Comparison of sublingual misoprostol with lidocaine spray for pain relief in office hysteroscopy: a randomized, double-blind, placebo-controlled trial.

Objective: To compare the effectiveness of sublingual misoprostol with lidocaine pump spray for office hysteroscopy.

Methods: Premenopausal women who had an indication for office hysteroscopy were included in this randomized, double-blind, placebo-controlled study. Eighty-two patients were evaluable for the final analysis. Methods: A tertiary referral center. Methods: Premenopausal women who had an indication for office hysteroscopy were included. Eighty-two patients were evaluable for the final analysis. Methods: Patients were randomized to receive either sublingual misoprostol and placebo of lidocaine or lidocaine pump spray applied to the cervix and placebo of misoprostol.

Results: When compared with the lidocaine group, patients in the misoprostol group reported less pain by the immediate visual analog scale scores (2.2 ± 0.98 vs. 2.6 ± 0.99, p = .030), whereas visual analog scale scores at 10 minutes were similar between groups (2.1 ± 0.98 vs. 2.36 ± 1.06, p = .156).

Conclusions: Sublingual misoprostol is more effective than lidocaine spray in pain reduction during office hysteroscopy. Misoprostol may cause vaginal spotting, which may impair the vision during hysteroscopy especially just after the menstrual period. Preventive measures should be taken to make the procedure pain free because the physician may underestimate pain perception during the procedure.