Misoprostol and Isosorbide Mononitrate for Cervical Ripening before Hysteroscopy: a Randomized Clinical Trial

Background:Hysteroscopy is a diagnostic and therapeutic modality, while cervical ripening before hysteroscopy is an issue of concern and different agents have been used for this purpose. The goal of this study is to compare the effectiveness of misoprostol and isosorbide mononitrate (IMN) for cervical ripening before hysteroscopy. Methods:In this randomized clinical trial, 56 women who were candidates for hysteroscopy were randomly assigned to misoprostol or isosorbide mononitrate groups. During the early follicular phase of the cycle, a gynecology expert performed the hysteroscopies. Cervical dilation was measured by insertion of Hegar dilators up to size 9 without force. Vaginal bleeding, headache, abdominal pain, nausea, and vital signs were recorded by a specialized nurse. Results:There was no significant difference regarding age, systolic and diastolic blood pressure in the two groups. Heart rate was significantly higher in the IMN group. Bleeding rate was not significantly different between the two groups (25.8% in the misoprostol group and 24% in the isosorbide mononitrate group, p=0.8). Headache was significantly more frequent in the isosorbide group, while abdominal pain, nausea, vomiting were significantly prevalent in the misoprostol group. The mean Hegar number used in the misoprostol and IMN groups was 7.3±1.1 vs 6.7±0.8 (p=0.03) Conclusions:Isosorbide mononitrate (IMN) is more effective than misoprostol for cervical ripening before hysteroscopy and complications are more frequent in the misoprostol group.