Abstract
Purpose
This study compared two oral contraceptives (OCs) with the same triphasic regimen
of progestin (norgestimate 0.18, 0.215 and 0.25 mg) but differing doses of ethinyl
estradiol (EE) ��� 25 and 35 ��g EE ��� in their effects on androgens, mood and sexual
interest in women starting on OCs.
Methods
Total testosterone (T), free testosterone (FT), sex-hormone-binding globulin (SHBG)
and dehydroepiandrosterone sulphate (DHEA-S), together with measures of mood [Beck
Depression Inventory (BDI)], sexual interest [Dyadic and Solitary subscales of the
Sexual Desire Inventory (SDI)] and self-reported side effects were assessed before
starting on the OC and again after 3 months of use.
Results
Sixty women, all university students, were randomized to receive either the 25 ��g
EE (N/EE25) or the 35 ��g EE (N/EE35) pill; 12 women discontinued, leaving 48 who
completed the 3-month study. Their mean age was 19.7 years (18���30) and they were
predominantly white and single. Both OCs produced reductions in mean T [N/EE35: from
1.33 to 0.60 nmol/L, p<.001; N/EE25: from 1.12 to 1.02 nmol/L; nonsignificant (NS)]
and FT (N/EE35: from 41.3 to 4.4 pmol/L, p<.001; N/EE25: from 25.4 to 7.9 pmol/L,
p<.01), but the reduction in both T and FT was significantly greater with the higher
EE dose (N/EE35) (p=.05 and p=.03, respectively). DHEA-S was also reduced with both
formulations (N/EE35: from 7.26 to 5.22 ��mol/L); N/EE25: from 7.50 to 5.39 ��mol/L),
although the reduction was only significant in the N/EE35 group (p<.02). Considerable
variability in changes in mood was evident with both OCs, with some women showing
predominantly negative effects (10 in N/EE35, 5 in N/EE25); others, positive effects
(9 in N/EE35, 17 in N/EE25) and some, no change (four in each group). Women using
N/EE25 were significantly more likely to show improvement in premenstrual mood than
those in the N/EE35 group (p<.02), although there was no correlation between changes
in BDI and FT or DHEA-S. Sexual interest scores did not change significantly from
baseline to posttreatment with either OC (N/EE35: dyadic, from 40.5 to 39.6, NS; solitary,
from 5.9 to 6.4, NS; N/EE25: dyadic, from 36.7 to 37.0, NS; solitary, from 5.0 to
4.2, NS).
Conclusion
The lower EE pill reduced FT less and was associated with greater improvement in premenstrual
mood. A causal relation between these two effects is uncertain.
Keywords
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Article info
Publication history
Published online: May 21, 2007
Accepted:
March 10,
2007
Received in revised form:
March 8,
2007
Received:
March 19,
2006
Footnotes
���The study was supported by grants from The Regenstrief Institute, Indiana University Research and University Graduate School and Indiana University-Purdue University Indianapolis Office for Professional Development.
Identification
Copyright
© 2007 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
