Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR, USA.
Department of Obstetrics and Gynecology, University of California, Davis, Sacramento, CA, USA.
Contraception. 2022 Aug;112:43-47. doi: 10.1016/j.contraception.2022.03.016. Epub 2022 Mar 31.
To evaluate the cervical mucus effects of a norgestrel 0.075 mg progestin-only contraceptive pill over a 28-day cycle.
We recruited persons ages 18 to 35 with normal cycles at 2 US academic medical centers. Participants took norgestrel 0.075 mg daily for 28 days at the same time (within a 3 hour window) daily, recorded through a text-message based e-diary. We extracted cervical mucus using a standardized aspiration technique on the day of pill initiation and then at least every 3 to 4 days over the cycle. We monitored subjects for follicular activity with transvaginal ultrasound examination and blood sampling for ovarian hormones and gonadotropins at each visit. We assessed cervical mucus scoring using a 4-category/12-point modified Insler scale (score ≥9 [favoring fertility], 5-8 [intermediate], and ≤4 [unfavorable to fertility]). We stratified cervical mucus scores by serum estradiol levels and ovulatory status based on a modified Hoogland score.
Excluding enrollment, we collected and evaluated 413 mucus samples from 51 participants. Participants had a median mucus score of 0 (Interquartile Range 0, 2); most had scores ≤4 (samples = 385, 93%) and none had a score ≥9 favoring fertility. Seventeen (33%) participants ovulated, of which 14 (82%) had unfavorable mucus scores (≤4) at the time of ovulation and 3 (18%) had intermediate scores (5-8).
Norgestrel 0.075 mg daily prevents mucus changes that favor fertility, even during ovulatory cycles.
Daily administration of norgestrel 0.075 mg over an initial 28-day cycle did not result in fertile cervical mucus. Although approximately one-third of users ovulated in this first cycle of pill use, contraceptive efficacy may be maintained by mucus effects.
评估 28 天周期内诺孕酯 0.075mg 孕激素避孕药对宫颈黏液的影响。
我们在 2 家美国学术医疗中心招募了年龄在 18 至 35 岁、月经周期正常的志愿者。参与者每日服用诺孕酯 0.075mg，持续 28 天，每天同一时间（3 小时窗口期内）服药，并通过基于短信的电子日记记录。我们在开始服药当天以及服药周期内至少每隔 3 至 4 天，使用标准化抽吸技术提取宫颈黏液。我们通过阴道超声检查和每次就诊时的血液取样监测卵泡活性，以检测卵巢激素和促性腺激素。我们使用改良的 Insler 评分（4 分/12 分制，评分≥9[有利于生育]、5-8[中等]和≤4[不利于生育]）评估宫颈黏液评分。我们根据改良的 Hoogland 评分，按血清雌二醇水平和排卵状态对宫颈黏液评分进行分层。
排除入组，我们从 51 名参与者中收集并评估了 413 个黏液样本。参与者的宫颈黏液评分中位数为 0（四分位距 0，2）；大多数评分≤4（样本 385 个，93%），且无评分≥9 有利于生育。17 名（33%）参与者排卵，其中 14 名（82%）排卵时的黏液评分不佳（≤4），3 名（18%）评分中等（5-8）。
即使在排卵周期中，每日服用诺孕酯 0.075mg 也可防止有利于生育的黏液变化。
在最初的 28 天周期内，每日服用诺孕酯 0.075mg 不会导致有生育能力的宫颈黏液。尽管在使用避孕药的第一个周期中，约有三分之一的使用者排卵，但可能通过黏液作用来维持避孕效果。
