A prospective controlled study of the effect on blood pressure of contraceptive preparations containing different types and dosages of progestogen

Abstract

A prospective controlled study investigated the effects of oral contraceptives on blood pressure in 485 women who were between 17 and 46 years of age and had blood pressures of < 140/90 mmHg at entry. The women were divided into seven groups depending on the chosen method of contraception: intrauterine device o r barrier method (control group): ethinyl oestradiol 3 0 p g plus levonorgestrel 150 p g (Microgynon-30 or Ovranette); norethisterone 350 p g (Micronor): norgestrel 75 pg (Neogest): norethisterone oenanthate 200 mg intramuscularly every 2 months for the first 6 months, then every 3 months thereafter; ethinyl oestradiol 30 pg plus ethynodiol diacetate 2 mg (Conova-30); and ethynodiol diacetate 500 p g (Femulen). Blood pressures were measured every 3 months by the family planning clinic nurse under standardized conditions using an Elag-Koln automatic sphygmomanometer. After one year, blood pressure had risen significantly (P(0.05) in the 137 women taking ethinyl oestradiol plus levonorgestrel (mean systolic and diastolic rises 6 . 4 and 2 . 7 m m H g respectively) and in the 91 women taking ethinyl oestradiol plus ethynodiol diacetate (mean systolic and diastolic rises 6 . 2 and 3 .O m m H g respectively). The 9 4 women taking the progestogen-only preparations and the 143 women in the control group showed n o increases in blood pressure. These d a t a were confirmed after 2 years of follow-up.

Effects of two contraceptives containing drospirenone on blood pressure in normotensive women

“…Previous studies that evaluated COCs and progestogens other than DRSP reported increased BP [13,29,30], even when contraception was provided by the nonoral route [31]. Therefore, the presence of DRSP may have contributed toward a lack of change in BP in the groups and prevented its increase, as reported by other authors [3,12,22,24,25].…”

“…In normotensive patients, COCs can increase BP [8][9][10][11][12]. In addition, increases in BP levels of 4-5 mmHg have been documented with the use of COCs containing low doses of ethinylestradiol (EE) [10,13,14], and these results were confirmed by other studies using ambulatory blood pressure monitoring (ABPM) [11]. Small reductions in systolic blood pressure (SBP) (10 mmHg) and diastolic blood pressure (BP) (5 mmHg) are associated with one-to twofifths reduction in future cardiovascular disease [15].…”

“…However, recent evidence suggests that progestogens may also exert an important effect on BP [13,16]. Most progestogens used are ineffective in antagonizing the effects of estrogen, particularly on BP [17].…”

Impact of female hormones on blood pressure: Review of potential mechanisms and clinical studies

“…Most studies found that women using oral contraceptives have higher BPs than nonusers, but the magnitude of the differences vary, possibly reflecting differences in the populations studied and variations in the doses and types of agents used [36,37,38•,39-43,44••]. When evaluated, the effect of oral contraceptives on BP is more consistently related to estrogens than to progestational agents, whereas reports of the effects of progestogens on BP differ [40,41,43,45,46]. In some studies, progestogens reportedly have no effect on BP [43,46], although The Oral Contraceptive Study of the Royal College of General Practitioners, a prospective study, found that the incidence of hypertension increased with the duration of use and with increasing strength of the progestin [47].…”

The progestin-only oral contraceptive —its place in postpartum contraception

“…Initiation of POC use immediately or within seven days after childbirth has been suggested on the grounds that (a) it would not enhance the risk of thrombosis, (b) return of ovulation may precede return of menses, and (c) women may not return for subsequent follow-up visits, and hence may become pregnant early in the postpartum period [42]. Wilson et al [43] suggested that POC use be initiated three to four weeks after delivery to avoid the increased risk of puerperal breakthrough bleeding and any possible undesirable effect on the very young infant being breastfed.…”