Comparing cervical mucus changes in response to an oral progestin or oestrogen withdrawal in ovarian-suppressed women: a clinical pilot

Abstract

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.

Comparing endocervical mucus proteome of humans and rhesus macaques

“…Figure 1 describes the overall study design. We collected human samples ( n = 3) from a donors undergoing a clinical trial at Oregon Health and Science University examining the effects of the progestin‐only mini‐pill in women who had undergone ovarian suppression with add‐back hormonal therapy [6]. We used a vaginal speculum to expose the cervix and a scopette to clear the external os of any fluid or debris.…”

The effect of deliberate non-adherence to a norgestrel progestin-only pill: A randomized, crossover study

“…[11,12] A small clinical trial from Han et al demonstrated that even as oral norethindrone levels fall to near zero by 24 hours, mucus scores do not revert to being favorable. [13] However, that study did not examine mucus changes beyond 24 hours. Our study now provides the first measurements of mucus changes beyond 24 hours, and up to 48 hours in the case of a missed pill.…”

Mechanism of action of a 0.075 mg norgestrel progestogen-only pill 2. Effect on cervical mucus and theoretical risk of conception

“…However, unlike ovulation, serum progestin levels have not been directly studied with respect to cervical mucus changes. In one study of NORETHINDRONE 0.35 mg, cervical mucus is altered at very low serum NORETHINDRONE levels even while estradiol levels are elevated [21] .…”