A survey of provider experience with misoprostol to facilitate intrauterine device insertion in nulliparous women



      There is a significant need for research on treatments that provide pain relief during intrauterine device (IUD) insertion. Misoprostol is frequently used before IUD insertion but is not always necessary and its use may increase pain and side effects. This survey evaluated how providers who perform IUD insertion in nulliparous women report using misoprostol to facilitate the procedure.

      Study Design

      An anonymous Internet-based survey was distributed to members of three professional organizations with family planning providers.


      Of 2211 survey respondents, 1905 (86%) reported providing IUDs to nulliparous women. Of those providing IUDs to nulliparous women, 947/1905 (49.7%) reported using misoprostol, and 380 (40%) of 947 of misoprostol users reported using the treatment empirically with all nulliparous IUD insertions. There was wide variation reported in dose, route and timing of misoprostol administration. Providers most commonly reported learning of misoprostol use for IUD insertion by word of mouth rather than through the literature.


      Despite conflicting published data, nearly half of survey respondents use misoprostol before IUD insertion. Considerable variation in the timing of misoprostol use may explain differences in perception of its effectiveness. Evidence-based information about misoprostol for IUD insertion in nulliparous women, including pharmacokinetics, efficacy and optimal dosing, is needed.


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      1. Guttmacher Institute Facts on Induced Abortion. 2010 [cited 2010 December 26]; Available from:

        • Hatcher R.A.
        • Trussell J.A.
        • Nelson A.L.
        • Cates W.
        • Stewart F.H.
        • Kowal D.
        Contraceptive Technology, 19th revised edition.
        Ardent Media, New York2007
      2. Association of Reproductive Health Professionals. A clinical update on intrauterine contraception. 2008 [cited 2010 December 26]; Available from:

        • Lauersen N.H.
        • Kurkulos M.
        • Graves Z.R.
        • Leeds L.
        A new IUD insertion technique utilizing cervical priming with prostaglandin.
        Contraception. 1982; 26: 59-63
        • Li Y.T.
        • Kuo T.C.
        • Kuan L.C.
        • Chu Y.C.
        cervical softening with vaginal misoprostol before intrauterine device insertion.
        Int J Gynaecol Obstet. 2005; 89: 67-68
        • Saav I.
        • Aronsson A.
        • Marions L.
        • Stephansson O.
        • Gemzell-Danielsson K.
        Cervical priming with sublingual misoprostol prior to insertion of an intrauterine device in nulliparous women: a randomized controlled trial.
        Hum Reprod. 2007; 22: 2647-2652
        • Heikinheimo O.
        • Inki P.
        • Kunz M.
        • et al.
        Double-blind, randomized, placebo-controlled study on the effect of misoprostol on ease of consecutive insertion of the levonorgestrel-releasing intrauterine system.
        Contraception. 2011; 81: 481-486
        • Schaefer E.
        • VanHouten L.
        • Olson A.
        • Lecalir C.
        • Bednarek P.H.
        • Edelman A.
        Prophylactic misoprostol prior to IUD insertion in nulliparous women.
        Contraception. 2010; 82: 188
        • Dijkhuizen K.
        • Dekkers O.M.
        • Holleboom C.A.
        • et al.
        Vaginal misoprostol prior to insertion of an intrauterine device: an RCT.
        Hum Reprod. 2010; 26: 323-329
        • Hofmeyr G.J.
        • Gulmezoglu A.M.
        • Pileggi C.
        Vaginal misoprostol for cervical ripening and induction of labour.
        Cochrane Database Syst Rev. 2010; : CD000941
        • Kulier R.
        • Gulmezoglu A.M.
        • Hofmeyr G.J.
        • Cheng L.N.
        • Campana A.
        Medical methods for first trimester abortion.
        Cochrane Database Syst Rev. 2004; : CD002855
        • Crane J.M.
        • Healey S.
        Use of misoprostol before hysteroscopy: a systematic review.
        J Obstet Gynaecol Can. 2006; 28: 373-379
        • Dehlendorf C.
        • Ruskin R.
        • Darney P.
        • Vittinhoff E.
        • Grumbach K.
        • Steinauer J.
        The effect of patient gynecologic history on clinican contraceptive counseling.
        Contraception. 2010; 82: 281-285
        • Dehlendorf C.
        • Levy K.
        • Ruskin R.
        • Steinauer J.
        Health care providers' knowledge about contraceptive evidence: a barrier to quality family planning care?.
        Contraception. 2010; 81: 292-298
        • Hubacher D.
        • Reyes V.
        • Lillo S.
        • Zepeda A.
        • Chen P.
        • Croxatto H.
        Pain from copper intrauterine device insertion: randomized trial of prophylactic ibuprofen.
        Am J Obstet Gynecol. 2006; 195: 1272-1277