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Vaginal Misoprostol Before Hysteroscopy

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Women undergoing hysteroscopy without anesthesia for intrauterine evaluation because of infertility experience much less pain during the examination if misoprostol is administered vaginally the day before the procedure.

That finding is reported in Fertility and Sterility, published online August 21st, by Dr. Luis Humberto Sordia-Hernandez and colleagues at Hospital Universitario, “Jose E.Gonzalez,” Universidad Autonoma de Nuevo Leon, Mexico.

The investigators point out that hysteroscopy is well accepted for office evaluation of the uterine cavity. “Unfortunately, pain related to the procedure is the major limitation for its widespread use.”

The team conducted a study comparing oral and vaginal misoprostol to placebo in facilitating office-based diagnostic hysteroscopy in 62 infertile women.

The women were assigned sequentially to oral misoprostol at a dose of 600 mcg (200 mcg every 8 hours) starting 24 hours before the procedure; vaginal misoprostol at a dose of 400 mcg (200 mcg 12 hours apart, starting 24 hours before the procedure; or oral placebo (one pill every 8 hours) starting 24 hours before the procedure.

Pelvic pain, rated by the patients on a 10-point visual analog scale immediately after the procedure ended, was 6.04, 2.85, and 7.50 in the three groups, respectively (p<0.001), Dr. Sordia-Hernandez and colleagues report. Furthermore, they found the time taken to perform the examination in the three groups was 5.5, 2.7 and 6.3 minutes. The shorter time needed in the vaginal misoprostol group was probably due to a reduction in cervical resistance and the need for cervical instrumentation. Seven patients given oral misoprostol reported GI side effects compared to three of those in the vaginal administration group. The team concludes that vaginal misoprostol could “facilitate the wide use of office hysteroscopy during an infertility workup.” Reference:
Effectiveness of misoprostol for office hysteroscopy without anesthesia in infertile patients

Fertil Steril 2010.