Divergent effects of a combined hormonal oral contraceptive on insulin sensitivity in lean versus obese women

Abstract

Objective To evaluate the effects of a commonly used combined hormonal oral contraceptive (OC) on carbohydrate metabolism in obese as compared with obese women. Design 6-month prospective study. Setting Clinical Research Center at an academic medical center. Patients Premenopausal non-diabetic women with BMI < 25 kg/m2 (n=15) or > 30 kg/m2 (n=14). Intervention Ethinyl estradiol 35mcg and norgestimate 0.18/0.215/0.25 mg for 6 cycles. Main Outcome Measures Insulin sensitivity (Si) by frequent sampling intravenous glucose tolerance test; other indices of insulin sensitivity (ISI HOMA, Matsuda index); fasting lipid panel. Results Si changed from 6.62±3.69 min−1/mu/L (baseline) to 8.23±3.30 min−1/mu/L (6 months) in lean women, and from 4.36±2.32 to 3.82±2.32 min−1/mu/L in obese women (p for interaction=0.0494). Divergent effects on insulin sensitivity were also observed with ISI HOMA (p=0.0128) and Matsuda index (p=0.0227). LDL increased by approximately 20 mg/dL in both groups (p<0.005 [lean]; p<0.01 [obese]). Conclusions Lean and obese women exhibit differential changes in insulin sensitivity when given 6 months of a commonly used OC. The mechanisms of these differences, and whether these divergent effects persist long-term, require further investigations. Capsule Lean and obese non-diabetic women exhibit differential changes in insulin sensitivity when given 6 months of a commonly used OC (ethinyl estradiol 35mcg and norgestimate 0.18/0.215/0.25 mg)

Effects of Second and Third Generation Oral Contraceptives on Lipid and Carbohydrate Metabolism in Overweight and Obese Women: A Randomized Triple-Blind Controlled Trial

“…In a recently published study, no statistically significant difference was observed in the fasting glucose levels between obese and normal-weight women during three months of intervention (30). Similarly, in a study by Cheang et al, there were no significant differences in FPG between lean and obese women after six months (31). These findings may indicate that the changes in carbohydrate metabolism in overweight and obese women are similar to those of normal-weight women who take COCs.…”

Metabolic Effects of a Commonly Used Combined Hormonal Oral Contraceptive in Women With and Without Polycystic Ovary Syndrome

“…The other study evaluated the OC in regular cycling women without PCOS exclusively (NCT00205504). 9 Both the previous studies and the present study were approved by the Virginia Commonwealth University Institutional Review Board. All study participants provided informed consent.…”

“…All study participants provided informed consent. For this report, we included all PCOS women randomized to OC, but not metformin (from NCT00682890) 24 and matched their BMI to normal women (from NCT00205504) 9 using the nearest neighbor method. All subjects included in this report were overweight or obese.…”

“…6,7 However, OCs may be associated with insulin resistance and glucose intolerance. [8][9][10] Thus, there is concern that OCs may further exacerbate the underlying metabolic dysfunction and insulin resistance in women with PCOS. 11 This is specifically concerning in obese women with PCOS, who have insulin resistance both due to PCOS and excess adiposity.…”

“…OCs may be associated with insulin resistance and glucose intolerance even in women without PCOS. [8][9][10] Whether women with PCOS are more susceptible than normal women has only been evaluated in two studies. One study evaluated a norethindrone-containing OC in PCOS women compared to BMI-matched controls.…”