Oral contraceptive tablets containing 20 and 30 μg of ethinyl estradiol with 150 μg desogestrel: Their influence on lipids, lipoproteins, sex hormone binding globulin and testosterone

Abstract

The effect of two oral contraceptive (OC) pills, both containing 150 micrograms of desogestrel, but with 20 (Mercilon) or 30 micrograms (Marvelon/Desolett) of ethinyl estradiol on plasma levels of lipids, lipoproteins and sex hormone binding globulin (SHBG), total and free testosterone were compared in a double-blind, randomized, two-center study in a total of 60 women over one year. A significant rise with Marvelon but not with Mercilon was seen in total cholesterol, HDL cholesterol, HDL-3 and apolipoprotein B, whereas LDL cholesterol decreased with Mercilon only. These effects resulted in significant differences between the two groups in the magnitude of responses in all these parameters except HDL-3. HDL-2, apolipoprotein A-1 and total phospholipids were elevated with both pills after treatment and with no difference in the degree of response between groups. The HDL/LDL cholesterol ratio tended to increase in both groups and that of apolipoproteins A-1/B in the women on Mercilon. Total triglycerides increased in both groups, but more in the women on Marvelon. Total testosterone decreased, particularly in the Marvelon group, whereas the two pills caused a similar increase in SHBG and decrease in free testosterone. It is concluded that the direction of changes in plasma lipids and lipoproteins with both these pills may as a whole be interpreted as beneficial, and that the differences in effect on LDL cholesterol and apolipoprotein B may suggest a slightly advantageous effect of Mercilon in this aspect. However, the clinical significance of these changes is uncertain. The results indicate a lack of androgenicity of both pills.

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

“…When estrogenic activity prevails, there is an increase in HDL-cholesterol and a decrease in LDL-cholesterol levels, whereas the opposite occurs when androgenic activity is higher (198, 202, 205, 213–215). However, lipids seem to be less sensitive to the residual androgenic properties of the progestins (198, 213, 216–218). The ability of HCs to increase HDL-cholesterol levels is the most favorable and promising metabolic effect in PCOS and may overcome the negative impact on triglycerides and LDL-cholesterol because low HDL-cholesterol may be the critical link between PCOS and the metabolic syndrome (208, 219–223).…”

The effect of combined oral contraception on testosterone levels in healthy women: a systematic review and meta-analysis

“…These treatments often did not qualify for the subgroup analyses. The duration of treatment varied from 1 treatment cycle (Kuhnz et al ., 1991) up to 12 treatment cycles (Jung-Hoffman et al , 1988a; Åkerlund et al , 1994; Wiegratz et al , 1995; Sänger et al , 2008). Treatment was assessed for 6 cycles (the effect measure used for the meta-analysis) in 16 studies, 3 cycles in 14 studies and for 12 studies another time point had to be taken for the analyses.…”

“…(1993b)Open-label, non-comparativeHealthy womennormal menstrual cycleNo hormonal contraceptives: ≥2 months1 n = 15Mean (SD) age: 26 ± 6 yearsMean (SD) weight: 63 ± 7 kg3 cycles35 EE/2 mg CPA 21:7Control cycle (day NR) Tr. cycle 3 (Day 21)Direct RIAIntra-assay CV: NRInter-assay CV: 8–12%LLQ: NRDirect RIAIntra-assay CV: NRInter-assay CV: 5–9%LLQ: NR7Åkerlund et al (1994)Randomized, double-blind, comparative, parallel groupHealthy women18–40 yearsNo OC: ≥2 months1 n = 25Mean age: 25.0 yearsWeight/BMI: NR12 cycles20 EE/150 DSG 21:7Control cycle (Days 18–21) Tr. cycle 6 (Days 18–21)Direct RIACV: 6.5–8.9% at 3 nmol/lIntra-assay CV: NRInter-assay CV: NRLLQ: NRCalculated based on total T, SHBG and albumin (Levell et al ., 1987) CV: 8.5–12.6% at 50 pmol/l62 n = 26Mean age: 21.8 yearsWeight/BMI: NR12 cycles30 EE/150 DSG 21:7Kuhnz et al (1994)Open-label, non-comparativeHealthy womenNo OC: ≥2 months1 n = 14Mean (SD) age: 23 ± 3 yearsMean (SD) weight: 61 ± 8 kg3 cycles30–40-30 EE/50-75-125 LNG (6-5-10), 21:7Control cycle (day NR) Tr.…”

Drug-Induced Dyslipidemia

“…Oral contraceptives containing the older second-generation progestogens such as levonorgestrel and norethysterone, which have strong androgenic effects, increase LDL cholesterol and triglycerides and decrease HDL cholesterol [66,67]. The newer third-generation progestogens such as desogestrel and gestodene are least androgenic and do not cause unfavorable effects on LDL and HDL cholesterol, but may cause hypertriglyceridemia [68][69][70]. Even the combined contracep-tive vaginal ring containing ethinylestradiol and etonogestrel (NuvaRing) has been noted to increase serum triglycerides and apolipoprotein B levels in comparison with levonorgestrel containing combined oral contraceptives which increase LDL cholesterol [71].…”