title: A combination of misoprostol and estradiol for preoperative cervical ripening in postmenopausal women: a randomised controlled trial.
abstract: 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.
authors.affiliation: Department of Gynaecology, Helse Finnmark, Klinikk Hammerfest, Hammerfest, Norway. kevin.s.oppegaard@helse-finnmark.no
authors.forename: K S
authors.initials: KS
authors.lastname: Oppegaard
authors.forename: M
authors.initials: M
authors.lastname: Lieng
authors.forename: A
authors.initials: A
authors.lastname: Berg
authors.forename: O
authors.initials: O
authors.lastname: Istre
authors.forename: E
authors.initials: E
authors.lastname: Qvigstad
authors.forename: B-I
authors.initials: BI
authors.lastname: Nesheim
mesh_terms: 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
chemical_list: D004967:Estrogens; D010120:Oxytocics; D013607:Tablets; D016595:Misoprostol; D004958:Estradiol