Treating Inadequate Cervical Mucus

I have very little cervical mucus and I have been told I should take guaifenesin (Robitussin) to help increase the secretions. Is this appropriate treatment?

Question:

Guaifenesin is an expectorant, which has been proposed by one group to improve cervical mucus with reported successes. The utility of this treatment has not been prospectively compared to intrauterine insemination or estrogen therapy.

Cervical Mucus

Serum estrogen levels peak just before ovulation and stimulate the cervical glands which produce mucus. At the midcycle (day 14 of an "ideal" 28 day cycle) cervical mucus is thin, watery and stretchable (spinnbarkeit). It also ferns because of the high salt content. Normal spinnbarkeit is 8 to 10 cm. If the test for cervical mucus is performed too much before or after ovulation the mucus will appear to be abnormal or "less" because of the effects of progesterone. Further information on the evaluation of cervical mucus can be reviewed.

Causes of inadequate cervical mucus are inaccurate timing of the evaluation of cervical mucus, unrecognized anovulation (regular cycles but anovulatory), clomiphene citrate therapy, surgical procedures on the cervix such as cone biopsy or LEEP and unknown causes.

Inaccurate Timing

A basal body temperature chart will assist in insuring the test was done at the appropriate time. If not the test should be reevaluated.

Anovulation

A temperature chart helps to insure that the cycle was ovulatory. If it was not, ovulation induction must be instituted.

Clomiphene Citrate

Clomiphene citrate is and anti-estrogenic compound used to induce ovulation. It can also affect estrogen responsive cervical mucus glands by blocking the effects of estrogen locally. The influence of clomiphene 50 mg./day on cervical mucus is not significantly unfavorable. However, when clomiphene is administered in doses greater than 100 mg./day local anti-estrogen effects can be noted. Exogenous low dose estrogen administration can improve the cervical mucus in clomiphene cycles. In patients being treated with clomiphene over 50 mg./day, cervical mucus qualities may be investigated unless intrauterine inseminations are occurring which bypass the need for optimal cervical mucus.

Surgical Procedures

If surgical procedures have destroyed cervical mucus glands then intrauterine inseminations are commonly performed.

Recommendation

A discussion with your physician will provide you with the information necessary to determine the most appropriate evaluations and treatments necessary in your particular situation.

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