Background:  Intraoperative blood loss is a concern in the surgical treatment of myomatous uteri. Misoprostol causes the myometrium and isolated uterine arteries to contract and has blood‐saving effects in myomectomy.
Aim:  To assess the efficacy of rectal misoprostol in reducing haemorrhage during laparoscopy‐assisted vaginal hysterectomy (LAVH).
Methods:  Retrospective case–control study. Women who had undergone LAVH for leiomyoma were enrolled (n = 117). Forty‐nine women who used 400 μg of misoprostol rectally 1 h before LAVH were compared with 68 women who did not. The surgical outcomes were compared statistically with Mann–Whitney rank sum test, χ2 test, or Fisher’s exact test.
Results:  The demographic variables were similarly distributed in both groups. There were no significant differences in the estimated blood loss, reduction in haemoglobin, operation time, or uterine weight between the two groups (P > 0.05). The rates of operative complications (4.1 vs 10.3% for the misoprostol and control groups, respectively, P = 0.21) were not different. There was no febrile morbidity (>38°C) within 24 h of the misoprostol insertion.
Conclusion:  These data do not support the use of rectal misoprostol to reduce blood loss during LAVH. The pharmacoclinical effects of misoprostol in the uterus should be clarified.