Effect of injectable and oral contraceptives on serum lipids

Abstract

Objective: To estimate the effects of using depot medroxyprogesterone acetate (DMPA) or oral contraceptives (OCs) containing 20 micrograms ethinyl estradiol and 0.15 mg desogestrel on serum lipid levels.

Methods: Serum lipids were measured at baseline and every 6 months thereafter for 3 years in 703 white, African-American, and Hispanic women using DMPA, OC, or nonhormonal birth control. Those who discontinued DMPA were followed for up to 2 additional years. Participants completed questionnaires containing demographic and behavioral measures every 6 months and underwent 24-hour dietary recalls annually. Mixed-model regression analyses and general-estimating-equations procedures were used to estimate changes over time in lipids by method along with their predictors.

Results: Users of OCs experienced significantly greater increases in levels of triglycerides, total cholesterol, very-low-density lipoprotein (VLDL) cholesterol, and high-density lipoprotein (HDL) cholesterol than did nonhormonal-contraceptive users (P<.001). However, no difference was noted in the low-density lipoprotein (LDL) cholesterol:HDL ratio between OC users and nonhormonal-contraceptive users. Among DMPA users, HDL levels initially decreased for 6 months but then returned to baseline. The LDL:HDL ratio rose in the first 6 months of DMPA use but then dropped back to baseline over the next 24 months. After DMPA was discontinued, triglyceride, VLDL, and HDL levels were significantly higher in women who used OCs than in those who chose nonhormonal (P<.05) methods.

Conclusion: Use of very-low-dose OCs containing desogestrel can elevate lipid levels. Users of DMPA were at increased risk of developing an abnormally low HDL level as well as an abnormally high LDL level and an increase in the LDL:HDL cholesterol ratio, although these effects appeared to be temporary.

Level of evidence: II.

Figure 1

Mean change across 36 months of follow-up by contraceptive method for (A) total cholesterol, (B) serum triglyceride, (C) HDL cholesterol, (D) LDL cholesterol, (E) LDL-to-HDL ratio, and (F) VLDL Cholesterol. Solid lines represent the estimated mean (modeled) and dotted lines represent the unadjusted values. Green squares: nonhormonal contraception; black diamonds: depot medroxyprogesterone acetate; red circles: oral contraceptives.

Figure 2

Mean change of lipid profile after depot medroxyprogesterone acetate discontinuation across 24 months for (A) total cholesterol, (B) serum triglyceride, (C) HDL cholesterol, (D) LDL cholesterol, (E) LDL-to-HDL ratio, and (F) VLDL Cholesterol. Solid lines represent the estimated mean (modeled) and dotted lines represent the unadjusted values. Green squares: depot medroxyprogesterone acetate to nonhormonal contraception; red circle: depot medroxyprogesterone acetate to oral contraceptives.