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  • Title: Double-blind, randomized, placebo controlled study on the effects of the monophasic oral contraceptive containing 30 micrograms ethinyl estradiol and 2.00 mg dienogest on the hemostatic system.
    Author: Spona J, Feichtinger W, Kindermann C, Schneider B, Mellinger U, Walter F, Moore C, Gräser T.
    Journal: Contraception; 1997 Aug; 56(2):67-75. PubMed ID: 9315414.
    Abstract:
    Forty healthy female volunteers aged between 19 and 35 years (27.3 +/- 4.1 years) with normal menstrual cycles were included in a double-blind, randomized, placebo-controlled study to investigate the influence on the hemostatic system of an oral contraceptive containing 30 micrograms ethinyl estradiol in combination with 2.00 mg dienogest, which is a 19-norprogestin without a 17 alpha-ethinyl group. At baseline and during one treatment cycle, 12 hemostatic parameters were measured on cycle days 7, 14, and 21. The hemostatic parameters were categorized as either procoagulatory, anticoagulatory and profibrinolytic, or antifibrinolytic and indicative of fibrin turnover. Differences between placebo and 30 micrograms ethinyl estradiol and 2.00 mg dienogest of plasma levels of hemostatic parameters on cycle days 21 of the precycle and treatment cycle were chosen as target variables. Prothrombin fragment 1 + 2 (F 1 + 2) was chosen as the main target variable. Equivalence of F 1 + 2 between placebo and active treatment was noted. Among the procoagulatory factors, only factor VII activity was found to be increased over placebo in the active treatment group, but decreased in the placebo group. Protein C activity increased during the treatment with 30 micrograms ethinyl estradiol and 2.00 mg dienogest, and was higher than that of the placebo group in which this parameter decreased during the treatment cycle. There was a corresponding increase in fibrinolytic activity being reflected by higher plasminogen levels in the active treatment group in comparison with placebo. An increase was noted for the fibrinolytic parameter D-dimer. Apart from isolated measurements, the parameters remained in their respective normal ranges. The data combine to suggest that 30 micrograms ethinyl estradiol and 2.00 mg dienogest has a balanced effect on the hemostatic system stimulating both procoagulatory and fibrinolytic activity. The influence on the hemostatic system of a monophasic oral contraceptive (OC) containing 30 mcg of ethinyl estradiol and 2 mg of the progestin dienogest was investigated in a double-blind, placebo-controlled study involving 40 healthy German women 19-35 years old. A total of 12 hemostatic parameters were measured on cycle days 7, 14, and 21 at baseline and during 1 treatment cycle. The prothrombin fragment 1 + 2 (an early and sensitive marker for the activation of hemostasis) was equivalent between OC users and untreated controls. Among the precoagulatory factors, only factor VII activity was not equivalent; on day 21, there was a decrease in the placebo group and an increase in the OC group. Also on day 21 of the treatment cycle, protein C activity increased in OC users compared to controls. There was a corresponding increase in fibrinolytic activity, reflected by higher plasminogen levels in OC users, and an increase in the fibrinolytic parameter D-dimer. In general, hemostatic parameters remained within their normal ranges. These findings confirm that the OC analyzed has a balanced effect on the hemostatic system, simultaneously stimulating both procoagulatory and fibrinolytic activity.
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