Vaginal misoprostol for cervical priming before hysteroscopy in perimenopausal and postmenopausal women

Objective: To evaluate the effectiveness and possible adverse effects of vaginal misoprostol for cervical priming before hysteroscopy in perimenopausal and postmenopausal women. Methods: A total of 105 women scheduled for hysteroscopy were randomly assigned to 2 groups. The study group (n = 51) received 400 μg of vaginal misoprostol at least 12 h before the procedure and the control group (n = 54) received no cervical priming agent. The primary outcome measure was the number of women who required cervical dilation. Secondary outcomes were cervical width (the largest size of Hegar dilator inserted without resistance) as well as complications and adverse effects. Results: In the misoprostol group 27 women (52.9%) required cervical dilation vs. 53 (98.1%) in the control group (P < 0.0001). The largest size of Hegar dilator inserted without resistance was 7.6 ± 1.4 mm in the misoprostol group vs. 5.0 ± 1.1 mm in the control group (P < 0.0001). A similar effect of misoprostol on cervical dilation was also found in the subgroup of treated postmenopausal women. Only 2 women (3.9%) experienced mild lower abdominal pain after misoprostol application. Conclusion: Vaginal misoprostol applied before hysteroscopy reduced cervical resistance and the need for cervical dilation in perimenopausal and postmenopausal women, with only mild adverse effects.