Androgenic effects of oral contraceptives: implications for patient compliance

Abstract

Androgenic disorders have many negative physical effects. These effects may be caused by excess androgen (exogenous or endogenous) or by end-organ sensitivity to normal levels of androgens. Historically, androgenic progestins in oral contraceptives have also been associated with some of these negative effects. The most apparent signs of androgen excess are the external manifestations, including oily skin, acne, hirsutism, android obesity, and androgenic alopecia. Of equal concern are the potential metabolic disturbances associated with hyperandrogenicity. Unfavorable lipid profiles and increased incidence of diabetes and hypertension are very real threats to long-term health. In oral contraceptive users, external manifestations of androgenicity often lead to poor compliance, decreased efficacy, and discontinuation of oral contraceptive use, especially in the younger patient. With the introduction of the newer oral contraceptive formulations containing less androgenic progestins (norgestimate, desogestrel, gestodene), androgen-related effects have been reduced and better compliance is anticipated.

PIP: One of the primary reasons why women discontinue use of oral contraceptives (OCs) containing androgenic progestins is because of unwanted side effects. A new generation of progestin-based OCs have shown promise in lowering androgenic side effects while preventing pregnancy. Many of these side effects are manifested externally, but there are also long-term health risks due to potential metabolic disturbances and high lipoprotein levels. This paper considers implications of OC androgenic effects for user compliance; it discusses the biologic effects of progestins used in OCs on endometrial tissues; further, it reviews, describes, and compares older OC formulations to new generation OCs in the progestin group. Low doses of progestins in OCs decrease unwanted androgenic side effects. New generation progestin OCs have shown a decreased incidence of unwanted/negative external physical side effects; they also appear to increase high-density lipoprotein (HDL) levels and reduce low-density lipoprotein (LDL) levels. The author concludes that the improved user compliance rate resulted from the prescription of new generation progestin OCs.