Misoprostol Prior to Intrauterine Device (IUD) Insertion in Nulliparous Women

• Patient perceived pain on a 100-point visual analogue scale. [ Time Frame: Prior to insertion, immediately after insertion, and prior to clinic discharge. ] [ Designated as safety issue: No ]
• Ability to insert the IUD without the use of adjunctive measures including ultrasound guidance or cervical dilation. [ Time Frame: During IUD insertion and immediately after. ] [ Designated as safety issue: No ]
• Time for IUD insertion procedure. [ Time Frame: Assessed immediately after IUD insertion. ] [ Designated as safety issue: No ]
• Presence of medication side effects. [ Time Frame: Assessed prior to IUD insertion, prior to leaving clinic, and at 1 week follow-up. ] [ Designated as safety issue: No ]
• Procedure complications. [ Time Frame: Assessed up to 1 month from time of IUD insertion. ] [ Designated as safety issue: Yes ]
• Need for additional pain medications the week following the procedure. [ Time Frame: 1 week after IUD insertion. ] [ Designated as safety issue: No ]

The purpose of this study is to see if using misoprostol makes the intrauterine device insertion easier and less painful in women who have never had a baby.

The Intrauterine Device (IUD) is an excellent contraceptive option because of its ease of use, long term duration (5-10 years), low side-effect profile, and the immediate return to fertility after IUD removal. Despite advantages associated with the IUD, the smaller cervical diameter of nulliparous patients may lead to a more difficult and uncomfortable insertion. Some providers have started pre-medicating nulliparous patients with misoprostol prior to IUD insertion because of the drug's known effect as a cervical ripening agent. Limited evidence is available addressing the effect of misoprostol on patient comfort and provider ease of IUD insertion in nulliparous women. The goal of this study is to evaluate whether using misoprostol as a cervical ripening agent in nulliparous patients eases IUD insertion and decreases pain.

• Drug: Misoprostol
  400 micrograms inserted buccally or vaginally, per the participants desire.
• Drug: Misoprostol
  400 micrograms inserted buccally or vaginally, per the participants desire prior to the IUD insertion.

• Experimental: Misoprostol
  Misoprostol 400 micrograms inserted buccally or vaginally, per the participants desire.
  Intervention: Drug: Misoprostol
• Placebo Comparator: Placebo
  Pills which are identical to the study drug in appearance, taste, and smell.
  Intervention: Drug: Misoprostol

Inclusion Criteria:

• 14 years old or older
• Negative pregnancy test
• No prior pregnancies lasting beyond 19 6/7 weeks
• Minimum 2 weeks after spontaneous or medical abortion
• Minimum 4 weeks post 2nd trimester or surgical abortion
• No previous IUD insertions
• No PID in last 3 months
• No current cervicitis
• Willing to follow-up in 1-2 months for an IUD string check

Exclusion Criteria:

• Active cervical infection
• Current pregnancy
• Prior pregnancy beyond 19 6/7 weeks gestation
• Known uterine anomaly
• Fibroid uterus distorting uterine cavity
• Copper allergy/Wilson's Disease (for Paragard)
• Undiagnosed abnormal uterine bleeding
• Cervical or uterine cancer