Effects of the triphasic oral contraceptive on lipid and lipoprotein metabolism.

PIP: The effects of the triphasic oral contraceptive (OC) ethinyl estradiol (EE) and levonorgestrel (LNG) on lipid and lipoprotein metabolism were evaluated in 97 black Kenyan women. Subjects were recruited from the Family Planning Clinic and were followed for 12 months. There was an increase in fasting levels of total cholesterol. These changes were not statistically significant. However, the triglyceride increase was statistically significant at 9 months and 12 months (p0.05). The high density cholesterol remained unchanged. Thus, this triphasic OC was found to have minimal effect on lipid and lipoprotein metabolism.^ieng

The effect of low-oestrogen combined pill, progestogen-only pill and medroxyprogesterone acetate on oral glucose tolerance test.

The effect of a low-oestrogen combined pill, progestogen-only pill and medroxyprogesterone acetate on oral glucose tolerance test was studied in 29, 30 and 9 indigenous Kenyan women respectively. Glucose tolerance test was performed before treatment was started and then after 1,3 and 6 months in microgynon users. The mean areas under the glucose curves were also significantly elevated. Significant increase in blood glucose values were noted only at 30 minutes after 6 months of use of the progestogen-only oral contraceptive but the mean blood glucose values were higher than in the control after 1,3 and 6 months of use. However, the mean values of the areas under the glucose curves were significantly elevated after 1,3, and 6 months of use. Medroxyprogesterone acetate users showed significantly lower fasting blood glucose values at 60 and 90 minutes after 1 month of use, after which the blood glucose values returned to the pre-treatment values. The mean values of the glucose curve areas showed no significant change. It is concluded that both microgynon and minipill cause relative impairment of glucose tolerance test as early as after 1 month of use. Medroxyprogesterone acetate does not impair oral glucose tolerance for at least the first 6 months of use. The implications of these findings are discussed.

PIP: Researchers followed 68 women who attended the Family Welfare Clinic at the Kenyatta National Hospital in Nairobi, Kenya to determine if the low estrogen combined oral contraceptive (OC) Microgynon, a progestogen only OC, and Depo-Provera induce changes in the oral glucose test. These women did not take any steroidal contraceptives before entry into the study. Blood glucose levels were significantly higher after 60, 90 and 120 minutes than the control levels for women taking Microgynon. In addition, the mean areas under the glucose curves were substantially elevated after 1, 3, and 6 months above the control (p.002, .005, and .01 respectively). The only significant change in blood glucose levels in women taking the progestogen only OC occurred at 30 minutes after 6 months. Yet the mean areas under the curve were significantly higher than the control after ,1 2, and 3 months (p.005, .05 and .002 respectively). As for Depo-Provera, significantly lowered blood glucose levels only occurred after 1 month at 30, 50, and 90 minutes although no significant changes occurred after 1, 3, and 6 months in the mean areas under the glucose curves. Metabolic change occurred earlier and more often in Microgynon users than progestogen only OC users. This could be due to the progestogen levonorgestrel which has been shown to interrupt glucose metabolism. These changes could possible adversely effect women who are predisposed to developing diabetes, since 1 woman did develop a diabetic curve after 1 month of using Microgynon. Nevertheless no pattern towards abnormal glucose tolerance existed. Standard deviations of areas under the curves indicated that the number of women who develop glucose intolerance may increase with duration of use.

Changes in plasma HDL-cholesterol in women using oral contraceptives in Kenya.

PIP: 125 black Kenyan women attending the Kenyatta National Family Welfare Clinic were randomly allocated to combined and fixed dose oral contraceptives (Eugynon: 500 mcg dl-norgestrel + 50 mcg ethinyl estradiol or Microgynon: 150 mcg levonorgestel + 30 mcg ethinyl estradiol). They were between 18-33 years of age with a mean of 25 +or- 7 years. The mean parity of this group was 3 and they had a mean education standard of 8 years. Fasting blood sampled were taken on recruitment (control cycle) and thereafter once for cycles 1, 3, 6, 9, and 12 during OC use. HDL-cholesterol was estimated in the sear. The 2 OCs elicited a significant decrease in levels of HDL-cholesterol (p0.01).^ieng

Menstrual blood loss (MBL) in nulliparous Kenyan women.

PIP: Menstrual blood loss (MBL) was evaluated in 74 nulliporous Kenyan women aged between 20 and 27 years. The hemoglobin levels were all in normal range with the mean of 13.65 +or- 0.8, 13.84 +or- 1.2 and 13.04 +or- 1.2 g/100 ml respectively in 3 populations. The MBL was comparable in the 3 populations with the mean of 35.1 +or- 12.6, 30.6 +or- 8.7 and 32.2 +or- 9.4 ml respectively. There was no difference of statistical significance between the 2 periods studied per each individual. This study objectively assesses the menstrual blood loss in 3 population groups--2 urban and 1 rural. The data can be used to evaluate menstrual blood loss before and after initiation of various contraceptives used in Kenya. Subjects were volunteers who were not on any contraception except barrier or natural rhythm methods, not under psychological stress and who exhibited normal physical female characteristics on examination. Those who wished to drop out, became pregnant or desired contraception, were excluded. The study confirms the individual constancy of the menstrual blood loss in this population. This has important practical implications since a single determination of the menstrual blood loss may be a fairly good expression for the average blood loss in a woman. The immediate effect of various treatments such as IUD insertion or oral contraceptives on the MBL may easily be evaluated quantitatively by measurements in consecutive periods using only 1 period as a control. The quick method can be easily used in evaluating pathological conditions e.g. iron-deficiency due to heavy bleeding, IUD-associated hemorrhage, menorrhagia and uterine fibroid.^ieng