Cancer 2026

Objectives: Outpatient hysteroscopy (OPH) is a crucial diagnostic standard for uterine pathology, yet minimizing procedural failures and managing patient pain remain continuous challenges. This clinical audit cycle evaluated OPH completion rates, catalogued common clinical indications, identified barriers leading to procedural abandonment or general anaesthesia (GA) utilization, and assessed the efficacy of inhaled methoxyflurane (Penthrox) on patient-reported pain scores.

Methods: A retrospective audit was conducted on 365 patients referred for OPH over a 4.5-month period (August–December 2025). Clinical data, indications, procedural findings, and visual analogue scale (VAS) pain scores were collected from electronic health records and standardized OPH proformas.

Results: Of the 365 patients, 246 (67.4%) successfully completed OPH, while 119 (32.6%) did not. The predominant clinical indications were postmenopausal bleeding (PMB: 39.2%), PMB on HRT (19.3%), and heavy menstrual bleeding (18.8%). Completed procedures revealed normal cavities (32.9%), atrophic endometrium (32.5%), or polyps (30.4%). Conversely, the primary reasons for procedural non-completion were severe pain (26.1%), inappropriate referrals (20.2%), and patient choice (16.0%). Ultimately, 70 patients (19.2% of the total cohort) required booking under GA, primarily driven by severe pain or poor tolerance (44.3%). Inhaled methoxyflurane was utilized as a pain relief aid by 76 patients. The methoxyflurane subgroup demonstrated a clinically significant VAS pain score reduction of 3.4 points, dropping from a mean pre-procedural baseline of 6.7/10 down to 3.2/10 post-procedure. The audit identified crucial documentation gaps regarding the exact offer-to-uptake ratio of the inhaler.

Conclusions: Severe procedural pain and poor referral triage remain major bottlenecks that drive OPH failure and increase GA utilization rates. Inhaled methoxyflurane is an effective, non-invasive analgesic that provides significant pain reduction during the procedure. To improve diagnostic yield and optimize clinic capacity, service actions must prioritize the revision of OPH proformas to strictly mandate methoxyflurane tracking, implement tighter referral screening against NICE NG88 guidelines, and provide target education to referrers.

Dr. Amechi Williams Igochukwu is a trained Obstetrics and Gynaecology Specialist and Specialty Doctor at Kettering General Hospital, NHS. United Kingdom, With over 10 years of experience, he qualified as a doctor in 2010 and had his formal O&G residency in Nigeria. He has extensive international NGO experience as a gynaecology expatriate with Medecins Sans Frontieres (MSF) and CUAMM/Doctors with Africa, serving in Sierra Leone, South Sudan, and Northern Nigeria. A dedicated husband and father to three lovely children. His passion is delivering excellent, compassionate women’s healthcare globally.