Background
Uterine leiomyomas are the most common benign tumours in women. Misoprostol, which is widely used in the treatment and prevention of postpartum haemorrhage in obstetrics, may decrease intra‐operative bleeding in abdominal myomectomies when haemorrhage constitutes a challenging problem.

Aims
To assess the effect on intra‐operative blood loss of using a single pre‐operative dose of rectal misoprostol in abdominal myomectomy surgeries.

Materials and Methods
In a randomised double‐blind placebo‐controlled trial, 50 women undergoing abdominal myomectomy for symptomatic uterine leiomyomas were randomly assigned to receive a single dose of pre‐operative of rectal 400 μg misoprostol (n = 25) or placebo (n = 25) 1 h before the operation. The primary outcome was intra‐operative blood loss. This clinical trial was registered in clinicaltrial.gov registry with number: NCT02061657.

Results
Intra‐operative blood loss was significantly lower in those women randomised to receive rectal misoprostol versus the placebo group (574 ± 194.8 mL vs 874 ± 171.5 mL). Additionally, the drop in postoperative haemoglobin was significantly less in the misoprostol group (1.7 ± 0.4 g/dL) compared with the placebo group (2.1 ± 0.5 g/dL).

Conclusion
A single pre‐operative dose of rectal misoprostol (400 μg) is a simple applicable method for reducing intra‐operative blood loss and operative time in abdominal myomectomy.