Please select the eligibility criteria that correspond to the clinical trial below.
Title: Effect of Prophylactic Misoprostol Prior to Intrauterine Device Insertion
Brief Summary: The purpose of this study is to see if using misoprostol (a medication that softens the cervix) before placing an intrauterine device for contraception reduces pain in women who have never delivered a baby.


Options:
A: Inclusion Criteria:

* Nulliparous women (defined as those without a history of pregnancy, despite the outcome, beyond 20 weeks gestation)
* Ages 18-45
* Seeking long-term reversible contraception with an intrauterine device (either Mirena or Paraguard) through the OHSU Center for Women's Health and Planned Parenthood of the Columbia Willamette

Exclusion Criteria:

* Pregnancy occurring less than 6 weeks from time of presentation
* History of prior intrauterine device placement
* History of Mullerian tract anomalies
* History of uterine surgery
* Allergy or intolerance to misoprostol or other prostaglandin
* Pelvic inflammatory disease (current or within the past 3 months)
* Sexually transmitted diseases (current)
* Puerperal or postabortion sepsis (current or within the past 3 months)
* Purulent cervicitis (current)
* Undiagnosed abnormal vaginal bleeding
* Malignancy of the genital tract
* Known uterine anomalies or fibroids distorting the cavity in a way incompatible with intrauterine device insertion
* Allergy to any component of the intrauterine device or Wilson's disease (for copper- containing intrauterine device)
B: Inclusion Criteria:

* Female
* 18 years or older
* Requesting suction aspiration for spontaneous or elective abortion
* Intrauterine pregnancy documented with ultrasound. For women with a gestational sac, the gestational age (EGA) must be ≥ 5 weeks 0 days but ≤ 12 weeks 0 days based on the following criteria:

  * If no embryonic pole present: EGA (days) = mean sac diameter (mm) + 30 (Mean sac diameter =\[length+width+depth\]/3)
  * If embryonic pole is present: EGA (days) determined by Hadlock scale for measured crown-rump length
* Desiring intrauterine contraception
* In general good health
* Willing and able to undergo informed consent
* Willing to comply with randomization and study follow-up schedule

Exclusion Criteria:

* Pelvic exam with evidence of active cervicitis or PID (eg. purulent discharge, adnexal mass, significant cervical or uterine tenderness)
* PID or sexually transmitted infection within the previous three months
* History of pelvic Actinomyces
* Unexplained vaginal bleeding
* Uterine anomaly (eg. bicornuate uterus)
* Leiomyomata that distort the uterine cavity
* Known or suspected complete molar pregnancy
* Current confirmed or possible ectopic pregnancy
* AIDS without treatment (individuals with HIV/AIDS who are clinically well are not excluded)
* Any prior surgical aspiration during this current pregnancy
* Use of osmotic dilators (eg. laminaria) or misoprostol for cervical preparation during the aspiration procedure
* Allergy to polyethylene
* Allergy to levonorgestrel (for levonorgestrel-containing IUS only)
* Allergy to copper (for copper T380A IUD only)
* Wilson's disease (for copper T380A IUD only)
* Current participation in another research study which would interfere with the conduct of this study
C: Inclusion Criteria:

* Woman currently using MIRENA for contraception or menorrhagia with duration use between 4 years 3 months and 4 years 9 months and willingness to continue with the method.
* Normal size uterus at insertion, corresponding to sound measure of 6-10 cm.
* Clinically normal cervical smear result within 12 preceding months or at screening.
* Clinically normal breast examination findings. For patients \>/= 40 years at screening, a clinically normal mammography result within 12 preceding months or at screening is required.

Exclusion Criteria:

* Menopausal symptoms impairing patient's quality of life or current estrogen therapy for menopausal symptoms.
* Known or suspected pregnancy.
* Any distortion of the uterine cavity, including congenital or acquired uterine anomalies and fibroids distorting the uterine cavity.
* Current or recurrent pelvic inflammatory disease.
* Abnormal uterine bleeding of unknown origin.
* Acute cervicitis or vaginitis not responding to treatment.
* History of, diagnosed or suspected genital or other malignancy (excluding treated squamous cell carcinoma of the skin), and untreated cervical dysplasia.
* Any active acute liver disease or liver tumor.
D: Inclusion Criteria:

* Age \>18 OR between the ages of 12-17 with a parent/legal guardian who can consent
* English speaking
* Desires a Mirena® or ParaGard® IUD
* Nulliparous woman
* Can use laughing gas
* Has not taken narcotic pain medications prior to procedure

Exclusion Criteria:

* Currently pregnant
* If you have been pregnant before, pregnancy lasting longer than 19 weeks, 6 days
* Less than 4 weeks have elapsed from the end of a spontaneous abortion or medical abortion.
* Desires Skyla® IUD
* Pelvic Inflammatory Disease in the last 3 months
* Current mucopurulent discharge
* Uterine anomaly that distorts the uterine cavity
* Known uterine fibroid with disruption of the uterine cavity
* Copper allergy/Wilson's disease (for ParaGard®)
* Current cervical or uterine cancer
* Inability to breathe through the nose
* Significant active upper airway infection

Answer: A