Desogestrel- and levonorgestrel-containing oral contraceptives have different effects on urinary excretion of prostacyclin metabolites and serum high density lipoproteins

Abstract

Prostacyclin synthesis is stimulated in vitro by high density lipoproteins (HDL), which themselves are differently affected by desogestrel (DG)- and levonorgestrel (LN)- containing oral contraceptives. In this study we measured the urinary excretion of the metabolites of prostacyclin [6-keto-prostaglandin F 1 alpha(6-keto) and 2,3-dinor-6-keto-prostaglandin F1 alpha (dinor)] and of thromboxane A2 [thromboxane B2 (TxB2)] as well as serum HDL- and HDL2 cholesterol concentrations before and during DG and LN administration alone or in combination with ethinyl estradiol (EE) in 26 women. Before the trial, urinary dinor excretion correlated with serum total HDL cholesterol (r = 0.499; P less than 0.01) and HDL2 cholesterol levels (r = 0.668; P less than 0.001; n = 26). Administration of DG (150 micrograms/day; 14 women) or LN (150 micrograms/day; 12 women) for 2 weeks caused no changes in the excretion of these prostanoids, but LN administration decreased serum HDL cholesterol levels. After that, the women underwent a monophasic regimen of 150 micrograms DG or LN plus 30 micrograms EE for 3 months and thereafter polyphasic regimens of the same steroids for a further 3 months. The DG-containing pills increased urinary dinor excretion by 25-40%, but caused no changes in 6-keto and TxB2 excretion, as measured on days 19-21 of the cycles. LN-containing pills reduced urinary 6-keto excretion by 22% at the end of polyphasic treatment, but caused no changes in dinor and TxB2 output. DG plus EE, but not LN plus EE, increased serum total HDL and HDL2 cholesterol concentrations by a maximum of 25%. Thus, a DG plus EE combination may stimulate PGI2 synthesis by increasing the levels of HDL/HDL2. Theoretically, this stimulation protects against occlusive vascular disorders.

PIP: The effects of desogestrel or levonorgestrel alone and in combination with ethinyl estradiol on the urinary excretion of metabolites of antiaggregatory prostacyclin (PGI2) and thromboxane A2 (TxA2) and on serum high density lipoprotein (HDL) and HDL2 cholesterol concentrations were investigated in 26 women. Baseline urinary 6-keto, dinor, and TxB2 excretion and serum HDL or HDL2 cholesterol concentrations did not differ between study groups. Administration of desogestrel and levonorgestrel alone for 2 weeks caused no changes in PG excretion, but it reduced serum HDL and HDL2 cholesterol concentrations. The desogestrel-estradiol combination was accompanied by 40% and 25% rises in urinary dinor excretion and 20% and 15% rises in urinary 6-keto and dinor excretion at the end of the monophasic and polyphasic regimens, respectively, but no significant changes in urinary TxB2 excretion. The levonorgestrel-estradiol combination produced a 22% decrease in urinary 6-keto excretion during polyphasic treatment, but led to no change in the excretion of the other prostanoids. Both monophasic and polyphasic levonorgestrel and estradiol administration lowered serum HDL and HDL2 cholesterol levels, while monophasic desogestrel plus estradiol increased serum HDL2. The mean relative changes in serum HDL2 cholesterol and urinary dinor excretion were parallel in users of desogestrel plus estradiol, suggesting that a serum HDL cholesterol increase induced by this regimen could be related to increased vascular PGI2 production. Although the mechanism that causes increases in PGI2 and HDL during desogestrel-estradiol administration remains unknown, such a combination has the potential to reduce the risk of occlusive-thrombotic vascular disorders--currently the most serious side effect of oral contraceptive use.