EDITOR—Studies that may reduce the number of unnecessary investigations or treatments are always welcomed by clinicians. Kremer et al perceive a reluctance to abandon general anaesthetic procedures for the investigation of menstrual problems,1 and this has also been reported by Penney et al.2

Kremer et al compared a group given outpatient hysteroscopy with one given day case hysteroscopy. They found no significant difference between the two groups with respect to postoperative pain, but it is difficult to compare these groups accurately for several reasons. Outpatient hysteroscopy was performed without analgesia, but general anaesthetic procedures presumably included a short acting opiate with the anaesthetic. The analgesics used for general anaesthesia are unfortunately not described. Was the method of anaesthesia standardised?

Only 62% of the patients who had outpatient hysteroscopy underwent endometrial sampling, whereas all of the women who had hysteroscopy under general anaesthesia had curettage. This makes comparison of the groups difficult as curettage may be a painful procedure in itself.

It may be possible to reduce the pain associated with outpatient hysteroscopy further by using mefenamic acid before the procedure3 or using smaller diameter scopes than the 3.6 mm …