-VAS Scores Pre- and Post-Hysteroscopy Compares mean (standard deviation) EuroQoL-5 Dimension-5 Level (EQ-5D-5L) dimensions and EuroQoL visual analogue scale (EQ-VAS) scores pre-hysteroscopy and at 2-weeks and 6-weeks post-hysteroscopy. P-value determined by paired T-test analysis. Supplementary Material File (bjog.hsc qol table 1.demographics.docx) Download 19.82 KB File (bjog.hsc qol table 2.docx) Download 20.60 KB Information & Authors Information Version history V1 Version 1 27 January 2026 Copyright This work is licensed under a Non Exclusive No Reuse License. Keywords general gynaecology gynaecological surgery: endometrial resection gynaecological surgery: general gynaecological surgery: hysteroscopy gynaecology: endometrial sampling gynaecology: outpatient procedures Authors Affiliations Teresa Tam [email protected] Ascension Saint Joseph Hospital View all articles by this author Yuanyuan Groves Ascension Saint Joseph Hospital View all articles by this author Haley Primuth Aurora Health Aurora Obstetrics & Gynecology View all articles by this author Elliot Levine Rosalind Franklin University of Medicine and Science Chicago Medical School View all articles by this author Carlos Fernandez Advocate Illinois Masonic Medical Center Library View all articles by this author Metrics & Citations Metrics Article Usage 144 views 68 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Teresa Tam, Yuanyuan Groves, Haley Primuth, et al. Effectiveness of Office Hysteroscopy on a Patient’s Health-Related Quality of Life (HRQoL): a Prospective Observational Study. Authorea . 27 January 2026. DOI: https://doi.org/10.22541/au.176953525.57532722/v1 If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download. For more information or tips please see 'Downloading to a citation manager' in the Help menu . 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