The Effect of Preoperative Sublingual Misoprostol Use on Outcome of Hysteroscopic Myomectomy

Background: Hysteroscopic myomectomy is a minimally invasive approach for managing submucous fibroids, but intraoperative bleeding remains a challenge. Misoprostol, a prostaglandin E1 analogue, may enhance uterine tone and reduce blood loss. This study aimed to assess the effect of preoperative sublingual misoprostol on intraoperative blood loss and overall operative outcomes during hysteroscopic myomectomy. Methods: This randomized controlled trial included 44 women with symptomatic submucous fibroids (FIGO types 0–2, <5 cm) who were randomly assigned to receive either 400 µg sublingual misoprostol 30 minutes before surgery (n = 22) or no preoperative medication (n = 22). Primary outcomes included estimated intraoperative blood loss and postoperative hemoglobin/hematocrit changes. Secondary outcomes were operative time, fluid deficit, and visual clarity assessed by a 10-point VAS scale. Results: Misoprostol group had significantly lower blood loss (360 ± 140 vs 450 ± 167 mL, p=0.031) and shorter operative time (10 ± 3 vs 15 ± 4 min, p<0.001). Visual clarity scores were higher (8.3 ± 0.7 vs 4.1 ± 0.8, p<0.001). Fluid deficit was also lower (0.347 ± 0.135 vs 0.834 ± 0.157 L, p<0.001). No intraoperative or postoperative complications occurred. Two patients in the misoprostol group experienced mild, transient abdominal discomfort or fever. Conclusion: Preoperative sublingual misoprostol appears to be a safe and effective adjunct that reduces blood loss and improves surgical performance during hysteroscopic myomectomy. However, the small sample size and lack of blinding warrant cautious interpretation and further multicenter RCT validation.