Application of Monsel's solution after cervical biopsy: a randomized trial

Objective: To estimate the efficacy and side effects of Monsel's solution for hemostasis after cervical punch biopsy.

Methods: In a prospective, randomized trial, we compared application of Monsel's solution versus a ‘wait and see’ approach in women undergoing cervical punch biopsies. The primary endpoint was vaginal bleeding (VB) after 15 minutes measured by scoring a sanitary pad with a 5-level pictogram. Secondary endpoints were VB after 3, 6, and 24 hours (5-level pictogram), subjective estimation of overall VB during 24 hours, pain after 15 minutes and subjective estimation of overall pain after 24 hours, and overall satisfaction after 24 hours (11-level visual analogue scale).

Results: 145 women were randomized. Mean objective VB scores after 15 minutes in 75 women with Monsel's solution were 1.2 ± 0.6 compared to 1.8 ± 1.0 in 70 women without Monsel's solution (p < 0.001). The secondary endpoints VB after 3 and after 6 hours, but not after 24 hours, were also in favor of Monsel's solution (2.1 ± 1.1 versus 2.9 ± 1.2; p < 0.001; 1.6 ± 0.7 versus 2.2 ± 1.0; p < 0.001; 1.6 ± 0.9 versus 1.7 ± 0.9; p = 0.4, respectively). Subjective estimation of overall VB during 24 hours was lower for Monsel's solution (23.2 ± 15.8 versus 35.9 ± 19.5; p < 0.001), but pain after 15 minutes, overall pain, and overall satisfaction were not significantly different between groups (19.2 ± 14.4 versus 17.9 ± 16.2; p = 0.3, 20.7 ± 15.8 versus 20.1 ± 18.0; p = 0.5, and 44.1 ± 21.5 versus 43.6 ± 23.2; p = 0.9, respectively).

Conclusion: Application of Monsel's solution reduces bleeding for six hours after cervical biopsy but does not reduce pain or increase patient satisfaction. Therefore, its use may be omitted.