Steroidal contraceptives: effect on carbohydrate metabolism in women without diabetes mellitus

Lopez, Laureen M; Grimes, David A.; Schulz, Kenneth F.

doi:10.1002/14651858.cd006133.pub2

Cited by 21 publications

(18 citation statements)

References 61 publications

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“…Studies, mostly cross-sectional in healthy women, found decreased insulin sensitivity and increased glucose response to a glucose load during HC use, although these results varied according to the estrogen dose and the type of progestin used (197–202). The residual androgenic activity of the progestin contained in the HC formulation may influence glucose metabolism more than the dose of ethinyl estradiol (203–207). Some of these studies found that HCs had deleterious effects on glucose tolerance in obese, but not in lean, women with PCOS (208–210), but our systematic review did not confirm this (211).…”

Section: Methods Of Development Of Evidence-based Clinical Practice Gumentioning

confidence: 99%

“…A Cochrane meta-analysis concluded that HCs do not have a significant effect on glucose tolerance, although this conclusion was based on limited and low-quality evidence (203). On the other hand, long-term studies performed in healthy women are promising because HC use did not result in an increased incidence of T2DM either in the general population (202) or in women with a history of gestational DM (205, 206) and was not associated with an increased risk of complications in women with type 1 diabetes (205).…”

Section: Methods Of Development Of Evidence-based Clinical Practice Gumentioning

confidence: 99%

See 1 more Smart Citation

Diagnosis and Treatment of Polycystic Ovary Syndrome: An Endocrine Society Clinical Practice Guideline

Legro

Arslanian

Ehrmann

et al. 2013

The Journal of Clinical Endocrinology & Metabolism

1,555

1,346

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Objective:The aim was to formulate practice guidelines for the diagnosis and treatment of polycystic ovary syndrome (PCOS).Participants:An Endocrine Society-appointed Task Force of experts, a methodologist, and a medical writer developed the guideline.Evidence:This evidence-based guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to describe both the strength of recommendations and the quality of evidence.Consensus Process:One group meeting, several conference calls, and e-mail communications enabled consensus. Committees and members of The Endocrine Society and the European Society of Endocrinology reviewed and commented on preliminary drafts of these guidelines. Two systematic reviews were conducted to summarize supporting evidence.Conclusions:We suggest using the Rotterdam criteria for diagnosing PCOS (presence of two of the following criteria: androgen excess, ovulatory dysfunction, or polycystic ovaries). Establishing a diagnosis of PCOS is problematic in adolescents and menopausal women. Hyperandrogenism is central to the presentation in adolescents, whereas there is no consistent phenotype in postmenopausal women. Evaluation of women with PCOS should exclude alternate androgen-excess disorders and risk factors for endometrial cancer, mood disorders, obstructive sleep apnea, diabetes, and cardiovascular disease. Hormonal contraceptives are the first-line management for menstrual abnormalities and hirsutism/acne in PCOS. Clomiphene is currently the first-line therapy for infertility; metformin is beneficial for metabolic/glycemic abnormalities and for improving menstrual irregularities, but it has limited or no benefit in treating hirsutism, acne, or infertility. Hormonal contraceptives and metformin are the treatment options in adolescents with PCOS. The role of weight loss in improving PCOS status per se is uncertain, but lifestyle intervention is beneficial in overweight/obese patients for other health benefits. Thiazolidinediones have an unfavorable risk-benefit ratio overall, and statins require further study.

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Section: Methods Of Development Of Evidence-based Clinical Practice Gumentioning

confidence: 99%

Section: Methods Of Development Of Evidence-based Clinical Practice Gumentioning

confidence: 99%

Diagnosis and Treatment of Polycystic Ovary Syndrome: An Endocrine Society Clinical Practice Guideline

Legro

Arslanian

Ehrmann

et al. 2013

The Journal of Clinical Endocrinology & Metabolism

1,555

1,346

View full text Add to dashboard Cite

show abstract

“…Hormonal contraceptives (including COCs) have been associated with subclinical disturbances in carbohydrate metabolism, including impaired glucose tolerance and insulin resistance43 that may increase the risk of type 2 diabetes and vascular disease. Studies evaluating the effects of oestrogen on carbohydrate metabolism have reported contradictory findings44-50.…”

Section: Discussionmentioning

confidence: 99%

Effects of a monophasic combined oral contraceptive containing nomegestrol acetate and 17β-oestradiol compared with one containing levonorgestrel and ethinylestradiol on haemostasis, lipids and carbohydrate metabolism

Ågren¹,

Anttila²,

Mäenpää-Liukko³

et al. 2011

The European Journal of Contraception & Reproductive Health

107

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Objectives To compare the effects of a combined oral contraceptive (COC) containing nomegestrol acetate and 17β-oestradiol (NOMAC/E2) on haemostasis, lipids, carbohydrate metabolism, C-reactive protein (CRP) and sex hormone-binding globulin (SHBG) with those of a COC containing levonorgestrel and ethinylestradiol (LNG/EE). Methods In a randomised, open-label study, 121 healthy women, 18-50 years of age, were randomly assigned to receive NOMAC/E2 (2.5 mg/1.5 mg) in a 24/4-day regimen ( n = 60) or LNG/EE (150 μg/30 μg) in a 21/7-day regimen ( n = 61) for six cycles. The primary outcome was the change from baseline to cycle 6 for all indices. Results All parameters were similar at baseline between the two groups. Over six cycles, NOMAC/E2 had less effect on most haemostatic indices than LNG/EE. Lipids were essentially unchanged with NOMAC/E2, whereas with LNG/EE high-density lipoprotein cholesterol decreased and low-density lipoprotein cholesterol and triglycerides slightly increased. NOMAC/E2 induced negligible changes in glucose and insulin parameters, in contrast to LNG/EE. A much smaller increase in CRP was observed with NOMAC/E2 than with LNG/EE. NOMAC/E2 was associated with a greater increase in SHBG. Conclusions The monophasic COC NOMAC/E2 had less influence on haemostasis, lipids and carbohydrate metabolism than the COC LNG/EE.

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“…24 Available data do not support a meaningful effect of combined oral contraceptives on glucose metabolism. 24,40,41 Combined oral contraceptives increase the risk of venous thromboembolism; this risk is also influenced by increasing age, smoking, obesity, and the specific progestin used. 40 When prescribing combined hormonal contraceptives, providers should carefully consider medical eligibility criteria such as those of the U.S. Centers for Disease Control and Prevention.…”

Section: Strategies and Evidencementioning

confidence: 99%

Polycystic Ovary Syndrome

2016

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A 22-year-old woman reports having hirsutism and irregular menses. She describes unpredictable and infrequent menses (five or six per year) since menarche at 11 years of age. Dark, coarse facial hair began to develop at 13 years of age. The symptoms worsened after she gained weight in college. The physical examination includes a body-mass index (BMI; the weight in kilograms divided by the square of the height in meters) of 29, blood pressure of 135/85 mm Hg, and moderate hirsutism without virilization. Laboratory tests reveal a total testosterone level of 65 ng per deciliter (2.3 nmol per liter) (assay reference range, 14 to 53 ng per deciliter [0.5 to 1.8 nmol per liter]), calculated free testosterone level of 15.3 pg per milliliter (53.1 pmol per liter) (assay reference range, 0.6 to 6.8 pg per milliliter [2.1 to 23.6 pmol per liter]), and glycated hemoglobin level of 5.7% (normal value, ≤5.6%). How should this case be evaluated and managed?

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Steroidal contraceptives: effect on carbohydrate metabolism in women without diabetes mellitus

Cited by 21 publications

References 61 publications

Diagnosis and Treatment of Polycystic Ovary Syndrome: An Endocrine Society Clinical Practice Guideline

Diagnosis and Treatment of Polycystic Ovary Syndrome: An Endocrine Society Clinical Practice Guideline

Effects of a monophasic combined oral contraceptive containing nomegestrol acetate and 17β-oestradiol compared with one containing levonorgestrel and ethinylestradiol on haemostasis, lipids and carbohydrate metabolism

Polycystic Ovary Syndrome

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