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Pain-control strategies for blind office endometrial biopsy: a systematic review with inert-controlled meta-analysis

Year: 2026

Type: article

Study designs: Systematic Review, Meta-Analysis

Abstract: Background Blind office endometrial biopsy is common, but pain during sampling can limit acceptability. Prior reviews have often combined different procedures, comparators, and pain timepoints. We evaluated randomized evidence for pain-control strategies during blind outpatient or office-based endometrial biopsy or sampling. Methods For the primary estimand, we restricted meta-analysis to randomized comparisons against placebo, saline, placebo gel, distilled water, or other inert controls, defined as controls without intended analgesic activity, that reported extractable intra-procedural pain scores on a 0–10 compatible scale. We searched PubMed, CENTRAL, Embase, Web of Science, Scopus, Wanfang, VIP, ClinicalTrials.gov, and WHO ICTRP from inception to 9 May 2026, with update checks of PubMed and ClinicalTrials.gov on 12 June 2026. CNKI, SinoMed/CBM, and ChiCTR were checked supplementally. Random-effects mean differences were pooled. Risk of bias was assessed with RoB 2 and certainty with GRADE. Results The PRISMA-counted searches identified 2632 records; 619 duplicates were removed and 2013 records were screened. Eight randomized trials involving 944 participants were included in the primary meta-analysis. Pain-control interventions lowered average pain during biopsy compared with inert controls (mean difference, -1.87 points; 95% confidence interval, -2.52 to -1.22; I-squared = 86.7%). REML and Hartung-Knapp sensitivity analyses remained directionally consistent, although the prediction interval crossed no effect. Excluding the single systemic COX-2 inhibitor trial left seven local-anesthetic trials and 864 participants with a similar direction of effect (mean difference, -2.10; 95% confidence interval, -2.71 to -1.48; I-squared = 83.7%). Evidence was driven mainly by local anesthetic trials. Harms were sparsely and inconsistently reported. Certainty was low for pain reduction and very low for safety. Conclusions Low-certainty randomized evidence suggests that tested pain-control strategies, mainly local anesthetic interventions, may reduce average intra-procedural pain during blind office endometrial biopsy with inert comparators, but heterogeneity is substantial and the optimal intervention class remains uncertain. These findings support patient-centered discussion of pain-control options but do not establish any specific agent or intervention class as standard care. Trial registration Not applicable. This systematic review was not prospectively registered.

Source: BMC Women s Health

DOI: 10.1186/s12905-026-04787-3