Am J Clin Exp Obstet Gynecol 2013;1(1):62-68
Original Article
Inserting intrauterine devices in nulliparous women: is misoprostol
beneficial? A registered clinical trial
Pamela S Lotke, Anita Tiwari, Velia Leybas Nuño
Department of Obstetrics and Gynecology, University of Arizona School of Medicine, Tucson, AZ, USA
Received October 15, 2013; Accepted November 18, 2013; Epub December 7, 2013; Published December 15, 2013
Abstract: 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. (AJCEOG1310005).
Keywords: Intrauterine device, nulliparous, misoprostol, pain, cervical priming
Address correspondence to: Dr. Pamela S Lotke, Department of Obstetrics and Gynecology, University of Arizona
School of Medicine, PO Box 245078, 1501 N Campbell Ave, Tucson, AZ 85724, USA. Tel: 520-626-6591; Fax:
520-626-1519; E-mail: plot-ke@obgyn.arizona.edu
Original Article
Inserting intrauterine devices in nulliparous women: is misoprostol
beneficial? A registered clinical trial
Pamela S Lotke, Anita Tiwari, Velia Leybas Nuño
Department of Obstetrics and Gynecology, University of Arizona School of Medicine, Tucson, AZ, USA
Received October 15, 2013; Accepted November 18, 2013; Epub December 7, 2013; Published December 15, 2013
Abstract: 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. (AJCEOG1310005).
Keywords: Intrauterine device, nulliparous, misoprostol, pain, cervical priming
Address correspondence to: Dr. Pamela S Lotke, Department of Obstetrics and Gynecology, University of Arizona
School of Medicine, PO Box 245078, 1501 N Campbell Ave, Tucson, AZ 85724, USA. Tel: 520-626-6591; Fax:
520-626-1519; E-mail: plot-ke@obgyn.arizona.edu
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