Six trials were included (468 patients). Four trials were considered to have been high quality.
In pre-menopausal women, mifepristone had no effect on pain (one trial), and results for misoprostol compared with placebo were mixed in two other trials. In postmenopausal women, pain following hysteroscopy was significantly reduced with misoprostol, but there was no difference between groups during clamping of the cervix or endometrial biopsy (one trial). In studies that contained pre- and post-menopausal women, significant reductions in pain were reported after hysteroscopy when misoprostol was compared with no intervention (one trial) and after cervical dilatation to 6mm when misoprostol was compared with placebo (one trial). The result after cervical dilatation remained significant in post-menopausal women only. There were no significant differences between groups specifically in relation to need for dilatation of the cervix following priming versus placebo (three trials). Statistically significant differences were found in one further trial for the amount of force needed for dilation above 6mm (pre- and post-menopausal women) and in another trial for required dilation above 6mm (premenopausal women).
There were no significant differences between groups for nausea (two trials; Ι²=0%); diarrhoea (two trials; Ι²=0%); vaginal bleeding (four trials; Ι²=78%); cervical laceration (three trials; Ι²=19%); or failed procedures (two trials; Ι²=72%).