Inserting intrauterine devices in nulliparous women: is misoprostol beneficial? A registered clinical trial

Background: To determine if misoprostol use prior to intrauterine device (IUD) insertion decreases pain and eases insertion in nulliparous women. Study Design: Nulliparous women requesting IUDs for contraception were randomized to 400 micrograms of misoprostol or placebo prior to IUD insertion. The primary outcome was pain at the time of insertion using a 100 mm visual analog scale. Additional outcomes included medication side effects, patient satisfaction, and provider rated ease of insertion. Results: The 2 groups were similar, with 31 subjects in the placebo group and 30 receiving misoprostol. There was no difference in baseline pain, and no difference in pain immediately after IUD insertion (57.2 ± 22.5 mm for placebo, 56.7 ± 22.1 mm for misoprostol, P=0.92). Patients receiving misoprostol experienced more cramps (16.7% placebo, 60% misoprostol, P=0.002) and fevers and chills, though this did not reach significance (7% placebo, 27% misoprostol, P=0.081). Providers reported easier insertions following misoprostol (24.1 ± 14.2 mm misoprostol vs 33.4 ± 20.3 mm placebo, P=0.04). All patients had successful IUD placement and none had complications. Overall satisfaction with the IUDs was high, with 84% of the women in the placebo group and 77% of women in the misoprostol group reporting they were satisfied or very satisfied (P=0.94). Conclusions: Routine use of misoprostol prior to intrauterine device insertion is not warranted in nulliparous women.