Oxidative stress, lipid profile and liver functions in average Egyptian long term depo medroxy progesterone acetate (DMPA) users

Effects of hormonal contraceptives on lipid profile among women attending family planning unit in Goba Town Public Health Facilities, Bale, Southeast Ethiopia: a comparative cross-sectional study

BACKGROUND

Hormonal contraceptives are a widely used contraceptive method for the prevention of pregnancy in women. It is associated with change in lipid profile which results in congestive heart failure, coronary heart disease, angina, deep vein thrombosis and stroke which are the major cause of premature death. We aim to investigate the effects of hormonal contraceptive use on lipid profile among women attending family planning unit in Goba Town Public Health Facilities.

METHODS

A comparative cross-sectional study design was conducted on 93 hormonal contraceptive users and 93 non-users' women in Goba Town Public Health Facilities from September to November, 2022. Blood samples for the estimation of TC, TG, HDL-c and LDL-c levels were collected. Student's independent t-test was used to compare the results of lipid profiles. One-way ANOVA was used to identify the variation of lipid profile between progestin only pills, DMPA and implant users. Simple linear regression was used to determine the change in lipid profiles in relation to the duration of hormonal contraceptive use. P-value less than 0.05 was considered as statistically significant.

RESULT

The mean serum level of TC, TG and LDL-c was significantly increases in hormonal contraceptive users in comparison with non-users. The mean serum level TC, TG, LDL-c and HDL-c was significantly different between DMPA, implanon and POP users. The mean serum level of TC, TG and LDL-c in implanon users was lower than DMPA and POP users. As the duration of DMPA and POP use increases, the serum level of TC, TG and LDL-c were significantly increased. But, the serum level of HDL-c was significantly decreased. LDL-c was significantly increased with the duration of implanon use.

CONCLUSION

The mean serum level of TC, TG and LDL-c were significantly increased among hormonal contraceptive users. The mean serum level of lipid profile was significantly different between DMPA, implanon and POP users. The serum level of TC, TG, LDL-c were directly proportional to the duration of DMPA and POP use. Routine evaluation of lipid profiles is advisable before and after initiation of hormonal contraceptives.

Assessment of liver function tests of women taking hormonal contraceptives at University of Gondar comprehensive specialized hospital and Family Guidance Association of Gondar (FGAE), 2022; a comparative cross-sectional study

INTRODUCTION

Hormonal contraceptives are artificial preparations that contain artificial progestins and Ethinylestradiol; these preparations are utilized by women of reproductive age to prevent pregnancy. Roughly a billion women in the world use some form of contraceptive worldwide. Despite the utility of these preparations, they are linked with several adverse effects, including disturbances of liver functionality and integrity. However, previous studies conducted to assess the association between hormonal contraceptive utilization and liver function tests reported conflicting results, and the effects remained a matter of concern.

METHODS

The study enrolled a total of 264 participants, who were allocated into two groups. One group of hormonal contraceptive users who use the medication for a minimum of six months: Depot medroxyprogesterone acetate (DMPA), combined oral contraceptives (COC), Norplant, and Implant users and another age-matched non-user control group in a ratio of 1:1. A semi-structured questionnaire was used to collect socio-demographic, behavioral, and clinical data. Five ml serum blood sample was collected for liver function test analysis on a Beckman Coulter Clinical Chemistry analyzer (DXC 700 AU). Independent t-test was used to compare liver function tests of hormonal contraceptive users and non-user controls, whereas ANOVA followed by a Bonferroni post hoc test was used for intra- (between classes of contraceptives) and inter-group (between each class of contraceptives and controls) comparisons and to identify factors associated.

RESULTS

Hormonal contraceptive users were observed to have a statistically significant higher mean value of liver enzymes assessed compared to non-user control groups: aspartate aminotransferase (AST) (47.07±14.79 versus 25.92±7.37; p <0.001), alanine aminotransferase (ALT) (35.83±13.76 versus 16.56 ± 5.03; p <0.001), alkaline phosphatase (ALP) (63.34±14.74 versus 45.41±14.34, p <0.001) and for γ-glutamyl transferase (GGT) (47.37±24.32 versus 19.45 ± 6.86 p <0.001). Similarly, the mean value of total and direct bilirubin (mg/dL) among HC users showed a statistically significant elevation (0.68 ± 0.22 against 0.32 ± 0.13, p <0.001) for total bilirubin and (0.14 ± 0.06 against 0.06 ± 0.03, p <0.001) for direct bilirubin respectively. However, no statistically significant result was observed in the mean values of total protein and albumin. For total protein (6.7 ± 0.89 versus 6.5 ± 1.15, p 0.07) and for albumin (5.4 ± 0.92 versus 5.3 ± 1.08; p 0.30). The current study also indicates the level of hepatic function test alteration is related to the type of hormonal contraceptives, duration of usage, and level of adherence to a specific class of contraceptives.

CONCLUSION AND RECOMMENDATION

Hormonal contraceptive use was observed to affect hepatic function. Based on this finding, we strongly recommend to closely monitor liver function tests in women using hormonal contraceptives.

Melatonin attenuates glucocorticoid effect induced by medroxyprogesterone acetate in rats

Medroxyprogesterone acetate (MPA) acts on glucocorticoid receptors and, when it is in excess, can cause clinical disorders comparable to hyperadrenocorticism. Melatonin (MEL) is a hormone with potent antioxidant and anti-glucocorticoid activity and it can be beneficial in the excessive activation of glucocorticoid receptors. To evaluate the protective effects of MEL on the glucocorticoid effect of MPA, 34 male Wistar rats were randomized into four groups: CON (control), MEL, MPA, and MPA + MEL. The animals were treated for 28 days, by subcutaneous injection. At the high dose that we used, the MPA caused effects compatible with an excessive activation of glucocorticoid receptors, resulting on a reduction in adrenal size, less weight gain, lower final body weight and feeding efficiency, and fewer lymphocytes compared with the control group. In addition, there was an increase in abdominal fat, cholesterol, very-low-density lipoprotein (VLDL), triglycerides, erythrocytes, hemoglobin, hematocrit, and hepatic vacuolization. We concluded that MEL was effective reducing the mean values of total cholesterol, high-density lipoprotein (HDL), urea, VLDL, triglycerides, hepatic microvacuolization and abdominal fat/weight in rats treated with MPA. These findings indicate that MEL attenuates the harmful effects of MPA.

Anthropometric indices, blood pressure, and lipid profile status among women using progestin-only contraceptives: comparative cross-sectional study

BACKGROUND

The major types of hormonal contraception used currently in Ethiopia are progestogen-only. This study aimed to assess the differences in anthropometry indices, blood pressure, and lipid profile among women using progestin-only contraceptives in selected health facilities of Jimma town, southwest Ethiopia.

METHODS

A facility-based comparative cross-sectional study was conducted among women of reproductive age using Depo-medroxyprogesterone acetate (DMPA) and implant in selected health facilities from April 11 to May 11, 2019. A total of 146 women (45 DMPA and 51 implant users and 50 non-users) were selected randomly for inclusion in the study. One-way analysis of variance was used to examine variations in health outcomes while Bonferroni post-hoc tests were conducted to determine significance of variations between multiple outcomes.

RESULTS

There was a statistically significant difference in the mean Body Mass Index (p = 0.045), Hip-to-waist ratio (p = 0.012), systolic blood pressure (p = 0.027), diastolic blood pressure (DBP) (p = 0.017), total cholesterol (TC) (p = 0.005), low-density lipoprotein (p = 0.023) and triacylglycerol (TAG) (p = 0.000) between women using progestin-only contraceptives and non-users. DMPA users had higher TC (p = 0.024) than non-users. Results from Pearson correlation analysis showed that DBP of DMPA users was higher with longer duration of use.

CONCLUSION

The findings suggest the need for family planning service providers to undertake appropriate client profiling before recommending a particular method to women seeking the services in order to minimize adverse health risks, especially for those who may have pre-existing conditions.

Medroxyprogesterone Acetate in Gender-Affirming Therapy for Transwomen: Results From a Retrospective Study

CONTEXT

Medroxyprogesterone acetate (MPA) is a widely used progestin in feminizing hormone therapy. However, the side effects and hormonal changes elicited by this drug have never been investigated in the transgender population.

OBJECTIVE

We evaluated the incidence of self-reported effects among transwomen using MPA and this drug's impact on hormonal and metabolic parameters.

DESIGN, SETTING, AND PARTICIPANTS

We retrospectively collected data from 290 follow-up visits (FUVs) of transwomen treated at Rhode Island Hospital from January 2011 to July 2018 (mean duration of therapy 3.4 ± 1.7 years). FUVs followed regimens of estradiol (E) and spironolactone, with MPA (n = 102) or without MPA (n = 188).

MAIN OUTCOME MEASURES

We assessed the incidence of self-reported effects after MPA treatment. We also compared blood levels of E, testosterone, and various laboratory parameters between MPA and non-MPA groups.

RESULTS

Mean weighted E level was 211 ± 57 pg/mL after MPA treatment and 210 ± 31 pg/mL otherwise; this difference was nonsignificant [t(274) = 0.143, P = 0.886]. Mean weighted testosterone level was 79 ± 18 ng/dL after MPA treatment and 215 ± 29 ng/dL otherwise; testosterone levels were significantly lower in the MPA group [t(122) = 32.4, P < 0.001]. There were minimal changes in other laboratory parameters. Of 39 patients receiving MPA, 26 reported improved breast development and 11 reported decreased facial hair. Five patients experienced mood swings on MPA.

CONCLUSIONS

In our cohort of transwomen, we found minimal side effects, unchanged E levels, and a decline in testosterone associated with MPA, outcomes consistent with feminization. Prospective studies are needed to confirm our findings.

Effect of vitamin E and C supplements on lipid peroxidation and GSH-dependent antioxidant enzyme status in the blood of women consuming oral contraceptives

BACKGROUND

Oral contraceptives (OCs) may affect oxidative stress status. We aimed to assess whether supplementation with vitamins E and C reduced this OC effect.

STUDY DESIGN

One hundred twenty healthy female individuals were divided into three groups: A, control; B, untreated OCU (OC users); and C, treated OCU (OC users with vitamin E and C supplementation). In all cases, plasma glutathione peroxidase (GPx) and glutathione reductase (GR) activities and malondialdehyde (MDA) level were determined.

RESULTS

Significant increases were found in the plasma MDA level, and activities of GPx and GR in plasma were decreased in Group B compared to the control group. Supplementation with vitamin C and E significantly increased the activity of GPx and GR activity, and reduced plasma MDA levels in Group C (p<.05).

CONCLUSIONS

These data suggest that low-dose OCs, by enhancing the stress oxidative and lipid peroxidation, may represent a potential cardiovascular risk factor, and the use of vitamins E and C may be beneficial in ameliorating this side effect of OCs.

Effects of long-term use of depo-medroxyprogesterone acetate on lipid metabolism in Nepalese women

Various synthetic progestogens that are used as contraceptives have been reported to influence lipid and lipoprotein fractions differently. Depo-medroxyprogesterone acetate (DMPA), a synthetic progestogen, is used by Nepalese women as a contraceptive agent. Our study aims to determine the effects of long-term use of DMPA on lipid metabolism. We performed this study on 60 healthy Nepalese women who had been using DMPA for more than 2 yr and age- and weight-matched control subjects who were not using hormonal contraceptives. Fasting blood samples were collected from the subjects for the estimation of total cholesterol (TC) and triglyceride (TG) levels, and the levels of high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) were estimated using the Friedewald's equation. TC and LDL-C levels in DMPA users were significantly higher than those in non-users. Our study concluded that DMPA use induces lipid metabolism changes that can increase the risk of cardiovascular diseases.

Effects of oral contraception with ethinylestradiol and drospirenone on oxidative stress in women 18-35 years old

BACKGROUND

Oral contraceptives (OCs) with estrogens and progestins may affect oxidative stress (OS) status.

STUDY DESIGN

A group of 32 women using oral contraceptives (OCU) containing 0.03 mg ethinylestradiol and 3 mg drospirenone have been compared to a matched control group of 30 noncontraception users (NCU). Blood levels of antioxidants, trace elements and markers of lipid peroxidation were assessed by biochemical methods. A microarray analysis of whole blood mRNA levels of 200 genes involved in OS-dependant pathway was also performed.

RESULTS

Levels of zinc, vitamin E and antibodies to oxidized low-density lipoproteins (LDLs) were not significantly different between the two groups. On the other hand, significant increases in the mean levels of lipid peroxides (+176%, p<.001), oxidized LDLs (+145%, p<.002), copper (+103%, p<.001), Cu/Zn ratio (+100%, p<.001) and a significant decrease in the mean level of beta-carotene (-41%, p<.01) were observed in the OCU compared to NCU. There was a highly significant positive correlation between the lipid peroxide levels and the copper-to-zinc ratio. From the 200 genes tested by microarray, one coding for HSP70 was significantly up-regulated (log(2) fold change=+ 0.45, p<.02) and one coding for inducible nitric oxide synthase significantly down-regulated (log(2) fold change=-0.24, p<.05) in the OCU compared to the NCU.

CONCLUSIONS

The recently introduced combination of ethinylestradiol and drospirenone induced the heightening of lipid peroxidation correlated with high levels of copper, a situation that could be associated with increased cardiovascular risk.