Lipid metabolic disturbance induced by the synthetic steroids used in combination oral contraceptives (COCs) has been considered as one of the potential risk factors of cardiovascular diseases. A lower-dose preparation that contains 20 µg of ethinyl estradiol and 100 µg of levonorgestrel (20EE/LNG) has proven effective in most clinical studies, whereas its effect on lipid metabolism is still unclear. The purpose of this study was to estimate the effect of a lower dose of a COC (containing 20 µg of ethinyl estradiol and 100 µg of levonorgestrel) on lipid metabolism by conducting a systematic review and a meta-analysis. A literature search was performed using MEDLINE (PubMed), Embase, PsycINFO, and the Cochrane Central Register of Controlled Trials (CENTRAL database). The studies that are randomized controlled trials to compare a lower-dose COC (20EE/LNG) with a placebo or another COC that differed in terms of the drug, dosage, regimen, and study length were included. Meanwhile, studies should have evaluated the index of lipid metabolism changes. However, the studies with the interventions fewer than three consecutive cycles or the patients were primarily used the treatment of non-contraceptive were excluded. We pooled the low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), total cholesterol (TC), and triglyceride (TG) results, and compared 20EE/LNG with conventional-dose COCs using fixed-effects meta-analysis with inverse-variance weighting. Five randomized controlled trials, with a total of 423 participants (age range: 18–35 years), were included in this study. The results derived from all the included studies were pooled. LDL-C of 20EE/LNG group showed significant lower than control group after three (SMD, 0.16; 95% CI, 0.03–0.30; P=0.02) and six (SMD, 0.16; 95% CI, 0.01–0.31; P=0.04) cycles of treatment. However, there was no difference between the two groups after 12 cycles of administration (SMD, -0.06; 95% CI, -0.31 to 0.18; P=0.61). The pooled results showed there was a significant increase in HDL-C in the 20EE/LNG group after three cycles of treatment (SMD, 0.43; 95% CI, 0.13–0.73; P=0.005). No significant difference was observed between TC and TG groups. For LDL-C, the low-dose group shows a higher risk of suffering from cardiovascular diseases after three and six cycles of treatment, while no difference is observed after 12 cycles of treatment. For HDL-C, the 20EE/LNG group exhibits favorable effects after three cycles of treatment compared with the control groups. Similar effects are found between TC and TG profiles groups.
| Published in | American Journal of Internal Medicine (Volume 4, Issue 3) |
| DOI | 10.11648/j.ajim.20160403.12 |
| Page(s) | 49-59 |
| Creative Commons |
This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited. |
| Copyright |
Copyright © The Author(s), 2016. Published by Science Publishing Group |
Combination Oral Contraceptives, Ethinyl Estradiol, Levonorgestrel, Lipid Metabolism, Systematic Review and Meta-Analysis
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APA Style
Lin Chen, Jun Xu, Shaohui Cai. (2016). The Effect of Dose-Reduced Combination Oral Contraceptives Containing 20 µg of Ethinyl Estradiol and 100 µg of Levonorgestrel on Lipid Metabolism: A Meta-Analysis. American Journal of Internal Medicine, 4(3), 49-59. https://doi.org/10.11648/j.ajim.20160403.12
ACS Style
Lin Chen; Jun Xu; Shaohui Cai. The Effect of Dose-Reduced Combination Oral Contraceptives Containing 20 µg of Ethinyl Estradiol and 100 µg of Levonorgestrel on Lipid Metabolism: A Meta-Analysis. Am. J. Intern. Med. 2016, 4(3), 49-59. doi: 10.11648/j.ajim.20160403.12
AMA Style
Lin Chen, Jun Xu, Shaohui Cai. The Effect of Dose-Reduced Combination Oral Contraceptives Containing 20 µg of Ethinyl Estradiol and 100 µg of Levonorgestrel on Lipid Metabolism: A Meta-Analysis. Am J Intern Med. 2016;4(3):49-59. doi: 10.11648/j.ajim.20160403.12
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Download@article{10.11648/j.ajim.20160403.12,
author = {Lin Chen and Jun Xu and Shaohui Cai},
title = {The Effect of Dose-Reduced Combination Oral Contraceptives Containing 20 µg of Ethinyl Estradiol and 100 µg of Levonorgestrel on Lipid Metabolism: A Meta-Analysis},
journal = {American Journal of Internal Medicine},
volume = {4},
number = {3},
pages = {49-59},
doi = {10.11648/j.ajim.20160403.12},
url = {https://doi.org/10.11648/j.ajim.20160403.12},
eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajim.20160403.12},
abstract = {Lipid metabolic disturbance induced by the synthetic steroids used in combination oral contraceptives (COCs) has been considered as one of the potential risk factors of cardiovascular diseases. A lower-dose preparation that contains 20 µg of ethinyl estradiol and 100 µg of levonorgestrel (20EE/LNG) has proven effective in most clinical studies, whereas its effect on lipid metabolism is still unclear. The purpose of this study was to estimate the effect of a lower dose of a COC (containing 20 µg of ethinyl estradiol and 100 µg of levonorgestrel) on lipid metabolism by conducting a systematic review and a meta-analysis. A literature search was performed using MEDLINE (PubMed), Embase, PsycINFO, and the Cochrane Central Register of Controlled Trials (CENTRAL database). The studies that are randomized controlled trials to compare a lower-dose COC (20EE/LNG) with a placebo or another COC that differed in terms of the drug, dosage, regimen, and study length were included. Meanwhile, studies should have evaluated the index of lipid metabolism changes. However, the studies with the interventions fewer than three consecutive cycles or the patients were primarily used the treatment of non-contraceptive were excluded. We pooled the low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), total cholesterol (TC), and triglyceride (TG) results, and compared 20EE/LNG with conventional-dose COCs using fixed-effects meta-analysis with inverse-variance weighting. Five randomized controlled trials, with a total of 423 participants (age range: 18–35 years), were included in this study. The results derived from all the included studies were pooled. LDL-C of 20EE/LNG group showed significant lower than control group after three (SMD, 0.16; 95% CI, 0.03–0.30; P=0.02) and six (SMD, 0.16; 95% CI, 0.01–0.31; P=0.04) cycles of treatment. However, there was no difference between the two groups after 12 cycles of administration (SMD, -0.06; 95% CI, -0.31 to 0.18; P=0.61). The pooled results showed there was a significant increase in HDL-C in the 20EE/LNG group after three cycles of treatment (SMD, 0.43; 95% CI, 0.13–0.73; P=0.005). No significant difference was observed between TC and TG groups. For LDL-C, the low-dose group shows a higher risk of suffering from cardiovascular diseases after three and six cycles of treatment, while no difference is observed after 12 cycles of treatment. For HDL-C, the 20EE/LNG group exhibits favorable effects after three cycles of treatment compared with the control groups. Similar effects are found between TC and TG profiles groups.},
year = {2016}
}
TY - JOUR T1 - The Effect of Dose-Reduced Combination Oral Contraceptives Containing 20 µg of Ethinyl Estradiol and 100 µg of Levonorgestrel on Lipid Metabolism: A Meta-Analysis AU - Lin Chen AU - Jun Xu AU - Shaohui Cai Y1 - 2016/05/17 PY - 2016 N1 - https://doi.org/10.11648/j.ajim.20160403.12 DO - 10.11648/j.ajim.20160403.12 T2 - American Journal of Internal Medicine JF - American Journal of Internal Medicine JO - American Journal of Internal Medicine SP - 49 EP - 59 PB - Science Publishing Group SN - 2330-4324 UR - https://doi.org/10.11648/j.ajim.20160403.12 AB - Lipid metabolic disturbance induced by the synthetic steroids used in combination oral contraceptives (COCs) has been considered as one of the potential risk factors of cardiovascular diseases. A lower-dose preparation that contains 20 µg of ethinyl estradiol and 100 µg of levonorgestrel (20EE/LNG) has proven effective in most clinical studies, whereas its effect on lipid metabolism is still unclear. The purpose of this study was to estimate the effect of a lower dose of a COC (containing 20 µg of ethinyl estradiol and 100 µg of levonorgestrel) on lipid metabolism by conducting a systematic review and a meta-analysis. A literature search was performed using MEDLINE (PubMed), Embase, PsycINFO, and the Cochrane Central Register of Controlled Trials (CENTRAL database). The studies that are randomized controlled trials to compare a lower-dose COC (20EE/LNG) with a placebo or another COC that differed in terms of the drug, dosage, regimen, and study length were included. Meanwhile, studies should have evaluated the index of lipid metabolism changes. However, the studies with the interventions fewer than three consecutive cycles or the patients were primarily used the treatment of non-contraceptive were excluded. We pooled the low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), total cholesterol (TC), and triglyceride (TG) results, and compared 20EE/LNG with conventional-dose COCs using fixed-effects meta-analysis with inverse-variance weighting. Five randomized controlled trials, with a total of 423 participants (age range: 18–35 years), were included in this study. The results derived from all the included studies were pooled. LDL-C of 20EE/LNG group showed significant lower than control group after three (SMD, 0.16; 95% CI, 0.03–0.30; P=0.02) and six (SMD, 0.16; 95% CI, 0.01–0.31; P=0.04) cycles of treatment. However, there was no difference between the two groups after 12 cycles of administration (SMD, -0.06; 95% CI, -0.31 to 0.18; P=0.61). The pooled results showed there was a significant increase in HDL-C in the 20EE/LNG group after three cycles of treatment (SMD, 0.43; 95% CI, 0.13–0.73; P=0.005). No significant difference was observed between TC and TG groups. For LDL-C, the low-dose group shows a higher risk of suffering from cardiovascular diseases after three and six cycles of treatment, while no difference is observed after 12 cycles of treatment. For HDL-C, the 20EE/LNG group exhibits favorable effects after three cycles of treatment compared with the control groups. Similar effects are found between TC and TG profiles groups. VL - 4 IS - 3 ER -
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