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  • Title: [Oral contraception, glucid metabolism and monitoring criteria].
    Author: Gaspard U.
    Journal: Contracept Fertil Sex (Paris); 1988 Feb; 16(2):113-8. PubMed ID: 12342000.
    Abstract:
    Combined oral contraceptives (OCs) entail insulin resistence and decreased glucose tolerance proportional to their dose and type of progestin. Derivatives of 19-nortestosterone have more deleterious effects than do derivatives of 17-acetoxy progesterone. The effects are usually reversible and limited, and the diabetogenic role of currently available low-dose OCs is small. Metabolic and vascular risks must still be taken into account in prescribing OCs because hyperglycemia and hyperinsulinemia are significant vascular risk factors. Women with histories of OC use have increased risks of fatal and nonfatal myocardial infarct, cerebrovascular accidents, and peripheral vascular disease, but the increases are not always significant. Age and smoking are known to be primary risk factors whose effects are increased by OCs. Reduction of the estrogen dose of OCs may have resulted in a significant reduction of the venous thromboembolic risk, while reduction of the progestin dose may have resulted in a decreased incidence of venous accidents. The mechanisms of action by which OCs amplify existing vascular risks are largely unknown. Research with methods capable of quantifying insulin resistence suggests that a post-receptor intracellular effect is responsible for insulin resistence and diminished intracellular metabolism of glucose in users of OCs. Because OCs are ordinarily used by healthy young women over long periods of time with minimal medical supervision, it is desirable to identify cases in which cardiovascular and other undesirable secondary effects are likely. OCs are contraindicated for any woman with a history of cardiac accidents, venous or arterial vascular problems, or hypertension. Obesity is a relative contraindication because it may coexist with a problem of glucose metabolism and constitute a diabetic risk factor. Other diabetic risk factors that must be evaluated are age, family or personal history of gestational diabetics, and transitory problems of glucose tolerance. Low dose combined OCs have little effect on carbohydrate metabolism or glucose tolerance, but women with diabetic risk factors may be more sensitive to the vascular impact of OCs than other women. Weight, blood pressure, and fasting or nonfasting blood sugar should be assessed annually OC users. Obese women should undergo an endocrinologic and metabolic examination in the interests of general prevention before receiving a prescription for combined OCs. Women with family or personal histories of diabetic risk should be evaluated from a metabolic and vascular standpoint.
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