Abstract
Background
The metabolic effects of progestin-only long-acting reversible contraception [levonorgestrel-releasing
intrauterine system (LNG-IUS) and etonogestrel implant (ENG-I)] have been studied
in normal-weight women but not in obese [body mass index≥30kg/m2] women.
Study Design
A nonrandomized open-label prospective trial of healthy obese, reproductive-age women
desiring to use long-acting reversible contraception (LARC) or nonhormonal contraception
(NHC). At baseline, 3 months and 6 months, homeostasis model assessment insulin resistant
(HOMA-IR) score, insulin sensitivity (HOMA-%S) and β-cell function (HOMA-%B) were
calculated based on fasting insulin and glucose values. In addition, components of
metabolic syndrome [fasting glucose (FG), high density lipoprotein cholesterol and
triglycerides, systolic and diastolic blood pressure, abdominal circumference] were
measured. Twenty-four subjects total (8 in each arm) were needed to detect a 1.0 difference
in HOMA-IR with 80% power and a two-sided alpha of 0.05.
Results
We present data on eight NHC, eight ENG-I and nine levonorgestrel intrauterine system
(LNG-IUS) users. FG increased, and insulin sensitivity decreased over time among ENG-I
users to a greater extent than among LNG-IUS users when compared to women using a
nonhormonal method [FG change over 6 months=9.4mg/dL, 4.6mg/dL and −2.1mg/dL, respectively; p=.01); (HOMA-%S change over 6 months=−29.9%, −14.8% and 19.3%, respectively; p=.02)], while β-cell function and insulin resistance
did not change significantly (p>.05).
Conclusion
While changes in FG and insulin sensitivity were seen in the present study among obese
progestin-only contraceptive users, either progestin-only LARC method may be safely
used clinically.
Keywords
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Article info
Publication history
Published online: January 04, 2013
Accepted:
December 12,
2012
Received in revised form:
December 4,
2012
Received:
October 27,
2012
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
