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• W2029763921 abstract "Epidemiological studies suggesting a possible association between the use of combined oral contraceptives and an increased risk of cardiovascular disease have led to extensive investigations into the effect of oral contraceptives on lipid and carbohydrate metabolism, and on hemostasis. Since this association was originally suggested, the steroid dose in oral contraceptives has been significantly reduced and new progestogens have been developed. Also, triphasic formulations have been introduced which offer a well-balanced estrogen/progestogen ratio, allowing a further reduction in the progestogen dose per cycle, and thus helping to minimize unwanted metabolic and hemostatic effects. The metabolic interactions of triphasic levonorgestrel, the first triphasic formulation to be introduced, have received particular attention. Lipid metabolism appears to be largely unaffected by triphasic levonorgestrel, most studies reporting no significant change in high- (HDL-C) or low-density lipoprotein-cholesterol (LDL-C) levels. Several studies have reported a decrease in the lipoprotein subfraction HDL2-C levels, but in most cases measurements of the LDL-C/HDL-C and apolipoprotein A-1/B ratios reveal no clinically significant effects. Concerning lipids, most studies suggest that triphasic levonorgestrel has less metabolic impact than the monophasic formulation. In common with all currently available oral contraceptives, triphasic levonorgestrel appears to have some effect on carbohydrate metabolism. The study results vary, however; some investigators have found an impairment of glucose tolerance, whereas others have not detected any significant effect. Compared with lipid and carbohydrate metabolism, fewer studies have investigated the effect of triphasic levonorgestrel on hemostasis. In common with all estrogen-containing oral contraceptives, levonorgestrel appears to stimulate some procoagulant activity, elevating the levels of factors VII and X, and fibrinogen. However, the effect of triphasic levonorgestrel appears to be balanced, with most studies reporting a corresponding increase in anti-coagulant-fibrinolytic activity. Although most of the studies reviewed here reported some statistically significant metabolic interactions, many authors comment that the changes are probably not clinically relevant in terms of an altered risk of cardiovascular disease. The true risk of vascular disease associated with modern low-dose oral contraceptives remains to be confirmed when sufficient epidemiological data eventually become available.This review of studies published since 1985 on the metabolic effects of triphasic levonorgestrel in oral contraceptives (OCs) reveals that triphasic levonorgestrel tends not to affect lipid metabolism. Specifically, it does not significantly change the level of the lipids associated with increased vascular risk (low density lipoprotein-cholesterol (LDL-C), high density lipoprotein-cholesterol (HDL-C), and lipid ratios). Overall, triphasic levonorgestrel OCs do not affect triglycerides, while other OCs increase the level of triglycerides. They also have a lower effect on lipid metabolism than do monophasic levonorgestrel OCs. About 50% of the studies suggest that triphasic levonorgestrel OCs do not affect carbohydrate metabolism, while the remaining studies suggest that they cause a significant increase in carbohydrates. Some studies found that triphasic levonorgestrel OCs impair glucose tolerance. Studies on the effect of triphasic levonorgestrel on hemostasis are less numerous than those on lipid and carbohydrate metabolism. Unlike all combined monophasic OCs, triphasic levonorgestrel OCs appear to have a balanced effect on hemostasis. In fact, they stimulate both the coagulant and anti-coagulant-fibrinolytic pathways. Many of the researchers who found statistically significant metabolic interactions found that the changes fell within the normal clinical range and therefore did not increase the risk of cardiovascular disease. Triphasic levonorgestrel OCs tend to have less of a metabolic effect than its monophasic counterpart and a metabolic effect similar to other low-dose OCs." @default.
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• W2029763921 date "1996-01-01" @default.
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• W2029763921 title "The role of triphasic levonorgestrel in oral contraception: a review of metabolic and hemostatic effects" @default.
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• W2029763921 doi "https://doi.org/10.3109/09513599609027990" @default.
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