Comparison of the lipoprotein, carbohydrate, and hemostatic effects of phasic oral contraceptives containing desogestrel or levonorgestrel

Desogestrel (DSG) is a less-androgenic progestogen than levonorgestrel (LNG ). This difference in androgenicity may be responsible for observed differe nces in metabolic effects between oral contraceptive (OC) formulations cont aining almost equivalent estrogen doses but with either DSG or LNG as a pro gestogen, To test the hypothesis, a prospective 9-month randomized comparis on of plasma lipids, glucose, insulin, hemostasis, and sex hormone binding globulin (SHBG) was conducted in 66 healthy women using phasic formulations of OCs containing either DsG (DSG-OC) or LNG (LNG-OC). The study results s howed that SHBG increased 3-fold with DSG-OC and 2-fold with LNG-OC. DSG-OC increased HDL-C, HDL2-C and HDL3-C; LDL-C decreased transiently. LNG-OC de creased HDL2-C and increased HDL3-C; HDL-C was unchanged and LDL-C decrease d transiently. Both formulations increased VLDL-C and triglycerides, more w ith DSG-OC, but apolipoprotein B levels increased equally. Apo A-I and A-II increased more with DSG-OC than with LNG-OC. Neither formulation altered L p(a) or fasting glucose and insulin levels. Postprandially, both formulatio ns decreased glucose and increased insulin responses, but to an equivalent degree. Both OCs slightly enhanced procoagulant and profibrinolytic paramet ers to the same extent except for internally compensating decreases in Fact or V and protein S with DSG-OC. In summary, at almost equivalent estrogen d oses, a phasic OC containing DSG compared with LNG has a less androgenic ef fect on lipoproteins and SHBG, similar effects on hemostatic parameters wit h lower protein S and factor V activity and equivalent effects on carbohydr ate metabolism. The lipoprotein, SHBG, and protein S and factor V differenc es are likely due to the lesser androgenicity of DSG allowing for a greater expression of the dose of estrogen. (C) 2001 Elsevier Science Inc, All rig hts reserved.