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

a clinical pilot

Leo Han, Emily Padua, Kyle D. Hart, Alison Edelman, Jeffrey Jensen

Research output: Contribution to journalArticle

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 hypothalamus–pituitary–ovarian (HPO) axis and used transdermal oestradiol replacement to stimulate peak cervical mucus and then evaluated the effects of an oral progestin or oestradiol withdrawal. Materials and methods: We used a crossover design to examine cervical mucus changes in women receiving transdermal oestradiol replacement following intramuscular administration of leuprolide acetate. After increasing oestradiol patches to mid-cycle levels, subjects were assigned to either 0.35 mg oral norethindrone with continuation of the patches (NET) or oestradiol withdrawal by patch removal (E2WD). We collected serum and cervical mucus samples at 0, 2, 4, 6, 22 and 24 h following the intervention. Results: We analysed 12 cycles (6 NET, 6 E2WD) from three subjects. Baseline cervical mucus scores were favourable to sperm penetration [NET median 11, interquartile range (9–12), E2WD 13 (12–13)]. Two hours after removal of oestradiol patch or administration of norethindrone, cervical mucus scores declined [NET 8.5 (4–9), E2WD 10.5 (10–12)]. Low cervical mucus scores persisted at 24 h with NET [8.0 (7–8)] 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 unfavourable through 24 h. Oestradiol withdrawal did not result in similar unfavourable changes.

Fingerprint

Cervix Mucus
Progestins
Estrogens
Estradiol
Norethindrone
Leuprolide
Sperm-Ovum Interactions
Gonadotropin-Releasing Hormone
Cross-Over Studies
Hormones

Keywords

  • Cervical mucus
  • contraception
  • Insler score
  • mini-pill
  • norethindrone
  • progestin

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynecology
  • Pharmacology (medical)

Cite this

@article{94a365c1a6c6451cb62755f14e84890d,
title = "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 hypothalamus–pituitary–ovarian (HPO) axis and used transdermal oestradiol replacement to stimulate peak cervical mucus and then evaluated the effects of an oral progestin or oestradiol withdrawal. Materials and methods: We used a crossover design to examine cervical mucus changes in women receiving transdermal oestradiol replacement following intramuscular administration of leuprolide acetate. After increasing oestradiol patches to mid-cycle levels, subjects were assigned to either 0.35 mg oral norethindrone with continuation of the patches (NET) or oestradiol withdrawal by patch removal (E2WD). We collected serum and cervical mucus samples at 0, 2, 4, 6, 22 and 24 h following the intervention. Results: We analysed 12 cycles (6 NET, 6 E2WD) from three subjects. Baseline cervical mucus scores were favourable to sperm penetration [NET median 11, interquartile range (9–12), E2WD 13 (12–13)]. Two hours after removal of oestradiol patch or administration of norethindrone, cervical mucus scores declined [NET 8.5 (4–9), E2WD 10.5 (10–12)]. Low cervical mucus scores persisted at 24 h with NET [8.0 (7–8)] 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 unfavourable through 24 h. Oestradiol withdrawal did not result in similar unfavourable changes.",
keywords = "Cervical mucus, contraception, Insler score, mini-pill, norethindrone, progestin",
author = "Leo Han and Emily Padua and Hart, {Kyle D.} and Alison Edelman and Jeffrey Jensen",
year = "2019",
month = "1",
day = "1",
doi = "10.1080/13625187.2019.1605503",
language = "English (US)",
journal = "European Journal of Contraception and Reproductive Health Care",
issn = "1362-5187",
publisher = "Informa Healthcare",

}

TY - JOUR

T1 - Comparing cervical mucus changes in response to an oral progestin or oestrogen withdrawal in ovarian-suppressed women

T2 - a clinical pilot

AU - Han, Leo

AU - Padua, Emily

AU - Hart, Kyle D.

AU - Edelman, Alison

AU - Jensen, Jeffrey

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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 hypothalamus–pituitary–ovarian (HPO) axis and used transdermal oestradiol replacement to stimulate peak cervical mucus and then evaluated the effects of an oral progestin or oestradiol withdrawal. Materials and methods: We used a crossover design to examine cervical mucus changes in women receiving transdermal oestradiol replacement following intramuscular administration of leuprolide acetate. After increasing oestradiol patches to mid-cycle levels, subjects were assigned to either 0.35 mg oral norethindrone with continuation of the patches (NET) or oestradiol withdrawal by patch removal (E2WD). We collected serum and cervical mucus samples at 0, 2, 4, 6, 22 and 24 h following the intervention. Results: We analysed 12 cycles (6 NET, 6 E2WD) from three subjects. Baseline cervical mucus scores were favourable to sperm penetration [NET median 11, interquartile range (9–12), E2WD 13 (12–13)]. Two hours after removal of oestradiol patch or administration of norethindrone, cervical mucus scores declined [NET 8.5 (4–9), E2WD 10.5 (10–12)]. Low cervical mucus scores persisted at 24 h with NET [8.0 (7–8)] 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 unfavourable through 24 h. Oestradiol withdrawal did not result in similar unfavourable changes.

AB - 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 hypothalamus–pituitary–ovarian (HPO) axis and used transdermal oestradiol replacement to stimulate peak cervical mucus and then evaluated the effects of an oral progestin or oestradiol withdrawal. Materials and methods: We used a crossover design to examine cervical mucus changes in women receiving transdermal oestradiol replacement following intramuscular administration of leuprolide acetate. After increasing oestradiol patches to mid-cycle levels, subjects were assigned to either 0.35 mg oral norethindrone with continuation of the patches (NET) or oestradiol withdrawal by patch removal (E2WD). We collected serum and cervical mucus samples at 0, 2, 4, 6, 22 and 24 h following the intervention. Results: We analysed 12 cycles (6 NET, 6 E2WD) from three subjects. Baseline cervical mucus scores were favourable to sperm penetration [NET median 11, interquartile range (9–12), E2WD 13 (12–13)]. Two hours after removal of oestradiol patch or administration of norethindrone, cervical mucus scores declined [NET 8.5 (4–9), E2WD 10.5 (10–12)]. Low cervical mucus scores persisted at 24 h with NET [8.0 (7–8)] 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 unfavourable through 24 h. Oestradiol withdrawal did not result in similar unfavourable changes.

KW - Cervical mucus

KW - contraception

KW - Insler score

KW - mini-pill

KW - norethindrone

KW - progestin

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U2 - 10.1080/13625187.2019.1605503

DO - 10.1080/13625187.2019.1605503

M3 - Article

JO - European Journal of Contraception and Reproductive Health Care

JF - European Journal of Contraception and Reproductive Health Care

SN - 1362-5187

ER -