Misoprostol for Reduction of Blood Loss During Fibroid Surgery

Inclusion Criteria: * Patients presenting for abdominal myomectomy with documented uterine fibroids on pelvic imaging (pelvic ultrasound or MRI) within in last 12 months * Age ≥ 18 years and ≤ 50 years * Pre-operative hemoglobin \>8 g/dl * Willing to have buccal administration of misoprostol or a placebo at least one hour pre-procedure. * Ability to understand and the willingness to sign a written informed consent. * Admissible medical/surgical history * Can be previously treated with Depo-Lupron, Depo-Provera, or Oral Contraceptive pills * Intraoperative use of vasopressin and uterine tourniquet is permissible * Can have had prior Cesarean delivery Exclusion Criteria: * Patients who have had a prior abdominal myomectomy * Post-menopausal women * Patients with known bleeding/clotting disorders * Patients with a history of gynecologic malignancy * History of allergic reactions attributed to compounds of similar chemical or biologic composition to misoprostol * Any cases converted to abdominal hysterectomy or other additional elective surgical procedures performed at time of abdominal myomectomy will be excluded from data analysis * Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements.