More harm than good: the lack of evidence for administering misoprostol prior to IUD insertion

Abstract

The administration of misoprostol prior to insertion of an intrauterine device has become a widespread practice. Because of its utility for cervical ripening before procedures such as dilatation and curettage, misoprostol has been assumed to be a safe and useful adjunct both to facilitate the ease of insertion of an IUD and to reduce the pain experienced by women during this procedure. As this practice has become more widely used, a body of literature has evolved to assess whether or not it truly improves the IUD insertion experience for providers and patients. A literature search showed that six controlled trials have been carried out to assess this practice (one is reported in abstract form only). The dosing and route of administration vary between the trials; however, there are quite consistent findings that not only does misoprostol administration not improve the ease of insertion of IUDs but it also leads to increased unpleasant side effects. The routine use of misoprostol for IUD insertion should be abandoned.