Does self‐administered vaginal misoprostol result in cervical ripening in postmenopausal women after 14 days of pre‐treatment with estradiol? Trial protocol for a randomised, placebo‐controlled sequential trial*

Abstract

Objective To compare the impact of 1000 micrograms of selfadministered vaginal misoprostol versus self-administered vaginal placebo on preoperative cervical ripening after pre-treatment with estradiol vaginal tablets at home in postmenopausal women prior to day-care operative hysteroscopy.Design Randomised double-blind placebo-controlled sequential trial. The boundaries for the sequential trial were calculated on the primary outcomes of a difference of cervical dilatation ‡1 millimetre, with the assumption of a type 1 error of 0.05 and a power of 0.95.Setting Norwegian university teaching hospital.Population Postmenopausal women referred for day-care operative hysteroscopy.Methods The women were randomised to either 1000 micrograms of self-administered vaginal misoprostol or self-administered vaginal placebo the evening before day-care operative hysteroscopy. All women had administered a 25-microgram vaginal estradiol tablet daily for 14 days prior to the operation.Main outcome measures Preoperative cervical dilatation (difference between misoprostol and placebo group, primary outcome), difference in dilatation before and after administration of misoprostol or placebo, number of women who achieve a preoperative cervical dilatation ‡5 millimetres, acceptability, complications and side effects (secondary outcomes).Results Intra-operative findings and distribution of cervical dilatation in the two treatment groups: values are given as median (range) or n (%). Difference in dilatation before and after administration of misoprostol and placebo: values are given as median (range) of intraindividual differences. Percentage of women who achieve a cervical dilatation of ‡5 mm, percentage of women who were difficult to dilate. Acceptability in the two treatment groups: values are given as completely acceptable n (%), fairly acceptable n (%), fairly unacceptable n (%), completely unacceptable n (%). Pain in the two treatment groups: pain was measured with a visual analogue scale ranging from 0 (no pain) to 10 (unbearable pain): values are given as median (range). Occurrence of side effects in the two treatment groups. Values are given as n (%). Complications given as n (%). Re-use of this article is permitted in accordance with the Creative Commons Deed, Attribution 2.5, which does not permit commercial exploitation.

The Effect of Various Dosages of Misoprostol for Cervical Preparation Before the Hysteroscopy

“…In the current study, 200 and 400 μg misoprostol significantly shortened the dilatation time (20. 19 In the present study, it was shown that the misoprostol effect was similar in both premenopausal and postmenopausal women. This finding is similar to the results of a study performed by Gkrozou et al, which mentioned that vaginal misoprostol decreased the requirement for cervical dilatation in both premenopausal and postmenopausal patients (18).…”

A combination of misoprostol and estradiol for preoperative cervical ripening in postmenopausal women: a randomised controlled trial

“…We refer to the previously published trial protocol for comprehensive methodological details 24. Those eligible for the study were all postmenopausal women (defined as at least 1 year after the last menstrual period/menstruation) referred consecutively for day-care operative hysteroscopy, and who had provided informed written consent.…”

“…07/12515-8) for the study. The trial is registered with ClinicalTrials.gov, number NCT00572819, the European Clinical Trials Database, number 2007-004083-52, and the study protocol has been published in BJOG 24. Written informed consent was obtained from all patients before randomisation.…”

“…We refer to the previously published trial protocol for comprehensive methodological details. 24 Those eligible for the study were all postmenopausal women (defined as at least 1 year after the last menstrual period/menstruation) referred consecutively for day-care operative hysteroscopy, and who had provided informed written consent. Women were excluded if they did not want to participate, if they were medically unfit for hysteroscopy or for participation in any clinical trial, or if they did not have a medical indication for hysteroscopy.…”