Objective: To evaluate the Efficacy of intrauterine lidocaine plus buccal misoprostol in reducing the discomfort caused by endometrial biopsy with a suction curette. Methods: In this double-blind, randomized, placebo-controlled trial 126 women undergoing endometrial biopsy were administered a 200-mu g tablet of misoprostol buccally, followed by a 5-mL uterine instillation of either of 2% lidocaine or a saline solution. The main outcome measures were the intensity of pain during, immediately following, and 20 min following the biopsy, as assessed on a 10-cm visual analog scale. Statistical analysis was performed using the Friedman test with the Bonferroni 2 correction, the t test, and the Z test. Results: There were no statistically significant differences between the study and control groups in mean age, parity, or relevant medical history. A statistically significant difference in pain scores was noted in premenopausal women during the procedure (lidocaine, 4.93 +/- 1.67; placebo, 6.17 +/- 1.26; P < 0.001) as well as immediately later (lidocaine, 4.12 +/- 1.14vs. placebo, 5.42 +/- 1.08; P < 0.001) and 20min later (lidocaine, 3.60 +/- 1.10; placebo, 4.22 +/- 1.46; P < 0.001). No significant differences in pain scores were observed in postmenopausal women for any of the 3 time points (6.72 +/- 2.01, 5.18 +/- 1.22, and 4.56 +/- 0.80, respectively; P > 0.05). The number needed to treat was 2.6 (95% confidence interval, 1.9-4.8). Conclusion: Intrauterine lidocaine plus buccal misoprostol appears to be effective in decreasing pain in premenopausal women undergoing endometrial biopsy with a suction curette. (C) 2006 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.