Hemostatic and metabolic effects of lowering the ethinyl-estradiol dose from 30 mcg to 20 mcg in oral contraceptives containing desogestrel

Basdevant, Arnaud; Conard, J.; Pélissier, C; Guyene, Thanh‐Tam; Lapousterle, Catherine; Mayer, Marie; Guy‐Grand, Bernard; Degrelle, H

doi:10.1016/0010-7824(93)90141-s

Cited by 44 publications

(19 citation statements)

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“…This is in agreement with several studies of low dose oral contraceptives 18–21 . In contrast, Basdevant et al 22 found a decrease in antithrombin III antigen activity in women using a 30 μg EE/DES combination but not in women using a 20 μg EE/DES combination. Antigenic protein C levels have been shown to be increased, but studies of protein C activity suggest that functional protein C is unaffected by oestrogen/progestogen combinations 23–25 .…”

Section: Discussionsupporting

confidence: 91%

The effect of oestrogen dose and progestogen type on haemostatic changes in women taking low dose oral contraceptives

Norris

Bonnar

1996

BJOG

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Objective To determine the effect of oestrogen dose and progestogen type on the coagulation and fibrinolytic systems of a group of normal healthy women taking three different oral contraceptive combinations. Design Plasma levels of factor VII, X, antithrombin III, protein C, fibrinogen, tissue plasminogen activator activity, plasminogen activator inhibitor I antigen and fibrin (D‐dimer) degradation products were measured at pretreatment, 6, 14, 22 weeks of treatment and at 6 weeks post‐treatment in a group of 67 women taking either 30 μg ethinyloestradiol/150 μg desogestrel (n= 21), 20 μg ethinyloestradiol/150 μg desogestrel (n= 24), 30 μg ethinyloestradiol/75 μg gestodene (n= 22). Participants Sixty‐seven healthy normal women, 18 to 34 years, smoking fewer than 15 cigarettes per day. The subjects were within 10% of their normal body weight and had no history of thromboembolic disease. Setting Coombe Women's Hospital and St James's Hospital, Dublin, Ireland. Results Factor VII and X levels were significantly raised on treatment with both the 30 μg ethinyloestradiol/desogestrel and gestodene combinations. Higher levels of factor VII activity were observed in the 30 μg ethinyloestradiol/desogestrel combination compared with the gestodene combination. Factor VII and X were not significantly affected by the 20 μg ethinyloestradiol combination. Increased plasminogen, fibrinogen and D‐dimer levels and decreased plasminogen activator inhibitor 1 antigen levels were observed during the treatment phases in all three groups. Antithrombin TI1 and protein C activity did not change during treatment with any of the oral contraceptives studied. Conclusions Low dose oral contraceptives cause an activation of the coagulation system which is balanced by an activation of the fibrinolytic system. Reducing the dose of ethinyloestradiol from 30 μg to 20 μg reduces the effect on factor VII and X. This effect can be modified by the progestogen. The lesser effect of the 20 μg combination may make this a safer option for some women than pills containing a higher dose of oestrogen.

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Section: Discussionsupporting

confidence: 91%

The effect of oestrogen dose and progestogen type on haemostatic changes in women taking low dose oral contraceptives

Norris

Bonnar

1996

BJOG

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“…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 than previously marketed oral contraceptives. However, most published studies which have evaluated this progestin when used in an OC containing only 20 micrograms EE are based on small sample sizes or did not include a control group (22–28). As a result, a recent Cochrane review of interventional studies related to hormonal contraception stated that results are conflicting with regards to desogestrel’s effects on carbohydrate metabolism (29).…”

Section: Introductionmentioning

confidence: 99%

Effect of Injectable and Oral Contraceptives on Glucose and Insulin Levels

Berenson

Berg

Williams

et al. 2011

Obstetrics &Amp; Gynecology

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Objective To estimate the effect of using two methods of hormonal contraceptives (depot medroxyprogesterone acetate (DMPA) or oral contraceptives (OC) containing 20 micrograms ethinyl estradiol and 0.15 mg desogestrel) on serum glucose and insulin levels as well as predictors of any observed changes. Methods Fasting glucose and insulin levels were measured on 703 white, black, and Hispanic women using DMPA, OC, or nonhormonal (NH) birth control at baseline and every 6 months thereafter for 3 years. Participants also completed questionnaires containing demographic and behavioral measures every 6 months. Mixed model regression analyses were used to estimate changes over time in glucose and insulin levels by method, along with their predictors. Results DMPA, but not OC, users experienced slightly greater increases in glucose and insulin as compared with NH users (p <.001). Among DMPA users, a small, but steady increase in serum glucose (2 mg/dl at 6 months to 3 mg/dl at 30 months) was observed throughout the first 30 months but leveled off after that. In contrast, serum insulin showed an upward (3 units at 6 months to 4 units at 18 months) trend for the first 18 months of DMPA use and then remained almost flat thereafter. Elevation of insulin and glucose levels was slightly more pronounced in obese and overweight DMPA users than those who were normal weight. Conclusion Use of DMPA, but not very low dose OC containing desogestrel, can lead to slightly higher fasting glucose and insulin levels.

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“…Some studies demonstrate that clotting factors in women on 20 mg of ethinyl estradiol are lower than those of women receiving a 30-mg ethinyl estradiol combined oral contraceptive, 17 and that they may in fact even be comparable to nonusers. 18,19 However, such findings are not consistent across all studies. Various groups have demonstrated no difference in key variables of coagulation regulation when comparing women on a 20-mg oral contraceptive to those on a 30-mg preparation.…”

Section: Discussionmentioning

confidence: 89%