Espey 2014.

Methods	Location: Albuquerque, NM, USA Recruitment time: January 2010 to January 2013 Sample size calculation and outcome of focus: Assuming two‐sided alpha of .05 and a power of 80%, sample size of 80 women needed to detect 0.8 cm ± 1.25 difference in maximum pain with IUD insertion.
Participants	General with N: 83 nulliparous women Source: university reproductive health clinic Inclusion criteria: nulliparous women, desiring LNG‐IUS or CuT 380A IUD for contraception, English‐speaking, age ≥ 18 or age 14 to 17 with parental consent Exclusion criteria: history of pregnancy lasting beyond 19 6/7 weeks, any pregnancy in last 4 weeks, active genital infection or cervicitis, undiagnosed abnormal uterine bleeding, fibroids distorting uterine cavity, history of cervical or uterine cancer, uterine anomaly, PID within last 3 months, and ibuprofen or copper allergy
Interventions	1) Misoprostol 400 μg, buccally 2) Placebo Timing: 2 to 8 h before the IUD insertion
Outcomes	Primary: pain related to IUD insertion, assessed immediately after insertion (instruments removed) and pain before clinic discharge (10 cm VAS with 0 = none and 10 = worst imaginable pain) Secondary: satisfaction and side effects (1 to 2 weeks later)
Notes	IUC used: LNG‐IUS or CuT 380A
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Computer‐generated, 8‐block randomization sequence
Allocation concealment (selection bias)	Low risk	Pharmacy prepared medication at another university. Drug and placebo tablets packaged according to randomization list, labeled with consecutive numbers, and pulled in sequential order
Blinding of participants and personnel (performance bias) All outcomes	Low risk	Participants and investigators were blinded to assignment to treatment groups. Drug and placebo tablets were identical in appearance, taste and smell, and packaging.
Incomplete outcome data (attrition bias) All outcomes	Low risk	Loss to follow‐up: none for pain related to IUD insertion; also had follow‐up at 1 to 2 weeks