Both a combined oral contraceptive and depot medroxyprogesterone acetate impair endothelial function in young women☆

Abstract 

Background

The study was conducted to determine whether the use of a combined oral contraceptive (COC) or depot medroxyprogesterone acetate (DMPA) interferes with endothelial function.

Study Design

The study was conducted on 100 women between the ages of 18 and 30 years. Fifty women had not used hormonal contraception (control group) for at least 12 months, 25 were current users of a COC (ethinylestradiol 30 mcg+levonorgestrel 150 mcg) and 25 were current users of DMPA (150 mg) for at least a 6-month period. All women were evaluated for brachial flow-mediated dilation (FMD), intima-media thickness, carotid distensibility and stiffness index, arterial pressure, body mass index, waist circumference, heart rate and lipid profile.

Results

A significant difference in FMD was observed between the COC and control groups (6.4±2.2% vs. 8.7±3.4%, p<.01) and between the DMPA and control groups (6.2±2.1% vs. 8.7±3.4%, p<.01). The DMPA group had lower values of total cholesterol (TC) and low-density lipoprotein (LDL-C) than COC users and the control group (TC: DMPA=139.9±21.5 mg/dL vs. controls=167.1±29.2 mg/dL vs. COC=168.2±37.5, p=.001; LDL-C: DMPA=85.3±20.1 mg/dL vs. controls=102±24.5 mg/dL vs. COC=106.7±33.3 mg/dL, p=.01). The control group had higher levels of high-density lipoprotein (HDL-C) than the DMPA and COC groups (controls=52.4±14.1 mg/dL vs. DMPA=42.2±7.2 mg/dL vs. COC=45.4±9.1 mg/dL, p=.001). No significant differences were observed regarding the other variables.

Conclusions

FMD was lower among COC and DMPA users, suggesting that these hormonal contraceptives may promote endothelial dysfunction.

Keywords: Combined oral contraceptives, Echographic cardiovascular markers, Endothelial functional, Progestogen-only contraceptives, Arterial function, Cardiovascular disease