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  • Title: [Contraception in the hypertensive woman using a vaginal ring delivering estradiol and norgestrel].
    Author: Elkik F, Basdevant A, Corvol P.
    Journal: Arch Mal Coeur Vaiss; 1985 Oct; 78(11):1737-9. PubMed ID: 3938250.
    Abstract:
    A long term prospective study of contraceptive vaginal rings (CVR) that deliver estradiol and D-Norgestrel was conducted in 12 hypertensive women. Blood pressure was measured five times by an oscillometric automatic device during two control cycles, at the 1st, 2nd, 4th, 6th and 9th to 12th cycle of CVR use, and again after a one month recovery period. No significant change in blood pressure was noted during CVR usage and this method of contraception appeared safe in hypertensive women. Plasma renin substrate and plasma antithrombin III were non affected by the treatment. These observations are in marked contrast with the dramatic increase and decrease in these proteins that are respectively observed during oral estroprogestative contraception; and confirm the utility of a way of hormone administration that bypass the liver. The significant decrease in sex binding protein, HDL cholesterol, phospholipids and triglycerides that were observed under CVR treatment could be interpreted as reflecting the androgenic potency of D-Norgestrel. Combined oral contraceptives (OCs) induce elevations of blood pressure and can aggravate preexisting hypertension. They alter lipoprotein metabolism and coagulation factors, increasing vascular risks. Combined OCs are therefore contraindicated for hypertensive women. Intravaginal contraceptive rings releasing 17 beta estradiol and levonorgestrel have the triple advantage of extradigestive administration, use of the natural estrogen estradiol, and continuous and stable hormone release. 12 patients with moderate hypertension were studied to determine whether vaginal rings would be an appropriate contraceptive choice for hypertensive women. 8 of the 12 developed hypertension while using combined OCs. They observed a 6 month wait between termination of OC use and inclusion in the study or initiation of antihypertensive therapy. In 3 cases, blood pressure spontaneously returned to normal. The 9 other patients received an antihypertensive drug during the study. The vaginal rings were left in place for 3 weeks and removed for 1 week to permit withdrawal bleeding. When in place they delivered an average of 293 + or - 54 mcg/day of levonorgestrel and 133 + or - 34 mcg/day of estradiol. Clinical and gynecological examinations and blood pressure measurements were repeated during 2 control cycles before treatment, on the 21st day of cycles 1, 2, 4, 6, 9, and 12 of use, and 1 month after termination of use. Blood pressure was measured 5 times by an oscillometric automatic device. Modification of antihypertension treatment was not required in any case. No variation in systolic pressure greater than 5 mm Hg or of diastolic pressure greater than 4 mm Hg was observed. Plasma renin substrate and plasma antithrombin III were not affected by the treatment. Sex binding protein was reduced by 72% on average. The results confirm the utility of a method of hormone administration that bypasses the liver. Highly significant reductions in total cholesterol, high density lipoprotein cholesterol, phospholipids, and triglycerides were observed and could be interpreted to reflect the androgenic potency of levonorgestrel. The vaginal ring may become a very interesting contraceptive alternative for hypertensive women.
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