Misoprostol Not Helpful for IUD Insertion

Lara C. Pullen, PhD

July 24, 2012

July 24, 2012 — Misoprostol does not ease intrauterine device (IUD) insertion or reduce patient-perceived pain in nulliparous women, according to a new randomized controlled trial. Alternative methods to decrease pain and ease insertion in this patient population should be explored.

Carolyn Swenson, MD, from the Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, and colleagues published the results of their randomized study in the August issue of Obstetrics and Gynecology. The results of the study do not support the routine use of misoprostol before IUD insertion in nulliparous women.

Nulliparous women (n = 108) who requested either the copper T380A or levonorgestrel IUD were randomly assigned to receive either 400 μg misoprostol (n = 54) or placebo (n = 54). Three of the participants enrolled in the study withdrew before completion. Patients self-administered (either buccally or vaginally) the drug or placebo 3 to 4 hours before IUD insertion.

The primary outcome was healthcare provider–perceived ease of insertion, as measured on a visual analog scale ranging from 0 (extremely easy) to 100 (impossible). There was no significant difference in perceived ease of insertion between the 2 groups (25.0 vs 27.4 mm; P = .64). Healthcare providers were unable to correctly identify women who had received misoprostol before insertion.

Patients who received misoprostol before IUD insertion had significantly higher pain scores before placement when compared with patients who received placebo (17.1 vs 4.7 mm; P = .003). The groups did not differ in perception of pain during IUD insertion (58.4 vs 56.9 mm; P = .74). At 1 week after the procedure, more than half of the women in both groups reported the pain with insertion as "severe" or "very severe," according to the 5-point Likert scale.

There was no difference between the 2 groups with regard to failed insertions, need for adjuvant pain medication, and need for cervical dilation or ultrasonographic guidance. The authors documented 2 IUD expulsions in the misoprostol group and none in the placebo group.

The authors have disclosed no relevant financial relationships.

Obstet Gynecol. 2012;120:341-347. Abstract

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