Lipid Metabolic Effects Induced by Two Estradiol/Norgestrel Combinations in Women Around Forty

Prolonged use of combined oral contraceptives has been associated with an increased risk of developing cardiovascular disease, especially after the age of 40. One of the risk factors of such diseases is changes in serum lipid and lipoprotein metabolism. To evaluate the lipid metabolic effects of two estradiol-norgestrel combinations, 12 women aged 36-46 (mean 43) seeking contraceptive advice were allocated to 3 months' treatment with CyclabilR (preparation 1) immediately followed by CyclabilR + 2 mg ProgynonR (preparation II). Prior to this treatment the women had been monitored for 3 months with measurement of basal body temperature curves and serum progesterone in the luteal phase, which indicated that they had normal ovulatory cycles. Rather small changes were noted in serum lipids and lipoproteins, in contrast to the usual findings in the case of oral contraceptive use. A decrease of free and total cholesterol was seen, but no effects of triglycerides and phospholipids were encountered. With preparation II, the steroidal load on the liver might also influence lipid and lipoprotein metabolism, as indicated by the decrease in high-density lipoprotein (HDL) cholesterol, concomitant with an increase in very low-density lipoprotein (VLDL) triglycerides. On subdividing the group into two groups (i) with high HDL cholesterol levels Prior to treatment (group A) and (ii) those with lower concentrations (group B), interesting differences were found regarding the response of the two hormonal preparations. In group A, preparation I reduced HDL cholesterol, whereas preparation II did not alter the response. A concomitant increase in VLDL triglycerides was also seen. In group B, HDL cholesterol increased somewhat with preparation I and changed to a decrease on preparation II; concomitantly VLDL triglycerides were reduced with preparation I and increased on preparation II. These results indicate that women with high levels of HDL cholesterol prior to treatment are more susceptible to contraceptive preparations than those with lower values.