Adverse effects on carbohydrate and lipid metabolism

From this study emerged that DMPA and combined formulation-pill fasting blood sugar,while total cholesterol and LDL-cholesterol decreased in all groups except DMPA where it increased.  Triglyceride only increased in pill-group.  HDL-cholesterol increased with the pill and decreased with Norplant and DMPA. Partial thromboplastin time was prolonged in Norplant users(17).

Therfore,  Norplant use results in minimal metabolic alterations, while DMPA seems to have unfavorable outcome.  The vaginal hormone-releasing system (15 mcg EE,120 mcg Etonogestrel) showed in women with type- 1 diabetes, no clinically significant effects on carbohydrate and lipid metabolism with neutral impact on the hemostasis system(18,19,20).

Current evidence   suggests   that   hormonal   contraceptives   have   limited   effect   on carbohydrate metabolism and glucose tolerance in HC-users,  but women with diabetic risk factors may be more sensitive to the vascular impact of these formulations than others. However,strong statements cannot be made, though, due to having few studies that compared any particular types of contraceptives. Many trials had small numbers of participants and some had large losses to follow up.

Most studies had poor reporting of methods. No information was available regarding the effects among women who were overweight (21). Obese women should undergo an endocrinologic and metabolic examination,  in the interest of general prevention,  before receiving a prescription for combined hormonal contraceptives(22). Long-term studies do not indicate any trend toward diabetes in long-term users and long-term use of COCs does not appear to increase the risk of cardiovascular   disease.

Either   the   estrogen-induced   deterioration   of   glucose tolerance or the progestin-induced insulin resistance can lead to poor glucose tolerance or type 2 diabetes mellitus in few predisposed individuals. Considering that all HCs potentially, may induce some deterioration of glucose in the tolerance tests and increase in insulin secretion, although these changes were within normal accepted levels, accurate contraceptive counselling is necessary.

In addition, it is important to remember that glucose intolerance developed during pill use is not always reversible. In women with diabetes mellitus it is very important to take in account such factors as type of the diabetes, its lasting,  degree of metabolic compensation, presence of diabetes complications, body-mass index of the patient and,  presence of risk factors for cardiovascular diseases and future pregnancy planning(23).

Women with diabetes need safe,effective contraception.  Condom may be an acceptable method for some women but a high risk of user failure can be predicted. While,IUD or hormonal contraceptives may be the only reversible alternative(24,25)

Combined   hormonal   contraceptives   can   have   deleterious effects on serum lipids, although only persons predisposed to hyperlipidemia are truly at risk. Concern about a potential adverse effect on glucose control of the contraceptive use in women with uncomplicated diabetes is non realistic.

So, hormonal contraception use is appropriate and convenient for women with controlled diabetes type 1 and 2 who do not smoke and who do not have other risk factors for cardiovascular diseases. In fact, acute myocardial infarction may occur in young women taking hormonal contraceptives who have poor metabolic state(26). It is advisable in these cases prescribe low-dose HC (pill or vaginal ring) or combination containing progestins with moderate antiandrogenic activity.

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