Re: A Question on behalf of a client

January 10, 2008

I personally had a cerclage during my last pregnancy, and it has not

affected my mucus. I still experience several days of fertile mucus and

the normal mucus build up.

God bless,

Reisinger

kplanchet wrote:

> I am currently instructing a client couple in Creighton Model. She is

> 42 years old, G6 P4. She miscarried before the first and fourth

> children. After her fourth child, she had an Mirena IUD inserted which

> was removed in September of 2007 (about 3 years later). For her last

> two pregnancies she had a cerclage due to an incompetent cervix. Her

> mother took DES when she was pregnant, but she also had an incompetent

> cervix. In her charting, she has very limited mucus. She may see one

> or two days of mucus of a low quality and quantity. She would like to

> know if this lack of mucus could be the result of the cerclage she had

> during her pregnancies.

>

> Thank you for your help.

>

> Kathy Planchet, CFCP

>

January 10, 2008

I would be more inclined to think that her limited mucus is due to : 1) her age (over 40), as the cervical crypts have decreased mucus production with age and when approaching menopause, and 2) the additional aging of the cervical crypts and decreased mucus production after the use of hormonal contraceptives (Mirena includes a hormonal contraceptive, in addition to any other hormonal contraceptive she may have used before).

Pam, RN, FCP

El Paso, TX

A Question on behalf of a client

I am currently instructing a client couple in Creighton Model. She is 42 years old, G6 P4. She miscarried before the first and fourth children. After her fourth child, she had an Mirena IUD inserted which was removed in September of 2007 (about 3 years later). For her last two pregnancies she had a cerclage due to an incompetent cervix. Her mother took DES when she was pregnant, but she also had an incompetent cervix. In her charting, she has very limited mucus. She may see one or two days of mucus of a low quality and quantity. She would like to know if this lack of mucus could be the result of the cerclage she had during her pregnancies.Thank you for your help.Kathy Planchet, CFCP

January 11, 2008

Is she Catholic and was the Mirena removal motivated by conversion, or was this a purely medical reason?

Sincerely yours,

Dominic M. Pedulla MD, FACC, CNFPMC, ABVM, ACPh

Varicoseveins1@...

Associate Clinical Professor of Medicine, OU Health Sciences Center

Medical Director, The Oklahoma Vein and Endovascular Center

President, The Edith Stein Foundation

A Question on behalf of a client

I am currently instructing a client couple in Creighton Model. She is

42 years old, G6 P4. She miscarried before the first and fourth

children. After her fourth child, she had an Mirena IUD inserted which

was removed in September of 2007 (about 3 years later). For her last

two pregnancies she had a cerclage due to an incompetent cervix. Her

mother took DES when she was pregnant, but she also had an incompetent

cervix. In her charting, she has very limited mucus. She may see one

or two days of mucus of a low quality and quantity. She would like to

know if this lack of mucus could be the result of the cerclage she had

during her pregnancies.

Thank you for your help.

Kathy Planchet, CFCP

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January 12, 2008

Kathy,

It seems likely that several mechanisms are involved.

Having had 2 cerclage procedures for her last 2 pregnancies, it is entirely possible that there has been some scarring or damage to the cervix, which could conceivably decrease the number of functioning mucus crypts.

The Mirena IUD releases levo-norgestrel, a potent progestin with some androgenic activity. It is not at all unlikely that the steady effect of potent progestin locally has affected the cervix in the same way that extended use of an oral contraceptive can. One wonders whether the concentration of levo-norgestrel reaching the cervical tissue might even be higher with Mirena than with an oral contraceptive.

It is also possible that her age has some effect, as others have mentioned.

Mark Stegman MD CFCMC

A Question on behalf of a client

I am currently instructing a client couple in Creighton Model. She is 42 years old, G6 P4. She miscarried before the first and fourth children. After her fourth child, she had an Mirena IUD inserted which was removed in September of 2007 (about 3 years later). For her last two pregnancies she had a cerclage due to an incompetent cervix. Her mother took DES when she was pregnant, but she also had an incompetent cervix. In her charting, she has very limited mucus. She may see one or two days of mucus of a low quality and quantity. She would like to know if this lack of mucus could be the result of the cerclage she had during her pregnancies.Thank you for your help.Kathy Planchet, CFCP

January 17, 2008

Yes, she and her husband are Catholic. She had it removed when they came to fully understand the teachings of the Church.

From: nfpprofessionals [mailto:nfpprofessionals ] On Behalf Of pedullad@...Sent: Friday, January 11, 2008 9:54 AMTo: nfpprofessionals Subject: Re: A Question on behalf of a client

Is she Catholic and was the Mirena removal motivated by conversion, or was this a purely medical reason?

Sincerely yours,Dominic M. Pedulla MD, FACC, CNFPMC, ABVM, ACPhVaricoseveins1Associate Clinical Professor of Medicine, OU Health Sciences CenterMedical Director, The Oklahoma Vein and Endovascular CenterPresident, The Edith Stein Foundation A Question on behalf of a client

I am currently instructing a client couple in Creighton Model. She is 42 years old, G6 P4. She miscarried before the first and fourth children. After her fourth child, she had an Mirena IUD inserted which was removed in September of 2007 (about 3 years later). For her last two pregnancies she had a cerclage due to an incompetent cervix. Her mother took DES when she was pregnant, but she also had an incompetent cervix. In her charting, she has very limited mucus. She may see one or two days of mucus of a low quality and quantity. She would like to know if this lack of mucus could be the result of the cerclage she had during her pregnancies.Thank you for your help.Kathy Planchet, CFCP

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January 17, 2008

Yes, she and her husband are Catholic. She had it removed when they came to fully understand the teachings of the Church.

From: nfpprofessionals [mailto:nfpprofessionals ] On Behalf Of pedullad@...Sent: Friday, January 11, 2008 9:54 AMTo: nfpprofessionals Subject: Re: A Question on behalf of a client

Is she Catholic and was the Mirena removal motivated by conversion, or was this a purely medical reason?

Sincerely yours,Dominic M. Pedulla MD, FACC, CNFPMC, ABVM, ACPhVaricoseveins1Associate Clinical Professor of Medicine, OU Health Sciences CenterMedical Director, The Oklahoma Vein and Endovascular CenterPresident, The Edith Stein Foundation A Question on behalf of a client

I am currently instructing a client couple in Creighton Model. She is 42 years old, G6 P4. She miscarried before the first and fourth children. After her fourth child, she had an Mirena IUD inserted which was removed in September of 2007 (about 3 years later). For her last two pregnancies she had a cerclage due to an incompetent cervix. Her mother took DES when she was pregnant, but she also had an incompetent cervix. In her charting, she has very limited mucus. She may see one or two days of mucus of a low quality and quantity. She would like to know if this lack of mucus could be the result of the cerclage she had during her pregnancies.Thank you for your help.Kathy Planchet, CFCP

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January 18, 2008

Great! I suspect she simply has had delayed ovarian return to function, not at all unusual for Depo injections, and I suspect by analogy also with Mirena removal, which is another relatively powerful progestagenic influence which may occasionally cause prolongedpituitary feedback suppression and even possibly premature ovarian senescence (premature menopause) at times.

The duration of and degree to which these "temporary" interventions are disruptive to hypothalamic-pituitary-ovarian axis function are often underestimated by those who, after all, see fertility as a bother at best anyway, and therefore lack any motivation to protect it.