Furthermore, there were fewer disagreeable procedure evaluations by study participants in the misoprostol group (RR=0.49, 95% CI 0.35-0.68, NNT 3, p=0.000004) [6].Regarding side effects, there were no significant differences reported in complications during IUD insertion (bleeding, syncope, cramps, nausea, Vomiting, failed insertion).

A 2016 review by Matthews et al.

Literature was reviewed through November 2016.

From 2011-2013, LARC use was three times greater in parous women than nulliparous women [2]. IUD insertion was successful in 87.5% of subjects receiving misoprostol as compared to 61.9% of those receiving placebo (evaluable population RR=1.41, 95% CI 8.2-43.0, p=0.0066).

COVID-19 is an emerging, rapidly evolving situation. Subgroup analysis was performed to compare multiparous individuals (n=99) to nulliparous individuals (n=87). We present a review on the efficacy of vaginal misoprostol in facilitating IUD insertion and reducing procedure-associated pain.CDC – Centers for Disease Control; IUD – Intrauterine Device; LARC - Long-Acting Reversible Contraceptives; RCT – Randomized Controlled TrialIntrauterine devices (IUD) are a highly effective, reliable, and safe form of contraception [1].

Epub 2013 Mar 14.J Obstet Gynaecol Can. Less subjective difficulty of IUD insertion when misoprostol was used (RR=0.49, 95% CI 0.33-0.72, NNT 3, p=0.00001). 89.9% of subjects received Levonorgestrel-releasing IUDs with 10.1% receiving copper IUDs. Side effects also differ based on route of administration with milder side effects generally noted for vaginal administration [6].

The Contraceptive Choice Project demonstrated that with scripted and efficacy-based counseling, 37% of teens (14 to 17 year olds) will choose an IUD [3]. 2013 Jul;169(2):130-42. doi: 10.1016/j.ejogrb.2013.02.018. Epub 2019 Jun 27.Open Access J Contracept. performed a randomized, double-blind controlled trial to evaluate effectiveness of vaginal administration of misoprostol in dilating the cervix prior to IUD insertion in nulligravid women without history of prior uterine or cervical surgery.

had similar numbers of multiparous and nulliparous subjects and were able to perform subgroups analysis.

J Gynecol Res Obstet 3(2): 029-033. Additionally, providers often prescribe pre-insertion misoprostol for women with medical history of diseases such as endometriosis that they feel will cause increased pain during the procedure.

eCollection 2015.Wildemeersch D, Goldstuck N, Hasskamp T, Jandi S, Pett A.Open Access J Contracept.

Limitations of this study included the majority of women choosing a Levonorgestrel-releasing device with only 7 women choosing a copper IUD (0 misoprostol and 7 placebo). A significantly higher pain score was found in nulliparous subjects than multiparous subjects in both misoprostol and placebo groups (p<0.0001) as well as increased insertion difficulty in the nulliparous group (p<0.001).

Of the above studies, rates of expulsion were either very low or not addressed. However most reviews include studies with different routes and doses of misoprostol administration and do not account for this in comparisons. Misoprostol dose, route of administration, and timing of administration prior to procedure varies widely among available studies.

performed a double-blind, multicenter, randomized controlled trial in which 270 patients requesting an IUD were randomized to self-administer 400 micrograms of misoprostol or placebo vaginally 3 hours prior to procedure. Bahamondes et al.

Hoover E, Hardy-Fairbanks A, Stockdale CK (2017) Use of Vaginal Misoprostol Prior to Placement of an Intrauterine Device: A Review. Further research should be conducted in the specific population of individuals with prior IUD insertion failure.Also of relevance is the use of pre-IUD misoprostol in nulligravid women compared to multiparous women, as many nulligravidas fear IUD use due to concern of pain associated with insertion [1].

The study authors concluded misoprostol use is only indicated when there has been a previous IUD insertion failure.

conducted a case series of 8 patients who had previously failed IUD insertion.

Misoprostol has also been proposed as an agent to ease IUD insertion and decrease procedure-associated pain [1]. Additionally, multiple studies in the current literature include multiple routes of misoprostol administration (sublingual, oral, rectal, and vaginal) and do not account for this in analysis.

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