Oral misoprostol for cervical priming in non-pregnant women

Abstract

Endometrial biopsy and hysteroscopy are important investigations in women presenting with abnormal vaginal bleeding. Endometrial biopsy is often performed as an outpatient procedure by endometrial aspiration. Difficulty in entering the internal cervical os may be encountered, especially in nulliparous women. The same problem may occur during hysteroscopy or dilatation and curettage. It is well known that use of a cervical priming agent is effective in reducing complications during cervical dilatation in pregnant women. However, its use in non-pregnant women is not well established. We compared oral misoprostol versus placebo for a cervical priming effect in non-pregnant women prior to hysteroscopy. The cumulative force required for cervical dilatation was significantly lower whereas the baseline cervical dilatation was significantly greater in the misoprostol group. We conclude that oral misoprostol is effective for pre-operative cervical dilatation in non-pregnant women.

A randomised placebo-controlled trial of vaginal misoprostol for cervical priming before hysteroscopy in postmenopausal women

“…We empirically chose 800 mg as the study dose because we expect the degree of drug absorption to be less in menopausal women. Ngai et al 5 , with the dosage of 400 mg orally, did not report any significant side effect. Although there was no literature suggesting the optimal dose for this group of patients it seemed that this dosage is acceptable with low incidence of side effects.…”

Priming Effect of Misoprostol on Estrogen Pretreated Cervix in Postmenopausal Women

“…These beneficial effects on cervical ripening makes it also a desirable agent for helping cervical dilatation on non-pregnant women. Ngai et al (1997) had reported misoprostol usage on non-pregnant women. Following this study many reports had supported its beneficial effects on cervical dilatation.…”

Clinical use of misoprostol for cervical ripening before transcervical procedures in non pregnant women: a randomized comparison of vaginal and sublingual administrations

“…These studies did not find a significant ripening effect of misoprostol compared with placebo. 1,11,16 Two earlier studies have suggested that misoprostol is effective for cervical ripening in postmenopausal women but both studies included postmenopausal women as a subgroup in their analysis. 10,11 Atmaca et al studied the ripening effect of misoprostol on estrogen pretreated cervix in postmenopausal women.…”

“…These include creation of false passage, difficulty in entering the internal os, cervical tear, hemorrhage, uterine perforation etc 1 The incidence of these complications can be reduced if cervix is ripened before the procedures.…”

“…8,9 There are only few studies comparing sublingual, oral and vaginal misoprostol in non pregnant post menopausal women. 1,10,11 The present study was undertaken to evaluate the efficacy of 400mcg of misoprostol administered vaginally or sublingually for cervical ripening before transcervical gynaecological diagnostic procedures in both pre and post menopausal women.…”