{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T15:48:30Z","timestamp":1769010510421,"version":"3.49.0"},"reference-count":28,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2017,3,3]],"date-time":"2017-03-03T00:00:00Z","timestamp":1488499200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"St Antonius Hospital Investigational Funds"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2018,1]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To evaluate the reduction of pain by misoprostol compared with placebo prior to hysteroscopy in postmenopausal and premenopausal nulliparous women.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Randomised multicentre double\u2010blind placebo controlled trial.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Two Dutch teaching hospitals and one Dutch university medical centre.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>Postmenopausal and premenopausal nulliparous women undergoing office hysteroscopy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients were randomised to receive either 400 microgram misoprostol or placebo 12 and 24 hours before hysteroscopy. Pain was quantified by the use of real time pain measurement using the continuous pain score meter (<jats:styled-content style=\"fixed-case\">CPSM<\/jats:styled-content>) and <jats:styled-content style=\"fixed-case\">VAS<\/jats:styled-content> scores.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Primary outcome was pain measured by the <jats:styled-content style=\"fixed-case\">CPSM<\/jats:styled-content> during passage of the hysteroscope through the cervical canal, quantified by the area under the curve (<jats:styled-content style=\"fixed-case\">AUC<\/jats:styled-content>). Secondary outcomes included <jats:styled-content style=\"fixed-case\">VAS<\/jats:styled-content> scores, other <jats:styled-content style=\"fixed-case\">CPSM<\/jats:styled-content> parameters, failures and side effects.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In all, 149 patients were randomly assigned to either misoprostol (<jats:italic>n<\/jats:italic> = 74) or placebo (<jats:italic>n<\/jats:italic> = 75). The <jats:styled-content style=\"fixed-case\">AUC<\/jats:styled-content> during introduction did not significantly differ between the intervention and the placebo group. The <jats:styled-content style=\"fixed-case\">VAS<\/jats:styled-content> score during introduction, however, demonstrated a significant difference in premenopausal nulliparous women favouring misoprostol: 2.9 (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.3\u20134.4) versus placebo 5.5 (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 3.9\u20137.1), <jats:italic>P<\/jats:italic> = 0.02, as well as the <jats:styled-content style=\"fixed-case\">AUC<\/jats:styled-content> during the entire procedure: 618 (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 410\u2013827) versus 1126 (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 671\u20131580), <jats:italic>P<\/jats:italic> = 0.04. Failures were equally distributed between the misoprostol (16%) and placebo group (13%). Intestinal side effects occurred significantly more frequently in the misoprostol group (67%) than in the placebo group (32%) [<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 4.2 (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 2.1\u20138.3), <jats:italic>P<\/jats:italic> &lt; 0.01].<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Misoprostol prior to hysteroscopy reduces pain in premenopausal nulliparous women but not in postmenopausal women. It does cause side effects.<\/jats:p><\/jats:sec><jats:sec><jats:title>Tweetable abstract<\/jats:title><jats:p><jats:styled-content style=\"fixed-case\">RCT<\/jats:styled-content>: misoprostol versus placebo prior to hysteroscopy in 149 women significantly reduces some pain parameters.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.14567","type":"journal-article","created":{"date-parts":[[2017,1,21]],"date-time":"2017-01-21T07:34:43Z","timestamp":1484984083000},"page":"81-89","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["Misoprostol for cervical priming prior to hysteroscopy in postmenopausal and premenopausal nulliparous women; a multicentre randomised placebo controlled trial"],"prefix":"10.1111","volume":"125","author":[{"given":"ML","family":"Tasma","sequence":"first","affiliation":[{"name":"Amphia Hospital Breda the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"MD","family":"Louwerse","sequence":"additional","affiliation":[{"name":"VU University Medical Centre Amsterdam the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"WJ","family":"Hehenkamp","sequence":"additional","affiliation":[{"name":"VU University Medical Centre Amsterdam the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"PM","family":"Geomini","sequence":"additional","affiliation":[{"name":"Maxima Medical Centre Veldhoven the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"MY","family":"Bongers","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology GROW \u2013 School for Oncology and Developmental Biology Maastricht University Medical Centre Maastricht the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S","family":"Veersema","sequence":"additional","affiliation":[{"name":"St. Antonius Hospital Nieuwegein Utrecht the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"PJ","family":"van Kesteren","sequence":"additional","affiliation":[{"name":"OLVG Oost Hospital Amsterdam the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"E","family":"Tromp","sequence":"additional","affiliation":[{"name":"St. Antonius Hospital Nieuwegein Utrecht the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"JA","family":"Huirne","sequence":"additional","affiliation":[{"name":"VU University Medical Centre Amsterdam the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"GC","family":"Graziosi","sequence":"additional","affiliation":[{"name":"St. Antonius Hospital Nieuwegein Utrecht the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2017,3,3]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/0029-7844(96)00108-1"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1034\/j.1600-0412.2000.079007593.x"},{"key":"e_1_2_11_4_1","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1016\/j.fertnstert.2007.02.056","article-title":"Hysteroscopy: a technique for all? 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