Priming Effect of Misoprostol on Estrogen Pretreated Cervix in Postmenopausal Women

Abstract

[237][238][239][240][241] Misoprostol, which is a prostaglandin E1 analogue, is effectively used in cervical priming in women both for labor induction and for gynecological procedures. Although its efficacy is well documented in reproductive age women, during postmenopausal period this efficacy is limited probably due to estrogen deficit. Our objective is to evaluate if estrogen deficit in postmenopausal women is important for the effect of misoprostol on cervical ripening before diagnostic procedures. In this study, 45 patients were randomly allocated to estrogen or placebo group. The study group received local estrogen cream and other group received chlindamycine phosphate cream as placebo. The patients were given oral misoprostol 24 and 12 hours before the procedure for uterine cavity evaluation. Cervix was dilated by using Heagar dilator up to 6 mm. Data were analyzed by Student t-test, Mann-Whitney's U-test, chi-square test and paired samples t-test where appropriate. Basal cervical widths for the estrogen and placebo groups were 4.4 ± 0.7 and 3.7 ± 0.7 mm, respectively (p < 0.01). Mean time required for dilatation of cervix was 44.4 ± 16.2 seconds for the estrogen group and 61.4 ± 18.3 seconds for the placebo group (p < 0.01). As a conclusion, misoprostol treatment alone is not effective to get cervical priming in postmenopausal women, and as shown in our study, pretreatment with local estrogen overcome the failure. To get a beneficial effect of misoprostol on cervical ripening, estrogenic activity is necessary and when pretreated with local estrogen, misoprostol ameliorates cervical priming in postmenopausal women. misoprostol; postmenopausal women; cervical ripening; estrogen

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

“…It was concluded that misoprostol alone was ineffective for cervical ripening but it was effective in 22 women as they had used estriol vaginal cream for 14 days prior to dilatation. 7 The types of side effects were comparable in both the groups, consistent with the findings of previous studies. 6 However the frequencies of side effects were slightly more in our study.…”

“…6 Various studies in premenopausal women have shown misoprostol is a cheap alternative to laminaria tent whereas in post menopausal women it failed to show the similar benefit. 7 As far as the route is concerned both oral and vaginal has similar efficacy rate. Few studies have shown sublingual route is more effective when compared with vaginal and oral for pregnancy termination.…”

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*

“…References from identified publications were manually searched and cross-referenced to identify additional relevant articles. The studies have shown different cervical response and outcomes 13–18. In our previous study4 we found that 1000 micrograms of self-administered vaginal misoprostol at home at least 12 hours prior to operative hysteroscopy was effective, safe and acceptable for cervical priming in premenopausal but not in postmenopausal women.…”

218: Comparison of Self-administered Vaginal Misoprostol Versus Placebo for Cervical Ripening Prior to Operative Hysteroscopy Using a Sequential Trial Design

“…[11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] Most of the studies have separately, but not systematically, compared the effect on different groups of women, such as nulliparous women and postmenopausal women. Eight of the studies included less than 50 women, 12,13,16,18,[20][21][22]25 four did not compare the effect of misoprostol with a placebo, [23][24][25]27 and ten of the trials appear to be underpowered or lacking a sample size calculation as regards to evaluating primary outcome measures. [11][12][13][16][17][18][20][21][22]26 It appears that none of the trials has been designed and conducted in accordance with the CONSORT statement.…”

“…[12][13][14][15][16][17][19][20][21][22][23][24][25][26][27] Less commonly, preoperative ripening is assessed by measuring cumulative dilatation force using a cervical tonometer. 11,13,16 Cervical resistance to dilatation or complications encountered during the procedure are also parameters that can indicate effectiveness of cervical ripening.…”