Lipid metabolism effects with desogestrel-containing oral contraceptives

Abstract

Desogestrel is a gonane progestogen that in early studies had an improved ratio between desired progestational effects and undesired androgenic effects. A review of more than 50 clinical studies suggests that desogestrel differs from progestins currently used in oral contraception in that it does not interfere with the estrogen effects on lipoprotein metabolism. This profile is attributable to the high selectivity of desogestrel.

PIP: Desogestrel is a gonane progestogen that is rapidly metabolized to 3-keto-desogestrel, the metabolite believed to be exclusively responsible for the progestational effects of desogestrel after oral administration. More than 50 prospective studies have reported on the effects of the monophasic OC containing 30 mcg of ethinyl estradiol and 150 mcg of desogestrel. The results of a cross-sectional study were recently reported which was funded by the National Institutes of Health and involved 925 women who used seven combination OCs and 418 untreated controls. The desogestrel-containing OC induced a statistically significant increase in high-density lipoprotein cholesterol (HDL-C) in 40% of the observations and a decrease in low-density lipoprotein cholesterol (LDL-C) in 10% of the observations. An increase in HDL3-C was measured in 43% of the observations, whereas little effect on HDL2-C was apparent. The desogestrel-containing OC was associated with an average 25% increase in plasma triglyceride levels compared with a 31% average increase observed with low estrogen dose OCs. In this series, 54% of the studies reported an increase in HDL-C in women taking the desogestrel-containing OC. In women taking the levonorgestrel-containing triphasic OC, only 5% of the studies reported an increase, whereas 10% of the studies reported a decrease. For the monophasic levonorgestrel-containing OC, 53% of the studies reported a decrease in HDL-C. The desogestrel-containing OC was associated with a tendency to reduce LDL-C, whereas use of the triphasic levonorgestrel-containing OC was not associated with changes in LDL-C. In contrast, in 32% of the studies involving the monophasic levonorgestrel-containing OC, an increase in LDL-C was observed. The results of the large cross-sectional study concurred with the findings of the prospective studies. OC use ranged from 1.5 to 4 years. HDL2-2 was the most sensitive discriminator of the dose and type of progestin taken.