Role of vaginal misoprostol prior to levonorgestrel-releasing IUD insertion

Abstract

Objectives: We aimed to assess the effect of receiving vaginal misoprostol before Levonorgestrel-releasing intrauterine device (Mirena IUD) insertion regarding the easiness of insertion and pain score. Methods: We studied 113 women who used the Mirena IUD for contraception, divided into three groups, and received vaginal tablets 4 hours before Mirena IUD insertion. Group 1(n37) received vaginal placebo tablets, group 2 (n38) received 200mcg vaginal misoprostol, group 3 (n 38) received 400mcg vaginal misoprostol. Results: Compared to group 1 (placebo group), Mirena IUD insertion in group 2 and group 3 (misoprostol groups) was significantly easier (P=0.027 and 0.007, respectively) and expressed lower pain score (P=0.031 and 0.035, respectively). Regarding the side effects, nausea and/or vomiting and uterine cramps were found significantly more frequently among women who had misoprostol 400mcg (group 3) compared to women in group 1 (P=0.003 and 0.001, respectively) as well as compared to women in group 2 (P=0.042 and 0.048, respectively). Conclusion: 200mcg of vaginal misoprostol was equally effective to 400mcg with fewer side effects. Both groups were superior to the placebo group in the easiness of insertion, with women experiencing less pain.