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Background: Hypertension is recognized as a major risk factor for coronary, cerebral and renal vascular disease. Hormonal methods of contraception may increase the risk for cardiovascular events. We evaluated whether the combined hormonal contraceptive vaginal ring that releases 15-mcg ethinylestradiol and 120 mcg of etonogestrel each day influences 24-h ambulatory blood pressure. Study Design: At baseline, ambulatory blood pressure was automatically monitored every 30 min for 41 h in 18 normotensive healthy women during their follicular phase (Days 3–6). Each subject was immediately treated with the vaginal ring for six cycles. Monitoring of ambulatory blood pressure was repeated in the last days of the sixth cycle of treatment. Results: During the vaginal ring, a significant increase was observed for 24-h diastolic (2.75±5.13 mmHg; p=.03) and mean (2.69±5.35 mmHg; p=.048) blood pressure and for daytime diastolic (3.04±6.36 mmHg; p=.05) blood pressure. No variation was found in nighttime blood pressure. Heart rate increased in the 24-h period (3.39±5.85 beats/min; p=.025) and in the daytime (3.38±6.25 beats/min; p=.034) measurements. Conclusions: In normotensive women, the vaginal ring slightly increases 24-h blood pressure and heart rate. The underlying mechanisms and the clinical impact of these slight modifications require further evaluation. [ABSTRACT FROM AUTHOR]

Objective: To evaluate modification in body weight and anthropometric indexes in women at the time of menopause. Design: Prospective longitudinal study. Setting: Menopause Center at the University Hospital of Modena. Patient(s): Women in perimenopause (n = 87), ovariectomized (n = 60), and in postmenopause (n = 182) without and with treatment. Intervention(s): Data were retrieved from the electronic database of the Menopause Center. Main Outcome Measure(s): Modification of weight, body mass index (BMI), waist, hip, and waist-to-hip ratio in 12 months. Result(s): Body weight increased in perimenopausal (0.6 ± 0.1 kg) women, did not vary in postmenopausal (0.2 ± 0.1 kg) women, and decreased in ovariectomized (−0.5 ± 0.3 kg) women. Waist increased significantly in perimenopausal (2.3 ± 0.4 cm) and in postmenopausal (2.0 ± 0.4 cm) women. In comparison to no treatment, progestin administration (n = 29) decreased body weight (−0.2 ± 0.5 kg) and hip (−1.1 ± 0.9 cm) in perimenopausal women, estrogen (E) administration (n = 38) increased body weight (0.8 ± 0.3 kg) in ovariectomized women, whereas E plus progestin administration (n = 89) did not induce any modification in postmenopausal women. Conclusion(s): Present preliminary data indicate that body weight increases in perimenopausal women, decreases in ovariectomized women, and does not increase significantly in naturally postmenopausal women. Estrogens and progestins influence body weight differently, increasing and decreasing it, respectively. [Copyright &y& Elsevier]

Objectives: Oral contraceptives (OCs) containing androgenic second and third generation progestins decrease insulin sensitivity (SI). In this study we investigated whether an oral contraceptive containing the anti-androgenic progestin drospirenone (DRSP) still alters SI. Lipid modifications were investigated as well. Study design: Eleven young healthy women were allocated to receive for 6 months ethinyl-estradiol (EE) 30μg plus DRSP (3mg). SI and glucose utilization independent of insulin (Sg) was investigated by the minimal model method. Lipid modifications were also analyzed. Results: SI did not vary during EE/DRSP (from 3.72±2.62 to 3.29±2.93; p =0.73). Similarly, values of Sg did not vary (from 0.03±0.02 to 0.032±0.014; p =0.87). An increase was observed in HDL cholesterol (9.4±9.8mg/dl; p =0.05) and triglycerides (46.9±75.1mg/dl; p =0.046), with no modification in LDL cholesterol (−4.64±1.704mg/dl; p =0.6). Conclusions: EE/DRSP does not deteriorate SI. These results are reassuring for the long-term use of this association. [ABSTRACT FROM AUTHOR]

Abstract: Background: The study was conducted to investigate whether hormonal contraceptives administered via the oral and vaginal route exert a similar effect on insulin sensitivity (SI). Study Design: This is a prospective, randomized study performed in the University Hospital. Subjects were healthy lean young women, needing a hormonal contraceptive, randomly allocated to receive for 6 months (a) an oral contraceptive (OC) containing 30 mcg ethinylestradiol (EE)/150 mcg desogestrel (DSG) (high-estrogen group; n=12), (b) an OC containing 20 mcg EE/150 mcg DSG (low-estrogen group; n=12) and (c) a vaginal ring contraceptive releasing, per day, 15 mcg EE/120 mcg etonorgestrel, the active DSG metabolite (n=12). SI and glucose utilization independent of insulin (Sg) were evaluated by the minimal model method. Modifications of total, high-density lipoprotein (HDL) and low-density lipoprotein cholesterol and triglycerides were also evaluated. Results: Sg did not vary with any treatment. SI decreased during OCs (5.74±0.49 vs. 3.86±0.44; p=.0005), independently of the high/low-estrogen dose. SI did not decrease during vaginal ring use (4.64±1.03 vs. 5.25±1.36; p=.57; p=.019 vs. oral). Total cholesterol and HDL cholesterol increased (p=.02) during OCs, independently of the dose. Triglycerides increased during both oral (p=.01) and vaginal (p=.032) contraceptive use. Conclusions: The present data indicate that in contrast to OC use, vaginal contraception with the ring does not deteriorate SI. The vaginal ring may represent an appropriate choice for long-term contraception in women at risk for developing diabetes mellitus or metabolic syndrome. [Copyright &y& Elsevier]

Abstract: Background: Second-generation and third-generation oral contraceptives containing 30 mcg or more of ethinylestradiol (EE) decrease insulin sensitivity (SI). In this study, we investigated whether SI is decreased by contraceptives containing lower doses EE or by progestins with antiandrogenic properties. Study Design: Twenty-eight young healthy women were randomly allocated to receive 20 mcg of EE and 150 mcg of desogestrel (DSG) (n=14) or 30 mcg of EE and 2 mg of chlormadinone acetate (CMA) (n=14) for 6 months. SI and glucose utilization independent of insulin (Sg) were investigated by the minimal model method. Lipid modifications were also analyzed. Results: SI decreased with EE/DSG (7.09±1.4 vs. 4.30±0.91; p=.04; n=12), but not with EE/CMA (5.79±0.93 vs. 6.79±1.1; p=.48; n=12). SI modifications observed in the two groups were significantly different (−2.79±1.15 vs. 1.0±1.38; p=.05). Sg did not vary with either treatment. The response of C-peptide to glucose increased, but significantly so only with EE/CMA (p=.01). The C-peptide/insulin response increased with both EE/DSG (p=.05) and EE/CMA (p=.04). High-density lipoprotein (HDL) cholesterol (p=.02) and triglycerides (p=.02 and p=.01) increased in both groups, but HDL/low-density lipoprotein cholesterol (p=.02), apoprotein A1 (Apo-A1) (p=.04) and Apo-A1/apoprotein B (p=.048) increased significantly only with EE/CMA. Conclusions: The present study confirms that DSG, even when associated with low EE dose, decreases SI. By contrast, EE/CMA does not deteriorate SI and induces a favorable lipid profile. [Copyright &y& Elsevier]