Changes in blood levels of proteinase inhibitors, pregnancy zone protein, steroid carriers and complement factors induced by oral contraceptives. [Replacement hormonal therapy in correction of metabolic-trophic changes in ovarian failure syndrome] Use of levonorgestrel implants versus oral contraceptives in adolescence: a case-control study. Rx drugs

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Eur J Obstet Gynecol Reprod Biol. 1993 Sep;51(1):63-71.
Changes in blood levels of proteinase inhibitors, pregnancy zone protein, steroid carriers and complement factors induced by oral contraceptives.

Nielsen CH, Poulsen HK, Teisner B, Thorsen P, Hau J, Westergaard JG.

Department of Medical Microbiology, Odense University Hospital, Denmark.

Three low-dose oral contraceptives Trinordiol, Gynatrol, and Marvelon, containing ethinylestradiol (EE) in combination with triphasic levonorgestrel (LNg), monophasic levonorgestrel, and monophasic desogestrel (DGS), respectively, were given to 65 healthy women, n = 21-22 in each group. Blood levels of antithrombin III (AT III), alpha 2-macroglobulin (alpha 2M) alpha 1-antitrypsin (alpha 1at), complement factors (factor B, C3, C4), pregnancy zone protein (PZP), corticosteroid binding globulin (CBG), sex hormone binding globulin (SHBG) and albumin were measured before treatment and during the first and third treatment cycles. AT III levels decreased and alpha 1at levels increased in all three groups during treatment. alpha 2M increased during cycle 3 in the Trinordiol and Gynatrol groups. CBG, PZP and SHBG levels increased in all 3 groups, the CBG and PZP increase being higher in the Marvelon group than in the Gynatrol group. Increases in SHBG levels were found in the order Marvelon > Trinordiol > Gynatrol. Plasma levels of complement factors B, C3 and C4 remained unchanged. It is concluded that the increase in alpha 1at partly compensates for the fall in AT III, that the rise in PZP presumably enhances fibrinolysis, and that LNg has higher anti-estrogenicity and androgenicity than DSG.

PIP: Clinicians administered 3 types of oral contraceptives (OCs) to 65 healthy 15-31 year old women attending the Public Family Planning Clinic in Odense, Denmark, to determine the effect of the 3 OCs on enzyme inhibitors, complement factors, and steroid dependent proteins. The OCs were a low-dose monophasic containing ethinyl estradiol (EE) and desogestrel (Marvelon), another low dose monophasic containing EE and levonorgestrel (Gynatrol), and a triphasic containing EE and levonorgestrel (Trinordiol). 21-22 women were assigned to each group. Pretreatment values of the biochemical parameters were not significantly different between the 3 groups. In each group, mean plasma antithrombin III (AT III) levels fell (p .04-.002) and alpha1-antitrypsin (alpha1-at) levels increased (p .0001). Mean plasma levels of alpha2-macroglobulin rose sharply during cycle 3 in the Trinordiol and Gynatrol groups (p .04 and .002, respectively). In all 3 groups, mean serum levels of corticosteroid binding globulin (CBG), pregnancy zone protein (PZP), and sex hormone binding globulin (SHBG) increased significantly (p .03-.0001). The CBG and PZP levels were higher in the women using Marvelon than in those using Gynatrol. The increase in SHBG levels were only significant in the Trinordiol and Marvelon groups, however (p .0001). Mean plasma levels of complement factors B, C3, and C4 and of albumin did not change. Based on these results, the researchers concluded that the increase in alpha1-at only partially offsets the decrease in AT III, that the increase in PZP may intensify fibrinolysis, and that levonorgestrel has greater antiestrogenicity and androgenicity than desogestrel.

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Akush Ginekol (Mosk). 1995;(3):38-41.
[Replacement hormonal therapy in correction of metabolic-trophic changes in ovarian failure syndrome]

[Article in Russian]

Kuznetsov SIu.

Clinical and laboratory examination of 105 women was carried out: 46 of these were women with the ovarian exhaustion syndrome, aged 32 +/- 4.5, 42 healthy women aged 30 to 35 and 55 to 59, and 17 patients of a reproductive age after total oophorectomy. Metabolic changes were assessed from blood plasma lipid spectrum and osseous tissue compactness of the radial bone at its distal portion in two sites, 1/3 and 1/20 of its length. The efficacies of two drugs, presomen and anteovin, were compared in patients with ovarian exhaustion. Hypoestrogenism was shown to be one of the major pathogenetic factors in the development of dysmetabolic changes in women of a reproductive age with ovarian exhaustion. The author validates the desirability of substitution hormonal therapy in young women with prolonged estrogen deficiency in order to prevent the development of atherosclerosis and osteoporosis.

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Am J Obstet Gynecol. 1995 Apr;172(4 Pt 1):1128-35; discussion 1135-7.
Use of levonorgestrel implants versus oral contraceptives in adolescence: a case-control study.

Berenson AB, Wiemann CM.

Department of Obstetrics and Gynecology, University of Texas Medical Branch at Galveston 77555-0587, USA.

OBJECTIVE: We compared continuation rates, effectiveness, satisfaction with method, side effects, and condom practices among adolescents using levonorgestrel implants (Norplant, Wyeth-Ayerst Laboratories, Philadelphia) as compared with oral contraceptives. STUDY DESIGN: We conducted a case-control study comparing 94 adolescents < or = 18 years old who received Norplant between March 1, 1992, and Nov. 1, 1993 (cases), with 94 age-matched controls who selected oral contraceptives during this same time period. By use of a structured questionnaire, information was obtained on pregnancy status, duration of use, patient satisfaction, side effects, and condom practices 6 months after initiation. Objective measures included weight on Norplant and oral contraceptive users and hematocrit on implant patients. RESULTS: Forty (43%) oral contraceptive patients compared with no Norplant patients discontinued their selected method before the 6-month interview (p = 0.00). Six patients prescribed oral contraceptives became pregnant. Ninety-three percent of Norplant users expressed overall satisfaction despite experiencing menstrual irregularity and cramping, amenorrhea, nervousness, abnormal hair growth or loss, rashes, and an increase in appetite more often than oral contraceptive users. Although Norplant patients also reported an increase in the duration of menstrual flow and number of days of spotting more often than oral contraceptive users, evaluation of hematocrits in these patients demonstrated a significant increase over the 6-month period (p = 0.00). Assessment of condom practices since initiation demonstrated that Norplant patients used condoms less often than oral contraceptive users (p = 0.00). CONCLUSION: Use of levonorgestrel implants may cause more side effects than oral contraceptives in the early months after initiation but provide superior protection against unintended pregnancy. We concluded that Norplant is a reasonable alternative for adolescents, especially when compliance is an issue.

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