Letrozole pre-treatment plus misoprostol versus misoprostol alone in the medical management of miscarriage: a randomized controlled trial

Document Type : Original Article

Authors

Department of Obstetrics and Gynecology , Faculty of Medicine, Aswan University

Abstract

Misoprostol, a prostaglandin analogue, is commonly used for medical termination of miscarriage, though its efficacy varies. Letrozole, an aromatase inhibitor, may enhance uterine sensitivity by reducing estrogen and promoting progesterone withdrawal.
Aim: To assess whether Letrozole pretreatment improves the efficacy of misoprostol in inducing second-trimester missed miscarriage.
Methods: A randomized clinical trial was conducted at Aswan University Hospital including 70 women (14–26 weeks gestation). Group I received Letrozole (Femapent 2.5 mg, three times daily for three days) followed by two doses of vaginal misoprostol (400 µg total) on day four. Group II (control) received misoprostol alone (400 µg vaginally, two 200-µg tablets four hours apart).

Results: The Letrozole group required significantly lower total misoprostol doses, with shorter bleeding and expulsion times (p < 0.001). Complete abortion occurred in 68.6% versus 42.8% in the control group (p = 0.02). Adverse effects such as nausea, diarrhea, and chills were less frequent with Letrozole.

Conclusion: Letrozole pretreatment before misoprostol significantly enhances efficacy and tolerability for medical management of second-trimester missed miscarriage, reducing induction time, misoprostol dose, and side effects compared with misoprostol alone.

Keywords

Main Subjects

Aswan University Medical Journal
Volume 5, Issue 4
December 2025
Pages 191-199

Files

Share

How to cite

Statistics