A combination of misoprostol and estradiol for preoperative cervical ripening in postmenopausal women: a randomised controlled trial.
OBJECTIVE
To compare the impact of 1000 microg of self-administered vaginal misoprostol versus self-administered vaginal placebo on preoperative cervical ripening after 2 weeks of pretreatment with estradiol vaginal tablets in postmenopausal women prior to day-care operative hysteroscopy.


METHODS
Randomised, double-blind, placebo-controlled sequential trial.


METHODS
Norwegian university teaching hospital.


METHODS
Sixty-seven postmenopausal women referred for day-care operative hysteroscopy.


METHODS
The women were randomised to receive either 1000 microg of self-administered vaginal misoprostol or self-administered vaginal placebo on the evening before day-care operative hysteroscopy. All women had administered a 25-microg vaginal estradiol tablet daily for 14 days prior to the operation.


METHODS



METHODS
preoperative cervical dilatation at hysteroscopy.


RESULTS
difference in dilatation at recruitment and before hysteroscopy, number of women who achieved a preoperative cervical dilatation of 5 mm or more, acceptability, complications and adverse effects.


RESULTS
The mean cervical dilatation was 5.7 mm (SD, 1.6 mm) in the misoprostol group and 4.7 mm (SD, 1.5 mm) in the placebo group, the mean difference in cervical dilatation being 1.0 mm (95% CI, 0.2-1.7 mm). Self-administered vaginal misoprostol of 1000 microg at home on the evening before day-care hysteroscopy is safe and highly acceptable, although a small proportion of women experienced lower abdominal pain.


CONCLUSIONS
One thousand micrograms of self-administered vaginal misoprostol, 12 hours prior to day-care hysteroscopy, after 14 days of pretreatment with vaginal estradiol, has a significant cervical ripening effect compared with placebo in postmenopausal women.
Oppegaard
K S
KS
Department of Gynaecology, Helse Finnmark, Klinikk Hammerfest, Hammerfest, Norway. kevin.s.oppegaard@helse-finnmark.no
Lieng
M
M
Berg
A
A
Istre
O
O
Qvigstad
E
E
Nesheim
B-I
BI
D000282:Administration, Intravaginal; D000556:Ambulatory Surgical Procedures; D020070:Cervical Ripening / Q000187:drug effects*; D004359:Drug Therapy, Combination; D004958:Estradiol / Q000008:administration & dosage*; D004967:Estrogens / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000379:methods*; D008875:Middle Aged; D016595:Misoprostol / Q000008:administration & dosage*; D010120:Oxytocics / Q000008:administration & dosage*; D017698:Postmenopause; D011247:Pregnancy; D011300:Preoperative Care; D012646:Self Administration; D013607:Tablets
D004967:Estrogens; D010120:Oxytocics; D013607:Tablets; D016595:Misoprostol; D004958:Estradiol