Effect of Injectable and Oral Contraceptives on Serum Lipids

Abstract

Objective-To estimate the effects of using depot medroxyprogesterone acetate (DMPA) or oral contraceptives (OC) containing 20 micrograms ethinyl estradiol and 0.15 mg desogestrel on serum lipid levels.Methods-Serum lipids were measured at baseline and every 6 months thereafter for 3 years on 703 white, black, and Hispanic women using DMPA, OC, or nonhormonal (NH) birth control. DMPA discontinuers were followed for up to 2 additional years.Participants completed questionnaires containing demographic and behavioral measures every 6 months and underwent 24 hour dietary recalls annually. Mixed model regression analyses and general estimating equations procedures were used to estimate changes over time in lipids by method, along with their predictors.Results-OC users experienced significantly greater increases in levels of triglycerides (TG), total cholesterol (TC), very low density lipoprotein cholesterol (VLDL-C), and high density lipoprotein cholesterol (HDL-C) than NH users (P<.001). However, no difference was noted in the LDL-C to HDL-C ratio between OC and NH users. Among DMPA users, HDL-C levels initially decreased for 6 months, but then returned to baseline. The LDL-C to HDL-C ratio rose during the first 6 months of DMPA use, but then dropped back to baseline over the next 24 months. After DMPA was discontinued, women who used OC increased their TG, TC, VLDL-C, and HDL-C levels significantly more than those who chose NH (P< .05).Conclusion-Use of very low dose OC containing desogestrel can elevate lipid levels. DMPA users were at increased risk of developing an abnormally low HDL-C level as well as an abnormally high LDL level and an increase in the LDL to HDL cholesterol ratio, although these effects appeared to be temporary.Although a number of investigations have been conducted on the relationship between depot medroxyprogesterone acetate (DMPA) and lipid levels, results are not consistent between studies. For example, some have demonstrated that DMPA does not effect serum lipids while others have shown an adverse relationship. [1][2][3][4] Two others reported a beneficial effect. 5,6 Findings from all these studies are limited because they are cross-sectional in design 3,[6][7][8] or have very small sample sizes. 1,4,5,[9][10][11][12] Only three large trials have been published which NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript followed women for an extended period and they do not agree in their findings. [13][14][15] Furthermore, none of these three studies took into account the effect of diet on lipid levels.Moreover, data are limited on the effects of oral contraceptives (OC) containing only 20 micrograms ethinyl estradiol (EE) and 0.15 mg desogestrel on the lipid profile. This third generation progestin has been used in newer birth control pills because it is less androgenic and thus should have less effect on carbohydrate metabolism and lipid levels. It is not certain, however, whether this actually occurs with use of OC containing only 20 micrograms ethinyl estr...

Pathways Leading to Atherosclerosis

“…Because the lipid profile of OC users differs from that of non-OC users, 26 we tested the model fit of the female model in OC users and non-OC users separately. Despite the small number of participants without OC use, the same female model did show a good fit in both OC users and non-OC users.…”

Progestogen-only injectable contraceptive: Experience of women in Osogbo, southwestern Nigeria

“…[3,4] Injectable progestogen only contraceptive is associated with multiple side effects, with secondary amenorrhea being the most common; others are hypertension, and weight gain. [4][5][6] For most teenagers requesting contraceptive, injectable could be a good option. They are independent of intercourse and of the user's memory (and thus of continuing motivation), other than remembering the 8-or 12-weekly appointments.…”

Contraception in the Setting of Obesity and Bariatric Surgery

“…Additionally, a retrospective review found that girls who were obese at the initiation of DMPA gained more weight than normal weight adolescents using DMPA, and gained more weight than all weight categories of adolescents using OCs or non-hormonal contraception [ 108 ]. Need for effective contraception and concerns about weight gain must be balanced in adolescent populations, and further research is needed to clarify whether there are long-term consequences for these reported body composition changes.…”