Norgestrel 75 mcg is a progestin-only pill (POP), which is a kind of oral birth control pill. To be effective in preventing pregnancy, this kind of birth control pill is supposed to be taken every day at the same time, without delaying the intake for more than 3 hours. This study aims to find out if taking the pill 6 hours late or not taking it for one day will affect the way it works.
This study is an exploratory, prospective, multi-center, randomized, cross-over study to assess the effect of norgestrel 75 mcg on cervical mucus and ovarian activity during reported perfect daily use, after a delayed intake of 6 hours and after a missed pill. After a screening period up to one month, depending on the menstrual cycle of the subject, the subjects will take norgestrel 75 mcg for three 28-day treatment periods, every day at the same time except for one day in the middle of treatment period 2 and treatment period 3 where they will either take it 6 hours late or not take it. In week 5 (1st visit of treatment period 2), they will be randomized to 2 sequences, either 6 hours delayed intake in treatment period 2 and missed pill in treatment period 3 or the opposite. After the end of treatment period 3, a follow-up up to 12 days may be required to follow ovarian activities. Subjects will have visits twice a week and sometimes more often to assess the effects of the pill on: * cervical mucus properties by a cervical mucus sampling * ovarian activity by a vaginal ultrasound (TVUS) * reproductive hormones levels by a blood sample (Progesterone (P4), Estradiol (E2), Follicle Stimulating Hormone (FSH), Luteinizing Hormone (LH)) * plasma drug level by a blood sample
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
52
Subjects will take norgestrel 75 mcg every day at the same time for three 28-day treatment periods, except for 1 specific day during treatment period 2 and treatment period 3
University of California Davis
Sacramento, California, United States
Oregon Health and Sciences University
Portland, Oregon, United States
Effect of Delayed Intake or Missed Pill on Cervical Mucus Score (CMS)
Difference in Cervical Mucus Score between baseline (as Day 41 or Day 69) and delayed (Day 42 and Day 70) or missed pill (Day 43 or day 71) The Insler cervical mucus score (0-12) is the sum of 4 subscores: * viscosity from 0 (thick, highly viscous) to 3 (watery,minimally viscous) * ferning from 0 (no crystallization) to 3 (tertiary and quaternary stem ferning) * spinnbarkeit from 0 (\<1 cm) to 3 (\>= 9 cm) * rank for cells from 0 (\>20 cells per High Power Field or \>1000 cells per μL) to 3 (0 cell) A score \<5 is considered as a protective score while a score \>9 is considered as a non protective score
Time frame: Day 41 +/- 3 day to Day 43 +/3 days and Day 69 +/- 3 days to Day 71 +/-3 days
Duration of Protective Effect of Cervical Mucus After a 6h Delayed or a Missed Pill
Subjects are classified according to the risk of losing cervical mucus protection after a 6h delayed or a missed pill, on the day of the infringement and on the day after A cervical mucus score (CMS) \<5 is considered as a protective score * Full protection: CMS stay \<5 after both a delayed or a missed pill, on the day of infringement and on the day after. * Absence of risk increase: CMS stay \<5 on the day of infringement and on the day after. * Transient risk increase: CMS increase \>=5 on the day of infringement but go back to \<5 on the day after. * Prolonged risk increase: CMS increase \>=5 on the day of infringement and stay \>=5 on the day after.
Time frame: Day 41 +/- 3 day to Day 43 +/3 days and Day 69 +/- 3 days to Day 71 +/-3 days
Ovarian Status (OS)
Ovarian Status (OS) defined as: * OSq = quiescence defined as an Ovarian Activity Score (OAS) =\< 3 * OSa = active defined as OAS = 4 or 5 * OSalp = ovulation with abnormal luteal phase defined as OAS = 6 at only one visit * OSnlp = ovulation with normal luteal phase as defined as OAS = 6 at two consecutive visits or OAS = 7 Ovarian Activity Score between 1 and 7: * 1= No ovarian activity * 2= Potential activity * 3= Non-active follicle like structure * 4= Active follicle like structure * 5= Postovulatory, low progesterone level * 6= Postovulatory, intermediate progesterone level * 7= Postovulatory, high progesterone level
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Time frame: From Day 1 to Day 84 (if no follow-up) or up to Day 90 (if follow-up)
Cervical Mucus Protection
Higher Cervical Mucus Score (CMS) in: * Treatment Period 1 (Reported Perfect Use Period) * Delayed pill period: Treatment Period 2 for Arm A and Treatment Period 3 for Arm B * Missed pill period: Treatment Period 3 for Arm A and Treatment Period 2 for Arm B A score =\< 4 is considered as a protective score and a score \>= 9 is considered as a non protective score
Time frame: From Day 1 to Day 84
Conception Protection Risk
Binary analysis of whether a subject is at risk of conception based only on their ovarian status (OS) and cervical mucus score (CMS) the days before ovulation: Are considered protected, subjects with OSq, OSa OR CMS =\<4 Are considered at risk, subjects with OSalp or OSnlp AND CMS \>=5
Time frame: Day 1 to Day 84 (up to Day 90 if follow-up)
Conception Protection Level
Ternary analysis of the level of protection from conception of subjects, based only on the ovarian status (OS) and cervical mucus score (CMS) the days before ovulation: * Minimum protection or unlikely to be protected: OSnlp and CMS ≥ 9 * Medium protection or likely to be protected: OSnlp and CMS comprised between 5 and 8 or OSalp and CMS ≥ 5 * Maximum protection or highly likely to be protected: OSq or OSa or a CMS ≤ 4
Time frame: Day 1 to Day 84 (up to Day 90 if follow-up)