Cochrane Database Syst Rev
Misoprostol offers little benefit for routine IUD placement
Routine use of misoprostol for IUD placement isn't supported for most women, as it doesn't reduce pain or improve technical outcomes and increases side effects. Consideration may be given for women with a recent failed IUD placement, where misoprostol may improve success.
Study details: A 2025 Cochrane meta-analysis synthesized data from 14 randomized trials including 1,972 women undergoing interval placement of levonorgestrel or copper T IUDs. The review compared misoprostol (various regimens) with placebo or no treatment, assessing pain, provider ease of placement, need for cervical dilation, placement success, patient satisfaction, and adverse effects.
Results: Misoprostol resulted in little to no difference in pain scores during tenaculum placement, IUD placement, or post-procedure, and didn't meaningfully improve provider ease of placement or reduce need for cervical dilation. Placement success was unchanged except in women with a recent failed IUD attempt, where misoprostol modestly increased success rates. Misoprostol use was associated with increased preplacement abdominal pain/cramping and diarrhea. Patient satisfaction may be higher, but evidence is very uncertain.
Source:
Zapata LB, et al. (2025, September 23). Cochrane Database Syst Rev. Misoprostol for intrauterine device placement. https://pubmed.ncbi.nlm.nih.gov/40985300/