OBJECTIVE:The aim of the study was to evaluate the value of vaginal misoprostol 6 h prior to intrauterine device (IUD) insertion in women with previous Caesarean delivery. METHODS:A double-blind randomised controlled trial was conducted in 120 women who were eligible for IUD insertion. Participants were randomly divided to receive either 600 μg vaginal misoprostol or placebo 6 h before IUD insertion. The primary outcome measure was the pain score during the procedure. Secondary outcome measures were failure of insertion, insertion difficulty score, complications of IUD insertion and side effects related to misoprostol. RESULTS:Pain and insertion difficulty scores were significantly lower in the misoprostol group compared with the placebo group (5.7 ± 1.4 vs. 6.5 ± 0.9 and 4.1 ± 1.1 vs. 5.4 ± 2.2, respectively; p < .001). More women experienced nausea, vomiting (5 vs. 0; p = .06) and cramps (10 vs. 0; p < .001) in the misoprostol group than in the placebo group, respectively. CONCLUSIONS:The use of misoprostol before IUD insertion is associated with less painful and easier placement.