Investigations on the effect of an oral contraceptive and its components on liver function, serum proteins, copper, coeruloplasmin and gamma-glutamyl peptidase in postmenopausal women

A randomized cross-over study comparing pharmacodynamic and metabolic variables of a new combiphasic and a well-established triphasic oral contraceptive

In an open-label, randomized, cross-over study in 20 subjects, the short-term effects were investigated of Gracial (DSG/EE 7 x 25/40 micrograms/day + 15 x 125/30 micrograms/day) and Trigynon (LNG/EE 6 x 50/30 micrograms/day + 5 x 75/40 micrograms/day + 10 x 125/30 micrograms/day) on plasma concentrations of 17 beta-estradiol and progesterone as well as on carrier proteins (SHBG, CBG, ceruloplasmin), AT-III, carbohydrate metabolism (insulin, glucose, glycosylated proteins) and lipid metabolism (total cholesterol, triglycerides, phospholipids, HDL-C, LDL-C, HDL2-C, HDL3-C, HDL2-C/HDL3-C ratio, Apo A1, Apo B, Apo A1/Apo B ratio). Both preparations adequately and similarly inhibited ovulation in all subjects. Serum levels of carrier proteins were significantly higher with DSG/EE than with LNG/EE, whereas no between-group differences were observed with respect to fasting glucose and insulin, glycosylated proteins (mainly glycosylated albumin) and AT-III activity. DSG/EE showed significantly higher plasma levels than LNG/EE of estrogen-dependent lipid parameters such as triglycerides, HDL-C, HDL2-C, Apo A1, HDL2-C/HDL3-C ratio and Apo A1/Apo B ratio, whereas the levels of LDL-C and Apo B were significantly lower. Both oral contraceptive preparations were equally effective in suppression of follicular development, but combiphasic DSG/EE induced higher plasma levels of carrier proteins and higher plasma levels of potentially anti-atherogenic lipid parameters than did triphasic LNG/EE.

Effect of oral hormone replacement therapy on liver function tests

Five oral methods of hormone replacement therapy (HRT) were prescribed to groups of healthy post-menopausal women and their effects on a group of liver function tests were examined. No evidence of deterioration in liver function was noted.

Serum lipids and proteins during treatment with a new oral contraceptive combination containing desogestrel

The present study was carried out to measure lipid and protein levels in serum of healthy women during treatment with a new oral contraceptive combination containing 0.075 mg desogestrel (Org 2969, 17 alpha-ethinyl-18-methyl-11-methylene-4-estren-17-ol) plus 0.050 mg ethinyloestradiol per tablet. All 30 volunteers took 1 tablet daily for 21 consecutive days, followed by a tablet-free period of 7 days. Treatment lasted 3 months. At the end of treatment serum total cholesterol had increased by 0.26 mmol/l (5.0%), high-density lipoprotein-cholesterol by 0.22 mmol/l (15.2%) and triglycerides by 0.43 mmol/l (50%); the calculated low-density lipoprotein cholesterol had decreased by 0.16 mmol/l (4.9%). All lipid concentrations had returned to initial levels 2 months after treatment stopped. After 3 months treatment serum ceruloplasmin, cortisol-binding globulin capacity, sex-hormone-binding globulin capacity and thyroxine-binding globulin had significantly increased by 85.2, 133, 206 and 101%, respectively. All protein levels returned to normal 2 months after treatment stopped. The relationship between serum lipids and hormone-binding proteins has been discussed, as well as the significance of the high-density lipoprotein level with regard to contraceptive treatment.

Effects of oral contraceptive combinations containing levonorgestrel or desogestrel on serum proteins and androgen binding

The effects of the oral contraceptive combinations 0.125 mg Org 2969 (desogestrel) (13-ethyl-11-methylene-18,19-dinor-17alpha-pregn-4-en-20-yn-17-ol) + 0.05 mg ethinyloestradiol (EE) and 0.125 mg levonorgestrel + 0.05 mg EE on serum sex-hormone-binding globulin (SHBG), ceruloplasmin, transcortin and ratio free testosterone over total testosterone (percentage free testosterone) and ratio free 5alpha-dihydrotestosterone over total 5alpha-dihydrotestosterone (percentage free 5alpha-dihydrotestosterone) were compared in healthy female volunteers. Treatment was randomly distributed over the volunteers; 11 women received Org 2969 + EE and 11 women received levonorgestrel + EE. These combinations induced similar increases in transcortin levels (115 and 140%) and ceruloplasmin levels (115 and 123%) after 3 months of treatment. However, the combination Org 2969 + EE induced a substantial increase (213%) in SHBG capacity after 3 months of treatment, whereas a smaller increase (80%) was observed with levonorgestrel + EE. A return to pretreatment values was observed 2 months after termination of treatment for all parameters. The difference in the effects of both preparations oh SHBG was statistically significant and can be best explained by a difference in the androgenicity of the progestogens. A good correlation was free testosterone and the reciprocal value of the percentage free 5 alpha-dihydrotestosterone. These results confirm that SHBG is the major regulator of the biologically active free androgen fraction in women before, during and after combined oral contraceptive treatment.

The effect of menopausal status and sequential mestranol and norethisterone on serum biochemical profiles

Serum biochemical profiles were compared in matched groups of premenopausal and postmenopausal women. Significantly higher concentrations of sodium, urea, calcium, albumin and alkaline phosphatase were found in the postmenopausal group. In the postmenopausal group, following treatment with sequential mestranol and norethisterone, significant reductions were recorded in the concentrations of sodium, urea, calcium, albumin, alkaline phosphatase and glucose and significant increases were recorded in the concentration of globulin and in body weight. The findings suggest that haemoconcentration may take place after the menopause and that this effect may be modified by hormone treatment. No adverse effect on liver function was noted following the hormone treatment.

Effects of medroxyprogesterone acetate on serum lipids, protein, glucose tolerance and liver function in Thai women

Proteins (total, albumin, globulin and their subfractions), carbohydrate (intravenous glucose tolerance test), lipids (serum cholesterol, triglycerides and phospholipids), and liver function tests (alkaline phosphatase, lactic dehydrogenase and aspartate aminotransferase activities in the serum, bromsulphathalein retention test and serum bilirubin) were studied in 12 non-lactating healthy Thai subjects before, and subsequently at 3 weeks and 3, 6, 9 and 12 months after the initiation of treatment with injectable medroxyprogesterone acetate (150 mg I.M. every 90 days). Serum protein and lipid levels, and the results of liver function and I.V. glucose tolerance tests, remained unchanged in all subjects throughout the one-year study period. However, a significant and persistent increased insulin level was noted in all subjects, after initiation of the hormone treatment, during the first thirty minutes of intravenous glucose load. It is concluded that injectable medroxyprogesterone acetate used as a contraceptive agent does not interfere with glucose tolerance, lipid and protein metabolism, and that the liver function remains normal during its administration.

[Liver and ovulation inhibitors. Effects on liver function of estrogen-progestagen containing steroid oral contraceptives]

Since introduction of oral contraceptive steroids a variety of physiologic-adaptive and toxic side effects have been reported. -a review is given. The study reports also four cases of hepatic vein thrombosis (Budd-Chiari-Syndrome--Venoocclusive disease) and three cases of benign hepatic tumors (liver cell adenoma and focal nodular hyperplasia) in young women following 2- to 5-year treatment with oral contraceptive steroids.

Jaundice in pregnancy--1976

An integrative survey is given of three disease processes, in which recent progress of a fundamental nature has been made, primarily affecting the liver, either coincident with or caused by the gravid state. The three conditions considered include (1) recurrent cholestasis of pregnancy (RCP), (2) viral hepatitis coincident with pregnancy, and (3) acute fatty liver of pregnancy (AFLP). In addition to an assessment of our present knowledge with respect to RCP and AFLP, new genetic hypotheses are proposed. In the latter, the proposal of an ornithine transcarbamylase deficiency, similar to that seen in Reye's syndrome, has potential therapeutic implications that are explored. In light of the currently available information on the interaction between maternal viral hepatitis and the variant forms of vertical maternal-fetal transmission, tentative recommendations regarding management of the newborn are suggested.

Failure of a pure progestogen contraceptive to affect serum levels of iron, transferrin, protein-bound iodine, and transaminase

Medroxyprogesterone acetate, a pure progestational agent which is not metabolized to oestrogen, was given to 30 women and shown to have no effect on the serum levels of iron, total iron-binding capacity, transferrin, and protein-bound iodine. Eighteen of these women had previously taken oral contraceptives of the combined oestrogen-progestogen "sequential" type, and during that time these serum levels were raised. Nevertheless, the levels all fell significantly after medroxyprogesterone acetate was given and the "sequential" oral contraceptive was stopped. In a further 12 postpartum women the serum levels did not change significantly after medroxyprogesterone acetate.These observations strongly suggest that raised plasma protein levels resulting from the administration of oral contraceptives are due to the oestrogen component.