Purpose-Prior studies evaluating the effect of administered progestogens on peak cervical mucus have not controlled for the influence of endogenous hormones. To address this, we treated women with a gonadotropin-releasing hormone (GnRH) agonist to suppress the hypothalamuspituitary-ovarian (HPO) axis and used transdermal estradiol replacement to stimulate peak cervical mucus, and then evaluated the effects of an oral progestin or estradiol withdrawal.Materials and Methods-We used a crossover design to examine cervical mucus changes in women receiving transdermal estradiol replacement following intramuscular administration of leuprolide acetate. After increasing estradiol patches to mid-cycle levels, subjects were assigned to either 0.35 mg oral norethindrone with continuation of the patches (NET) or estradiol withdrawal by patch removal (E2WD). We collected serum and cervical mucus samples at 0, 2, 4, 6, 22 and 24 hours following the intervention.Results-We analyzed 12 cycles (6 NET, 6 E2WD) from three subjects. Baseline cervical mucus scores were favorable to sperm penetration [NET median 11, interquartile range (9-12), E2WD 13 (12-13)]. Two hours after removal of estradiol patch or administration of norethindrone, cervical mucus scores declined ]. Low cervical mucus scores persisted at 24 hours with ] but not E2WD [10.5 (8-11)]. Conclusions-We observed a rapid decline in cervical mucus Insler scores following administration of a single dose of oral norethindrone, and scores remained lower and unfavorable through 24 hours. Estradiol withdrawal did not result in similar unfavorable changes.

Our artificial cycle model (leuprolide acetate suppression) and dose escalation with estradiol patches produced favourable cervical mucus with mucus scores similar to those in the periovulatory phase of natural menstrual cycles. Additional studies are needed to validate the model for evaluation of mucus effects of contraceptive agents.

BackgroundResearch demonstrates removing barriers to access, decreasing costs and offering same-day placement of long-acting reversible contraception (LARC) increases contraceptive uptake in young women. For those in community college (CC), LARC utilization might reduce the risk of dropout and improve degree completion. We identified a local school who had documented an unmet need for on-campus services through a recent student assessment. We then established an on-campus, same day contraceptive clinic at the CC as part of a clinical trial. We found that students did not use the service even after multiple attempts to increase awareness and we ended the study. Here, we report lessons learned from attempting research in this environment in addition to results from a follow-up survey to determine why students did not access the clinical resource. Students reported that they already had good access to contraception and preferred to get their healthcare off-campus. This study demonstrates the complexities of studying highly focused interventions to influence access to care in the current health care environment with ever changing regulations.Trial registration NCT02735551 . Registered April 6, 2016.