ABSTRACT:
Study Objective: To determine whether playing instrumental music during office hysteroscopy (OH) lowers procedural pain and anxiety and enhances patient satisfaction among postmenopausal women. Design: A parallel-group randomized trial conducted at one center under an open-label allocation. Setting: Tertiary care hospital, February 2025 to February 2026. Participants: 124 postmenopausal women undergoing diagnostic OH for postmenopausal bleeding or sonographic suspicion of intrauterine pathology. Interventions: Participants were randomized 1:1 to listen to self-selected calming instrumental music from a prepared playlist during the procedure, or to undergo the same procedure without music. Measurements: Primary outcome was the highest pain experienced during office hysteroscopy, assessed using a 0–10 numerical rating scale immediately at hysteroscope withdrawal. Secondary outcomes included pain at 15 minutes, postprocedural anxiety, patient satisfaction, operator-rated ease of insertion, procedure duration, and adverse events. Main Results: Baseline characteristics were balanced. Procedural pain was reduced among women allocated to music compared with controls (3.9±1.0 vs 5.3±1.0; mean difference -1.4, 95% CI -1.8 to -1.1; p<0.001). Postprocedural anxiety was also lower (4.4±1.4 vs 6.4±1.1; MD -2.0, 95% CI -2.4 to -1.5; p<0.001), and patient satisfaction was higher (6.5±1.2 vs 4.0±0.6; MD+2.4, 95% CI 2.1 to 2.8; p<0.001). Procedure duration and adverse-event rates did not differ between groups. Conclusion: Among postmenopausal women undergoing office hysteroscopy, intra-procedural music was associated with lower pain and anxiety and higher satisfaction. However, the pain reduction was statistically significant but below the commonly cited threshold for clinical significance on a 0–10 NRS. Given the open-label design, these findings are best interpreted as improved patient experience rather than definitive evidence of clinically important analgesia.