title: A survey of provider experience with misoprostol to facilitate intrauterine device insertion in nulliparous women.
abstract: BACKGROUND
  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.
  
  
  METHODS
  An anonymous Internet-based survey was distributed to members of three professional organizations with family planning providers.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: University of Utah, College of Nursing, Salt Lake City, UT 84112, USA. katie.ward@nurs.utah.edu
authors.forename: Katherine
authors.initials: K
authors.lastname: Ward
authors.forename: Janet C
authors.initials: JC
authors.lastname: Jacobson
authors.forename: David K
authors.initials: DK
authors.lastname: Turok
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Murphy
mesh_terms: D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D003150:Community Health Workers; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D020407:Internet; D007434:Intrauterine Devices / Q000009:adverse effects*; D016595:Misoprostol / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D010120:Oxytocics / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D010146:Pain / Q000139:chemically induced / Q000517:prevention & control*; D010147:Pain Measurement; D010865:Pilot Projects; D010818:Practice Patterns, Physicians'; D013997:Time Factors
chemical_list: D018712:Analgesics, Non-Narcotic; D010120:Oxytocics; D016595:Misoprostol