gestodene and Diabetes-Mellitus--Type-1

To evaluate the long-term intake of Norplant, depot medroxyprogesterone acetate (DMPA) and low dose oral contraceptive pill (OCs) on glycemic control, lipoprotein metabolism and coagulation profile in diabetic women.. Prospective comparative study including 80 uncomplicated controlled diabetic women. Twenty women allocated to each group. Clinical, metabolic and coagulation status were followed up at 3, 6 and 9 months' visits.. Fasting blood sugar increased in OCs and DMPA users. Total cholesterol (TC) and LDL-cholesterol (LDL-C) decreased in all groups except DMPA where it increased. Triglyceride (TG) only increased in OCs group. HDL-cholesterol (HDL-C) increased with OCs and decreased with Norplant and DMPA. Compared to IUD users, significantly higher percentage TG and HDL-C and lower LDL-C were observed in OCs users, while DMPA users had significantly higher TC and LDL-C and lower HDL-C. Partial thromboplastin time was prolonged in Norplant users.. In diabetics, Norplant results in minimal metabolic alterations followed by OCs while DMPA has unfavorable outcome.

Topics: Adult; Blood Coagulation; Blood Glucose; Blood Pressure; Cholesterol; Contraceptive Agents, Female; Contraceptives, Oral, Combined; Contraceptives, Oral, Synthetic; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Drug Implants; Estradiol Congeners; Ethinyl Estradiol; Female; Humans; Intrauterine Devices, Copper; Levonorgestrel; Lipoproteins; Medroxyprogesterone Acetate; Norpregnenes; Prospective Studies

The effects of contraceptive steroids on the expression of endothelial homeostasis were examined by direct and indirect measures in women with insulin-dependent diabetes mellitus (IDDM) in a prospective nonrandomized controlled study. Study subjects were 13 women with uncomplicated IDDM treated with a monophasic combination of 30 micrograms ethinyl estradiol and 75 micrograms gestodene for 12 consecutive cycles and 13 women of comparable diabetic status as control. During the study period, none of the participants developed increased renal albumin excretion, which was used as a direct measure of endothelial function. In the indirect assessment of endothelial function, we found a proportionate increase in plasma levels of thrombin-antithrombin III (TAT) complexes and D-dimer during treatment. Hormonal intake was followed by decreased antigen concentrations of tissue plasminogen activator (t-PA) and plasminogen activator inhibitor (type 1 [PAI-1]), whereas the activities of t-PA and PAI-1 were unchanged. Plasma levels of plasminogen and histidine-rich glycoprotein (HRG) increased and decreased, respectively, whereas an increase in von Willebrand factor was observed in the treatment group. No significant changes in direct or indirect measures were observed in the control group during the observation period of 12 months. In conclusion, no adverse effect on endothelial function was demonstrated by direct measures, but our findings suggest that a procoagulant state, compensated by enhanced activity of the fibrinolytic system, is induced by hormonal treatment. Clinical and metabolic monitoring is recommended if the use of oral contraceptives in women with IDDM is extended.

Topics: Adult; Contraceptives, Oral, Hormonal; Diabetes Mellitus, Type 1; Endothelium, Vascular; Ethinyl Estradiol; Female; Homeostasis; Humans; Norpregnenes; Plasminogen; Plasminogen Activator Inhibitor 1; Prospective Studies; Proteins; Tissue Plasminogen Activator; von Willebrand Factor

In an open prospective study we evaluated the glycaemic control and lipoprotein metabolism in 22 women with uncomplicated insulin dependent diabetes mellitus during one year of oral contraception with ethinyl oestradiol and gestodene. Twenty women of comparable diabetic status using non hormonal contraception served as controls. No changes in glycaemic control were observed in any of the groups. In the oral contraceptive group decreased serum levels of low-density lipoprotein cholesterol and increased levels of triglycerides and lipoprotein A were noted whereas total cholesterol and high-density lipoprotein cholesterol levels were unchanged. In the control group a decrease of low-density lipoprotein cholesterol was observed. No effect of tobacco smoking on glycometabolic control or lipoprotein metabolism could be demonstrated during hormonal intake. In conclusion, we found no evidence of impaired glycometabolic control or adverse changes in serum levels of lipoproteins known to be associated to atherosclerosis in diabetic women during one year of oral contraception with ethinyl oestradiol and gestodene.

Topics: Adolescent; Adult; Blood Glucose; Contraceptives, Oral, Combined; Contraceptives, Oral, Synthetic; Diabetes Mellitus, Type 1; Estradiol Congeners; Ethinyl Estradiol; Female; Humans; Lipoproteins; Norpregnenes; Prospective Studies

Safe and effective contraceptive methods are essential for women with insulin-dependent diabetes mellitus (IDDM), but opinions on the use of hormonal oral contraceptives by these women are conflicting. We evaluated the effects on glycometabolic control and lipoprotein metabolism in women with IDDM treated with an oral contraceptive not previously studied in a diabetic population.. A total of 22 women with IDDM received a monophasic combination of ethinyl estradiol and gestodene for 1 year; 20 women of comparable diabetic status using nonhormonal contraception were selected as control subjects. Evaluation was performed before and after 1, 3, 6, and 12 months of hormonal intake using nonparametric statistical methods.. Except for a higher median age of the control group, the baseline values for all clinical and metabolic variables were similar in the two groups, and in neither of the groups were changes in blood pressure, body mass index, or glycemic control observed. In the oral contraceptive group, decreased serum levels of low-density lipoprotein (LDL) cholesterol and increased levels of triglycerides and lipoprotein A were noted, whereas total cholesterol and high-density lipoprotein cholesterol levels were unchanged. In the control group, a decrease of LDL cholesterol was observed. No effect of tobacco smoking on glycometabolic control or lipoprotein metabolism could be demonstrated during hormonal intake.. No evidence of impaired glycometabolic control or adverse changes in serum levels of lipoproteins known to be associated with atherosclerosis was observed in women with well-controlled IDDM during 1 year of oral contraception with ethinyl estradiol and gestodene.

Topics: Adult; Albuminuria; Apolipoproteins; Blood Glucose; Cholesterol; Contraceptives, Oral, Combined; Contraceptives, Oral, Hormonal; Diabetes Mellitus, Type 1; Estradiol; Female; Glycated Hemoglobin; Humans; Lipids; Lipoproteins; Norpregnenes; Triglycerides

The European Society of Contraception developed a survey to examine birth control methods in the 12 countries++ of the European Community. Responses to those questions relating to prescribing++ practices of oral contraceptives (OCs) are presented herein. The survey was sent to 400 physicians. One hundred two responded, most from France, Belgium, and the United Kingdom. The responses revealed that the most popular OCs are modern combined formulations containing low doses of ethinyl estradiol and progestogens such as norgestimate, desogestrel, gestodene, and levonorgestrel. More than half of physicians prescribe a particular formulation because of its tolerability and 20% because of its hormonal content. More than 90% prescribe OCs to healthy, nonsmoking women over 40. However, three fourths will not prescribe OCs to smokers over 35. Half of physicians recommend mammography for their older OC patients. Half also recommend cholesterol screening, but 8% only for women over 30. Most physicians are no longer reluctant to prescribe OCs to their diabetic patients: 61% prescribe OCs for women with non-insulin-dependent diabetes, 56% for those with insulin-dependent diabetes, and 85% for those with a history of gestational diabetes. Despite recent studies showing no relation between past OC use and cardiovascular disease, 42% of physicians said that their greatest OC-related health concern is cardiovascular disease. One third cited noncompliance as their greatest concern. These results reveal inhomogeneous prescribing practices for OCs among European physicians. ¿Over-screening¿--not prescribing the pill because of perceived (but not necessarily real) health risks--may be depriving many women of the contraceptive and noncontraceptive benefits of OCs. Complete and accurate information--as promoted by the European Society of Contraception--is one way to combat such overscreening.. Findings are presented from the 1993 European Society of Contraception Oral Contraceptive Survey conducted in 12 member countries among 102 physicians. Findings are considered suggestive because of the low response rate of 25% to the mailed questionnaire to 400 physicians. The aim is to determine the prescribing practices of oral contraceptives. Over 50% of physicians prescribed the following modern, low-dose combined formulations: Marvelon, Mercilon, Minulet, Gynera, Cilest, and Femodene. 66% of physicians prescribed monophasic pills containing 20-30 mcg of ethinyl estradiol and low doses of desogestrel, gestodene, levonorgestrel, or norgestimate. 58% preferred oral pills because of their tolerability. Other desirable features were the cost, hormonal content, and other factors. 94% prescribed oral pills for women aged over 40 years who were healthy and did not smoke. 75% would not prescribe oral pills to women who were over the age of 35 years and who smoked. Over 50% of physicians recommended mammograms for women aged over 35 years who used oral pills. 45% routinely performed lipoprotein screening of oral pill users. 8% did so only for patients aged over 30 years. 42 physicians out of the 102 responding had a protocol based on the total cholesterol level. 61% prescribed oral pills for women with non-insulin-dependent diabetes. The majority prescribed oral pills for women with insulin-dependent diabetes. 38% of physicians who prescribed oral pills for women with diabetes prescribed very-low-dose monophasic oral contraceptives. 85% prescribed oral pills for women with gestational diabetes. 42% were concerned about patient risk of cardiovascular disease. The study revealed a range of practices among physicians.

Topics: Adult; Aging; Cardiovascular Diseases; Contraception; Contraceptives, Oral; Data Collection; Desogestrel; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Estradiol Congeners; Ethinyl Estradiol; Europe; Female; Humans; Levonorgestrel; Norgestrel; Norpregnenes; Progesterone; Progesterone Congeners; Risk Factors; Smoking; Surveys and Questionnaires