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

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.

PIP: In Sweden, physicians followed women aged 18-40 for more than 12 months to determine the effects of two oral contraceptives (OCs) on plasma lipids, lipoproteins, sex hormone binding globulin (SHBG), and total and free testosterone. This double-blind comparative study examined OCs with 150 mcg desogestrel and 20 mcg ethinyl estradiol (Mercilon) and with 150 mcg desogestrel and 30 mcg ethinyl estradiol (Marvelon). The women served as their own controls. The Marvelon group experienced significant increases in total cholesterol (p 0.01 at 6 months and p 0.05 at 12 months), high density lipoprotein (HDL) cholesterol (p 0.01 at 6 months), HDL-3 (p 0.01 at 6 months), and apolipoprotein B (p 0.001 at 6 months and p 0.05 at 12 months), but the Mercilon group did not. Low density lipoprotein (LDL) cholesterol fell substantially only in the Mercilon group (p 0.05 at 6 months). HDL-2, apolipoprotein A-1, and total phospholipids increased significantly with both OCs. The degree of response did not differ between the two groups, however. At 6 months, the HDL/LDL cholesterol ratio was significantly higher in both groups than it was before treatment (p 0.01 for Mercilon and p 0.05 for Marvelon). The apolipoproteins A-1/B ratio increased significantly only in the Mercilon group (p 0.01 at 12 months). After treatment, total triglycerides increased significantly in both groups, especially in the Marvelon group (p 0.001 for both 6 and 12 months; p 0.05 for Mercilon group). Total testosterone decreased significantly in both groups, especially in the Marvelon group (p 0.001 vs. p 0.01). The OCs had similar significant effects on SHBG (increase) and on free testosterone (decrease). These findings indicate that both OCs have a beneficial effect on lipid and lipoprotein profiles with Mercilon having a somewhat greater beneficial effect on LDL cholesterol and apolipoprotein B than Marvelon. The OCs have an anti-androgenic effect.

Modern oral contraceptives and dysmenorrhoea.

Women with primary dysmenorrhoea not sufficiently helped by triphasic oral contraceptives (OCs) were offered a modern, low-dose monophasic OC containing 30 micrograms of ethinylestradiol and 150 micrograms of desogestrel. The study shows that for these women, the monophasic pill was the better alternative. The fact that 19 of 23 women who continue treatment on the monophasic OC indicates that this type of pill may be chosen as the first alternative for women with primary dysmenorrhoea.

PIP: The effectiveness of a monophasic oral contraceptive was compared to that of a triphasic for relief of primary dysmenorrhea in an open crossover study in 30 women who had been previously taking triphasics. The pills formerly used contained ethinyl estradiol and either norethisterone (3) or levonorgestrel (27). Women took the monophasic pill containing 150 mcg desogestrel and 30 mcg estradiol [sic] for 3 months, then resumed their former prescription. Dysmenorrhea pain, marked on 10 mm scale, was lessened in 18 and increased in 4 women during monophasic intake (p0.01). Total duration of pain was reported as 2081 hours on the monophasic, and 2237 hours on the triphasic. The amount of bleeding reported as light, medium or heavy on a calendar was less on the monophasic for 18 women, the same in 2 and less on the triphasic for 4 women. Analgesic use during the monophasic was reported as less by 13, the same by 1, and more by 6 women. 19 women expressed a desire to continue with the monophasic after the study. It is likely that monophasic pills relieve dysmenorrhea more effectively because of their more consistent inhibition of ovulation.