Misoprostol has been used before IUCD insertion to prime the cervical os. As the literature about this topic is controversial, we aimed to evaluate IUCD insertion failure, women’s pain perception, use of cervical dilators, and prevalence of side effects following misoprostol administration.
Researchers searched trials published in MEDLINE, Scopus, the Cochrane Library, and ClinicalTrials.gov. The primary outcome was IUCD insertion failure; secondary results were women’s pain perception, use of cervical dilators to facilitate insertion, and prevalence of side effects.
Fourteen studies were eligible for inclusion. Misoprostol premedication reduced IUCD insertion failure rates and the use of cervical dilators but significantly increased the prevalence of side effects. Nulliparas did not benefit from misoprostol premedication. Buccal misoprostol administration did not seem to be effective in reducing IUCD insertion failure.
Our data demonstrate reduced IUCD insertion failure among women with previous cesarean section and those with previous IUCD insertion failure, suggesting that misoprostol may be a reasonable choice in these groups of women. Although misoprostol premedication reduced insertion failures, it significantly increased side effects and had a heterogeneous efficacy pattern; thus, its routine use is not supported by the evidence.
Reference: https://www.tandfonline.com/doi/full/10.1080/13625187.2019.1706079
