Effects of Second and Third Generation Oral Contraceptives on Lipid and Carbohydrate Metabolism in Overweight and Obese Women: A Randomized Triple-Blind Controlled Trial

BACKGROUND: Combined oral contraceptives (COCs) have not been shown to have major effects on lipid and carbohydrate metabolism in normal-weight women. However, we have limited information about the effects on women at high risk for cardiovascular disease and diabetes due to being overweight and obese. OBJECTIVES: To evaluate the effects of second and third generation contraceptive pills on lipid and carbohydrate metabolism in overweight and obese women. PATIENTS AND METHODS: This triple-blind controlled trial was performed on 137 healthy women aged 18 - 40 years with a body mass index of 25-34.9 (kg/m(2)) who were referred to health centers in Tabriz, Iran from 2014 to 2015. The women were randomly divided into groups who were to take 30 mcg ethinyl estradiol/150 mcg levonorgestrel (EE/LGN) (n = 69) or 30 mcg ethinyl estradiol/150 mcg desogestrel (EE/DSG) (n = 68) with an allocation ratio of 1: 1 for three cycles. As primary outcomes, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and fasting plasma glucose (FPG) were assessed; total cholesterol (TC), triglycerides (TG), and 2-hour plasma glucose in the 75-g oral glucose tolerance test (2-hour 75-g OGTT) were assessed as secondary outcomes. RESULTS: The differences in lipid and carbohydrate parameters were not significant between the two groups, except for HDL-C (Adjusted MD (CI95%) = 7.00 (2.98 to 11.02)). HDL-C decreased with EE/LGN (P = 0.016) and increased with EE/DSG (P = 0.004). LDL-C and TC increased in both groups, whereas TG increased only with EE/DSG (P < 0.05). Compared with the baseline, FPG levels did not differ significantly in both groups, but EE/DSG increased 2-hour 75-g OGTT (P = 0.010). CONCLUSIONS: We observed no significant differences between the two groups in lipid and carbohydrate metabolism, except for HDL-C. Considering the importance of overweight and obese women’s health, studies with longer follow-up periods are recommended in this respect.