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

Abstract

BackgroundCombined oral contraceptives (COCs) have not been shown to have major effects on lipid and carbohydrate metabolism in normal-weight women. However, we have limited information about the effects on women at high risk for cardiovascular disease and diabetes due to being overweight and obese.ObjectivesTo evaluate the effects of second and third generation contraceptive pills on lipid and carbohydrate metabolism in overweight and obese women.Patients and MethodsThis triple-blind controlled trial was performed on 137 healthy women aged 18 - 40 years with a body mass index of 25-34.9 (kg/m2) who were referred to health centers in Tabriz, Iran from 2014 to 2015. The women were randomly divided into groups who were to take 30 mcg ethinyl estradiol/150 mcg levonorgestrel (EE/LGN) (n = 69) or 30 mcg ethinyl estradiol/150 mcg desogestrel (EE/DSG) (n = 68) with an allocation ratio of 1: 1 for three cycles. As primary outcomes, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and fasting plasma glucose (FPG) were assessed; total cholesterol (TC), triglycerides (TG), and 2-hour plasma glucose in the 75-g oral glucose tolerance test (2-hour 75-g OGTT) were assessed as secondary outcomes.ResultsThe differences in lipid and carbohydrate parameters were not significant between the two groups, except for HDL-C (Adjusted MD (CI95%) = 7.00 (2.98 to 11.02)). HDL-C decreased with EE/LGN (P = 0.016) and increased with EE/DSG (P = 0.004). LDL-C and TC increased in both groups, whereas TG increased only with EE/DSG (P < 0.05). Compared with the baseline, FPG levels did not differ significantly in both groups, but EE/DSG increased 2-hour 75-g OGTT (P = 0.010).ConclusionsWe observed no significant differences between the two groups in lipid and carbohydrate metabolism, except for HDL-C. Considering the importance of overweight and obese women’s health, studies with longer follow-up periods are recommended in this respect.

Effects of oral contraceptives on metabolic parameters in adult premenopausal women: a meta-analysis

“…Four intervention-outcome pairs showed indication of publication bias: LDLc change after desogestrel, TG change after drospirenone, HDLc change after drospirenone and LDLc change after levonorgestrel. There was a study in which there was a 63 mg/dL increase in LDLc after use of a desogestrel-containing OC ( 51 ), this outlier contributed only 2.6% of the weighted mean difference but was largely responsible for an asymmetric funnel plot and significant Egger and Begg’s tests (Supplementary Fig. 2).…”

Risks, benefits size and clinical implications of combined oral contraceptive use in women with polycystic ovary syndrome

“…HDL-C increased from 51.1 mg/dl to 61.4 mg/dl, average of 10.3 mg/dl ( p = 0.108). Three other studies [ 61 , 74 , 103 ] reported an decrease in the HDL-C levels from 48.6 mg/dl to 45.3 mg/dl, average of 3.3 mg/dl ( p = 0.592) in PCOS patients who used COCs containing DSG. COCs with GSD [ 85 ] presented a nonsignificant decrease in the HDK-C, from 46.7 mg/dl to 45.9 mg/dl ( p > 0.05).…”

“…Considering all formulations, fourteen studies reported on the influence of COCs on the systolic blood pressure (SBP) of PCOS patients [ 52 , 59 , 72 , 74 , 75 , 77 , 80 , 81 , 99 – 103 , 105 ]. Four studies reporting on 35 μg EE with 2 mg CPA use demonstrated a nonsignificant increase in the SBP, from 114.2 mmHg to 116.19 mmHg, average increase of 2 mmHg ( p = 0.144) [ 52 , 59 , 77 , 103 ] of women with PCOS.…”

“…Considering all formulations, fourteen studies reported on the influence of COCs on the systolic blood pressure (SBP) of PCOS patients [ 52 , 59 , 72 , 74 , 75 , 77 , 80 , 81 , 99 – 103 , 105 ]. Four studies reporting on 35 μg EE with 2 mg CPA use demonstrated a nonsignificant increase in the SBP, from 114.2 mmHg to 116.19 mmHg, average increase of 2 mmHg ( p = 0.144) [ 52 , 59 , 77 , 103 ] of women with PCOS. With the combination of 30 μg EE and 3 mg DRSP, seven studies [ 52 , 72 , 74 , 75 , 77 , 100 , 101 ] reported a nonsignificant decrease in SBP, from 118.9 mmHg to 118.4 mmHg, average decrease of 0.5 mmHg ( p = 0.730).…”

Effects of Ethinylestradiol/Cyproterone Acetate and Ethinylestradiol/Desogestrel Alone and in Combination with Low-Dose Metformin on Glucose and Lipid Homeostasis and Androgenic Hormone Profile in Hirsute Women with Polycystic Ovary Syndrome: A Randomized, Double-Blind, Triple-Dummy Study

“…LDLC has been shown to remain unchanged with desogestrel [12] but it increases TC and TAG [12]. However, a study conducted on obese women with PCOS showed that desogestrel-containing OCP increases the LDL-C as well [15]. On the other hand, some studies have not observed changes in LDL-C or HDL-C levels [32].…”