Background: Uterine fibroids are considered the most prevalent benign tumors in women. open myomectomy is the conventional management for large or numerous fibroids. However, hemorrhage is one of the most prevalent consequences in open myomectomy cases. Misoprostol, an analog of prostaglandin E1, is widely used in obstetrics and is capable of increasing uterine contraction and decreasing hemorrhage. Our aim was to assess the impact of sublingual intake of Misoprostol before myomectomy to minimize blood loss during surgery.   
Methods: A randomized controlled clinical trial was conducted on 150 women within their reproductive age with symptomatic fibroids who are planned for open myomectomy.  They were randomized into “study" and “control" groups to receive either one dose of Misoprostol sublingually (400 mcg) or placebo before myomectomy. The operative time, intraoperative blood loss and the effect of blood loss on hematocrit and hemoglobin levels were assessed.   
Results: The operative time among the Misoprostol group was significantly shorter than the placebo group ( 58.80±4.51 vs 71.08±10.62 minutes,p<0.001). Additionally, the blood loss in the suction apparatus and the total blood losses among the Misoprostol group were significantly reduced compared to the control group (279.16±44.61 vs 340.55±66.71 ml , p<0.001).
Conclusion: A sublingual dose of Misoprostol (400 mcg) one hour before surgery significantly reduces the intraoperative blood loss and the operation time during myomectomy.