Objective: To assess the effectiveness and safety of misoprostol before IUD insertion in women after the end of bleeding days of their menses.  
Materials and methods: The study was a randomized clinical trial conducted at Assiut Woman's Health Hospital; Egypt from October 2021 to March 2023 including women who requested copper T380A IUD insertion after the stoppage of bleeding days of the menses. The women were randomized to either group I: misoprostol (400 µg misoprostol tablets vaginally 3 hours before IUD insertion) and group II: no intervention group. The primary outcome was the degree of pain during IUD insertion measured using the visual analogue scale (VAS). The data was analyzed by an unpaired t-test, Mann-Whitney test, and chi-square test. 
Results: Sixty women consented to participate and were divided into two equal groups. There was a significantly lower VAS score for pain during and 5 minutes after IUD insertion. Also; a significantly lower easiness and higher woman's satisfaction was noted in the misoprostol group. However; the successful device placement, duration of insertion, and complications were comparable in both groups. 
Conclusion: The vaginal misoprostol use before copper T380A IUD insertion during the bleeding-free days of the menstrual cycle is safe and reduces IUD insertion pain, increases easiness of insertion, and women's satisfaction.