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Am J Obstet Gynecol. 1982 Mar 15;142(6 Pt 2):732-4.

Carbohydrate metabolism during treatment with estrogen, progestogen, and low-dose oral contraceptives.


The combination oral contraceptives have generally been shown to have an adverse effect on carbohydrate metabolism with resultant elevations of both blood glucose and insulin in users. Studies of the individual steroid components suggest that the estrogen is not at fault. The 19-norprogestins can produce these carbohydrate changes and seen to act at the insulin receptor level. Norgestrel, ethynodiol diacetate, and norethindrone alter carbohydrate metabolism, but norgestrel produces the most marked changes. Use of oral contraceptives containing less than 50 microgram of estrogen resulted in fewer metabolic changes than were seen with the drugs containing higher doses of estrogen.


Published studies on the effects of oral contraceptives (OCs) on carbohydrate metabolism generally concur that most OC users experience some elevation of blood glucose and plasma insulin levels and that these changes, which are usually small and somewhat variable, are most pronounced during a glucose tolerance test. Women at greatest risk for developing significant hyperglycemia during OC use are those considered at risk for developing this condition in general, such as women who have had hyperglycemia in the past (e.g., during pregnancy), those with a strong family history of diabetes mellitus, and those who are obese or of older age. The few studies on the effects of mestranol and ethinyl estradiol (the 2 estrogens of OCs) on carbohydrate metabolism in women fail to show much effect, even at a variety of dose levels. In large OC studies, dosage of the estrogens had little relation to the recorded abnormalities in glucose. Studies on the effects of individual progestogens in OCs show variable results. With norethindrone, the changes reported are generally fewer than those seen with other progestogens studied and are more apparent in insulin levels than in glucose levels. Ethynodiol diacetate shows an alteration in both blood glucose and plasma insulin level. Norgestrel studies showed a marked effect on carbohydrate metabolism. Marked elevation in both blood glucose and plasma insulin level has been observed after a few or many cycles. Other studies report significant reduction in insulin receptors. Studies on the "sub-50" OC products, or OCs with less than 50 mcg estrogen/pill show that the products containing norgestrel are associated with an alteration of glucose and/or insulin levels, while those containing norethindrone are not. Because of potential long-range problems associated with the pill, it seems prudent that patients should be given low-dose OCs with steroids that are relatively free of effects (e.g., mestranol, ethinyl estradiol, norethindrone).

[Indexed for MEDLINE]

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