Misoprostol prior to inserting an intrauterine device in nulligravidas: a randomized clinical trial

Scavuzzi, Adriana; Souza, Alex Sandro Rolland; Costa, André dos Santos; Amorim, Melânia Maria Ramos

doi:10.1093/humrep/det240

Cited by 39 publications

(35 citation statements)

References 22 publications

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“…Of the 15 RCTs included in our systematic review, 10 examined misoprostol [23–32], 2 examined intracervical 2% lidocaine [33,35], 1 examined diclofenac plus intracervical 2% lidocaine [37] and 2 examined nitric oxide donors [34,36]. Four RCTs [27,34–36] included only LNG IUDs, three [28,31,37] included only copper (Cu) IUDs and eight [23–26,29,30,32,33] included both LNG and Cu IUDs but did not stratify results by IUD type. Of the 12 RCTs that included LNG IUDs, 1 specifically reported including only 52 mg LNG IUDs [23]; it is unlikely that any of the other RCTs included the newer, smaller LNG IUD (13.5 mg) since most completed data collection before it became available [24–26,29,30,32–34,36,37].…”

Section: Resultsmentioning

confidence: 99%

Medications to ease intrauterine device insertion: a systematic review

et al. 2016

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Section: Resultsmentioning

confidence: 99%

Medications to ease intrauterine device insertion: a systematic review

et al. 2016

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“…Signifi cant concerns cited by healthcare providers regarding pre-procedure misoprostol use often include concern for higher rates of IUD expulsion and other negative side effects of misoprostol [6]. Of the above studies, rates of expulsion were either very low or not addressed.…”

Section: Discussionmentioning

confidence: 99%

“…The authors conclude the benefi ts of misoprostol use prior to IUD insertion outweigh the risks and suggested its use should become standard practice in nulligravid women [6]. This is the largest study evaluating use of vaginal misoprostol in nulligravidas identifi ed for this review.…”

Section: Methodsmentioning

confidence: 97%

“…It is known that peak misoprostol plasma concentration occurs at signifi cantly different time points depending on route of administration (< 30 minutes for sublingual use with rapid decrease compared to 1 hour for vaginal use with plasma levels remaining signifi cantly elevated for at least 6 hours). Side effects also differ based on route of administration with milder side effects generally noted for vaginal administration [6]. Additionally, a previous study by Zieman et al suggested that systemic bioavailability with a vaginal route of administration is 3 times greater than with oral administration and that there are signifi cant differences in the pharmacokinetics of misoprostol administered vaginally versus orally that could account for difference in clinical effi cacy [7].…”

Section: Introductionmentioning

confidence: 99%

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Use of Vaginal Misoprostol Prior to Placement of an Intrauterine Device: A Review

Stockdale¹

2017

J Gynecol Res Obstet

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Clinical Group AbstractIntrauterine devices (IUD) are a highly effective and safe form of contraception. However, many individuals, particularly nulligravidas, elect against IUD use due to fear of pain associated with insertion. Misoprostol has been proposed as an agent to ease IUD insertion and decrease associated pain. However, its effi cacy in the literature is inconclusive and its use varies widely between healthcare providers. We present a review on the effi cacy of vaginal misoprostol in facilitating IUD insertion and reducing procedureassociated pain.

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“…Intracervical nitroprusside gel36 and vaginal, oral, or sublingual misoprostol37–43 have been described with conflicting results.…”

Section: Proper Insertion Proceduresmentioning

confidence: 99%

Role of the levonorgestrel intrauterine system in effective contraception

Attia¹,

Ibrahim²,

Abou‐Setta³

2013

PPA

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Norgestrel, a synthetic progestin chemically derived from 19-nortestosterone, is six times more potent than progesterone, with variable binding affinity to various steroid receptors. The levonorgestrel-releasing intrauterine system (LNG IUS) provides a long-acting, highly effective, and reversible form of contraception, with a pearl index of 0.18 per 100 women-years. The locally released hormone leads to endometrial concentrations that are 200–800 times those found after daily oral use and a plasma level that is lower than that with other forms of levonorgestrel-containing contraception. The contraceptive effect of the LNG IUS is achieved mainly through its local suppressive effect on the endometrium, leading to endometrial thinning, glandular atrophy, and stromal decidualization without affecting ovulation. The LNG IUS is generally well tolerated. The main side effects are related to its androgenic activity, which is usually mild and transient, resolving after the first few months. Menstrual abnormalities are also common but well tolerated, and even become desirable (eg, amenorrhea, hypomenorrhea, and oligomenorrhea) with proper counseling of the patient during the choice of the method of contraception. The satisfaction rates after 3 years of insertion are high, reaching between 77% and 94%. The local effect of the LNG IUS on the endometrium and low rates of systemic adverse effects have led to its use in other conditions rather than contraception, as for the treatment of endometrial hyperplasia, benign menorrhagia, endometriosis, adenomyosis, and uterine fibroids.

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Misoprostol prior to inserting an intrauterine device in nulligravidas: a randomized clinical trial

Abstract: None.

Cited by 39 publications

References 22 publications

Medications to ease intrauterine device insertion: a systematic review

Medications to ease intrauterine device insertion: a systematic review

Use of Vaginal Misoprostol Prior to Placement of an Intrauterine Device: A Review

Role of the levonorgestrel intrauterine system in effective contraception

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