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  • Title: Hemostasis profile and lipid metabolism with long-interval use of a desogestrel-containing oral contraceptive.
    Author: Cachrimanidou AC, Hellberg D, Nilsson S, von Schoulz B, Crona N, Siegbahn A.
    Journal: Contraception; 1994 Aug; 50(2):153-65. PubMed ID: 7956214.
    Abstract:
    Thirty healthy women, aged 18 to 37, were randomly allocated to treatment with a desogestrel-containing oral contraceptive, with 20 women using a nine-week on, one-week off regimen, and 10 women using the traditional regimen. At 0, 3 and 12 months, blood samples were drawn for liver proteins, lipoproteins and hemostatic variables. No significant changes were observed between the two regimens. Sex hormone binding globulin (SHBG) and corticosteroid binding globulin (CBG, transcortin) were increased two- to four-fold, as a measure of estrogenicity. Minimal changes occurred within the lipoprotein cholesterol fractions, whereas there were some increases within the lipoprotein triglyceride fractions. Among the hemostatic variables, there were significant increases of fibrinogen, factor VII and thrombin/antithrombin III (TAT) complex. The coagulation inhibitors, antithrombin III, protein C and protein S, were essentially unchanged. A decrease of both tissue plasminogen activator antigen (t-PA) and tissue plasminogen activator inhibitor activity (PAI activity) of the fibrinolytic system was observed. A nine-week regimen does not seem to alter lipid metabolism and coagulation more than a three-week regimen. Clinicians followed 30 women, 18-37 years old, attending the family planning clinic of Falu Hospital in Sweden to compare the effect of a long interval of an oral contraceptive (OC) (30 mcg ethinyl estradiol + 150 mcg desogestrel) on the hemostasis system, lipid metabolism, and hormone binding proteins with that of a traditional 3-week regimen. They randomly allocated 20 women to the long-interval group (group I) and 10 to the 3-week group (group II). The long-interval consisted of 9 weeks taking the OC and 1 week not taking the OC. Between baseline and 12 months, sex hormone binding globulin (SHBG) levels increased 409% in group I (p .001) and 341% in group II (p .01). Corticosteroid binding globulin (CBG) levels increased 294% (p .001) for group I and 173% for group II. SHBG and CBG levels (markers of estrogenicity) were not significantly different between the 2 groups, however. Limited, insignificant changes took place with lipoprotein cholesterol fractions. VLDL-triglycerides and LDL-triglycerides increased significantly in group I (0.31-0.57 mmol/l) and group II (0.21-0.27 mmol/l) (p .05). Fibrinogen, factor VII, and thrombin/antithrombin III complex increased significantly in group I at 3 and 12 months. They had also increased in group II but not significantly. The coagulation inhibitors (i.e., antithrombin III, protein C, and protein S) remained virtually the same. Levels of tissue plasminogen activator antigen and tissue plasminogen activator inhibitor activity, both of the fibrinolytic system, fell (significant decrease only in group I). These findings show that the desogestrel-containing low-dose OC has limited effects on lipid metabolism, particularly the cholesterol subfractions, regardless of the regimen. It does increase minimally coagulation parameters, but the fibrinolytic system offsets this increase. In conclusion, the long-interval regimen is as safe as the 3-week regimen.
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