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.
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.
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).
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.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Contraception
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- The Royal College of General Practitioners' Oral Contraception Study: some recent observations.Clin Obstet Gynecol. 1984; 11: 759-786
- The effects of oral contraceptives on well-being and sexuality.Oxf Rev Reprod Biol. 1990; 12: 57-92
- To what extent do oral contraceptives influence mood and affect?.J Affect Disord. 2002; 70: 229-240
- The premenstrual syndrome ��� a reappraisal of the concept and the evidence.Psychol Med Monogr. 1993; 24: 1-47
- A prospective study of the effects of oral contraceptives on sexuality and well-being and their relationship to discontinuation.Contraception. 2001; 64: 51-58
- Effect of an oral contraceptive containing drospirenone and ethinylestradiol on general well-being and fluid-related symptoms.Eur J Contracept Reprod Health Care. 2003; 8: 37-51
- The relationship between mood and sexuality in women using an oral contraceptive as a treatment for premenstrual symptoms.Psychoneuroendocrinology. 1993; 18: 273-281
- Evaluation of a unique oralcontraceptive in the treatment of premenstrual dysphoric disorder.J Womens Health Gend Based Med. 2001; 10: 561-570
- The effects of steroidal contraceptives on the well-being and sexuality of women: a double-blind, placebo-controlled, two-center study of combined and progestogen-only methods.Contraception. 1995; 52: 363-369
- Sex-hormone-binding globulin.Clin Endocrinol. 1974; 3: 69-96
- Steroid hormones, the menopause, sexuality and well-being of women.Psychol Med. 1996; 26: 925-936
- Endogenous androgen levels and wellbeing: differences between pre- and postmenopausal women.Menopause. 2005; 13: 65-71
- The endocrinology of sexual arousal. Starling review.J Endocrinol. 2005; 186: 411-427
- Changes in androgens during treatment with four low-dose contraceptives.Contraception. 1996; 53: 171-176
- Minimal androgenic activity of a new oral contraceptive containing norethindrone acetate and graduated doses of ethinyl estradiol.Contraception. 2001; 63: 71-76
- Comparative profiles of reliability, cycle control and side effects of two oral contraceptive formulations containing 150��g desogestrel and either 30��g or 20��g ethinyl oestradiol.Br J Obstet Gynaecol. 1993; 100: 832-838
- A twelve-month comparative clinical investigation of two low-dose oral contraceptives containing 20��g ethinylestradiol/75��g gestodene, and 30��g ethinylestraiol/75��g gestodene, with respect to efficacy, cycle control, and tolerance.Contraception. 1997; 55: 131-137
- Sexual behavior of women taking low-dose oral contraceptive containing 15��g ethinylestradiol/60��g gestodene.Contraception. 2004; 69: 237-240
- A prospective study on sexual behavior of women using 30��g ethinylestradiol and 3��mg drospirenone oral contraceptive.Contraception. 2005; 72: 19-23
- Sexuality, hormones and the menopausal transition.Maturitas. 1997; 26: 83-93
- A prospective, randomized study of oral contraceptives: the effect of study design on reported rates of symptoms.Contraception. 1979; 20: 329-337
- Beck Depression Inventory (BDI).in: American Psychiatric Association Handbook of psychiatric measures. American Psychiatric Association, Washington (DC)2000: 519-523
- The Sexual Desire Inventory: development, factor structure and evidence of reliability.J Sex Marital Ther. 1996; 22: 175-190
- Perimenstrual complaints in women complaining of PMS, menorrhagia and dysmenorrhoea; towards a dismantling of the ���premenstrual syndrome���.Psychosom Med. 1993; 55: 133-145
- Serum distribution of the major metabolites of norgestimate in relation to its pharmacological properties.Contraception. 2003; 67: 93-99
- Estimation of the percentage of free steroid in undiluted serum by centrifugal ultrafiltration-dialysis.J Biol Chem. 1980; 255: 5023-5026
- Female androgen deficiency: the Princeton consensus statement on definition, classification, and assessment.Fertil Steril. 2002; 77: 660-665
- Circulating androgen levels and self-reported sexual function in women.JAMA. 2005; 294: 91-96
- Measurement of total testosterone in women: comparison of a direct radioimmunoassay versus radioimmunoassay after organic solvent extraction and celite column partition chromatography.Fertil Steril. 2005; 84: 1698-1704
- American Psychiatric Association, Washington (DC)2000: 771-774 Diagnostic and Statistical Manual of Mental Disorders. 4th ed., Text Rev.
- The relationship between premenstrual symptoms and oral contraceptive use: a controlled study.Psychosom Med. 1990; 52: 86-96
- The effects of oral contraceptives on mood and sexuality: a comparison of triphasic and combined preparations.J Psychosom Obstet Gynaecol. 1997; 7: 1-8
- Dehydroepiandrosterone monotherapy in midlife-onset major and minor depression.Arch Gen Psychiatry. 2005; 62: 154-162
- Does oral contraceptive-induced reduction in free testosterone adversely affect the sexuality and mood of women?.Psychoneuroendocrinology. 2007; 32: 246-255
Published online: May 21, 2007
Accepted: March 10, 2007
Received in revised form: March 8, 2007
Received: March 19, 2006
���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.
© 2007 Elsevier Inc. Published by Elsevier Inc. All rights reserved.