The value of misoprostol administration before intrauterine contraceptive device insertion: a systematic review and meta-analysis

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ObjectivesTo assess the value of misoprostol administration before IUD insertion.Search strategyScreening of PubMed, Scopus, Web Of Science, ScienceDirect, and clinical trials registry till April 2024 using the keywords misoprostol, prostaglandin E1 analogue, IUD, IUCD, intrauterine device, IUD insertion, and their MeSH terms.Selection criteriaAll RCTs that included misoprostol administration before IUD insertion. All doses, routes, and times of administration of misoprostol compared to placebo, analgesics, or other prostaglandins were included. This review included 19 RCTs including 2743 women (1333 had misoprostol administration and 1410 comparators (1281 received placebo, 16 received diclofenac, 43 received dinoglandin, and 70 received lignocaine).Data collection and analysisThe extracted data included location setting, number of participants randomized and analyzed, participants selection criteria, the exact intervention details (including misoprostol dose, route and timing of administration, the comparator group details, and type of IUD inserted), primary and secondary outcomes of the trial ( including pain score, easiness of insertion score, the need for analgesics, the need for additional measures as cervical dilatation, failure of insertion, complications of the insertions process, and drug side effects), risk of bias of the included studies, and trial registration number and site.Main resultsFailure of IUD insertion was evaluated in 9 studies with 1350 participants and revealed an odd ratio (OR) of 0.87 with 0.39–1.98 95% CI, P value = 0.75, and I2 score = 45%.The easiness score of insertion was evaluated in 7 studies with 780 participants and revealed an OR of − 1.12 with − 1.73 to 0.52 95% CI, P value < 0.001, and I2 score = 87%.The pain VAS was evaluated in 13 studies with 1776 participants and revealed a mean difference (MD) of − 0.23 with − 0.77 to 0.31 95% CI, P value = 0.41, and I2 score = 90%.The participants satisfaction score was evaluated in 3 studies with 366 participants and revealed a MD of 1.64 with 0.68–2.60 95% CI, P value < 0.001, and I2 score = 91%.The need for analgesics and additional measures as cervical dilatation were evaluated in 7 and 4 studies with 813 and 295 participants respectively. The reported OR (95% CI), P values, and I2 scores were 0.58 (0.32–1.03) and 0.79 (0.33–1.92), 0.06 and 0.61, and 48% and 35% respectively.ConclusionMisoprostol administration before IUD insertion was associated with higher easiness score, higher women satisfaction score, and higher side effects named nausea, vomiting, cramps, shivering, headache, and fever compared to placebo administration.Registration numberCRD42022364291.