A comparative study of the effects of the hemostatic system of two monophasic gestodene oral contraceptives containing 20 micrograms and 30 micrograms ethinylestradiol
- PMID: 8838483
- DOI: 10.1016/0010-7824(95)00271-5
A comparative study of the effects of the hemostatic system of two monophasic gestodene oral contraceptives containing 20 micrograms and 30 micrograms ethinylestradiol
Abstract
The effects of two oral contraceptives, containing gestodene and either 20 micrograms or 30 micrograms ethinylestradiol, on hemostatic parameters was investigated in a six-month randomized study involving a total of 40 healthy women between the ages of 18 and 30 years. A large number of hemostatic parameters were measured, which were categorized as either pro-coagulatory, anti-coagulatory, profibrinolytic, anti-fibrinolytic or indicative of fibrin turnover. Additionally, tissue plasminogen activator (t-PA) and plasminogen activator inhibitor (PAI-1) were measured before and after venous occlusion and delta and ratio values calculated. Pro-coagulatory factors as well as reaction products reflecting in vivo coagulatory activity (thrombin-antithrombin III complex, prothrombin fragment 1 + 2) were found to increase. Among the anti-coagulatory parameters, only protein S concentration and protein S activity decreased, most notably in the 30 micrograms EE group. There was a corresponding increase in fibrinolytic activity reflected by reaction products of in vivo fibrinolysis (plasmin-antiplasmin 2-complex, fibrin-degradation products). Measurement of t-PA and PAI-1, before and after venous occlusion, revealed that the fibrinolytic response was more pronounced in the 20 micrograms EE group. There was also an increase in the threshold of fibrinolytic inhibition (ratio PAI-1) in both groups, which was less pronounced in the 20 micrograms EE group. Apart from isolated measurements, all parameters remained within their normal ranges and values returned to baseline in the follow-up cycle. It is concluded that both preparations had a balanced effect on the hemostatic system stimulating both pro-coagulant and fibrinolytic activity. No statistically significant differences were observed between the two groups; however, there was a trend towards greater fibrinolytic capacity in the 20 micrograms EE group.
PIP: In Germany, 40 healthy women aged 18-30 with no contraindications to combined oral contraceptives (OCs) participated in a comparative study (2 pre-treatment cycles, 6 treatment cycles, and 1 post-treatment follow-up cycle). It aimed to assess the effect of the new low-dose monophasic OCs containing 20 mcg ethinyl estradiol (EE) and 75 mcg gestodene on the hemostatic system, the effect of reducing the EE dose from 30 mcg to 20 mcg, and the effect of this OC and another combined OC with 30 mcg EE on the fibrinolytic capacity at the vessel wall. Both OCs increased coagulatory and fibrinolytic parameters, except for isolated measurements, which remained within their normal ranges. The effect occurred as early as four days after beginning OC treatment. There was a general trend towards increased change during treatment. Within 14 days after stopping OC treatment, most parameters returned to baseline values. Protein C activity increased somewhat in both groups. Protein S activity was reduced in both groups, but the reduction was less in the 20 mcg EE group than in the 30 mcg EE group. There was a tendency towards greater plasminogen activator activity and lower plasminogen activator inhibitor activity in the 20 mcg EE group than in the 30 mcg EE group, suggesting increased fibrinolytic activity in the 20 mcg EE group. In both groups, an increase in the threshold of fibrinolytic inhibition occurred, but the increase was lower in the 20 mcg EE group. These findings suggest that both OC preparations have a balance effect on hemostasis, stimulating both pro-coagulant, anti-coagulant, and fibrinolytic activity. The 20 mcg EE OC tended to have a greater fibrinolytic activity than the 30 mcg EE OC, however.
Similar articles
-
The effect of oestrogen dose and progestogen type on haemostatic changes in women taking low dose oral contraceptives.Br J Obstet Gynaecol. 1996 Mar;103(3):261-7. doi: 10.1111/j.1471-0528.1996.tb09716.x. Br J Obstet Gynaecol. 1996. PMID: 8630312
-
Double-blind, randomized, placebo controlled study on the effects of the monophasic oral contraceptive containing 30 micrograms ethinyl estradiol and 2.00 mg dienogest on the hemostatic system.Contraception. 1997 Aug;56(2):67-75. doi: 10.1016/s0010-7824(97)00094-2. Contraception. 1997. PMID: 9315414 Clinical Trial.
-
Studies on oral contraceptive-induced changes in blood coagulation and fibrinolysis and the estrogen effect on endothelial cells.Ann Hematol. 1993 Jul;67(1):33-6. doi: 10.1007/BF01709663. Ann Hematol. 1993. PMID: 8392873
-
Effects of newer oral contraceptives on the inhibition of coagulation and fibrinolysis in relation to dosage and type of steroid.Am J Obstet Gynecol. 1990 Jul;163(1 Pt 2):396-403. doi: 10.1016/0002-9378(90)90590-4. Am J Obstet Gynecol. 1990. PMID: 2196812 Review.
-
The effects on hemostasis of oral contraceptives containing desogestrel.Am J Obstet Gynecol. 1993 Mar;168(3 Pt 2):1047-52. doi: 10.1016/0002-9378(93)90336-h. Am J Obstet Gynecol. 1993. PMID: 8447359 Review.
Cited by
-
Occlusive vascular diseases in oral contraceptive users. Epidemiology, pathology and mechanisms.Drugs. 2000 Oct;60(4):721-869. doi: 10.2165/00003495-200060040-00003. Drugs. 2000. PMID: 11085198 Review.
-
Metabolic effects of contraceptive steroids.Rev Endocr Metab Disord. 2011 Jun;12(2):63-75. doi: 10.1007/s11154-011-9182-4. Rev Endocr Metab Disord. 2011. PMID: 21538049 Review.
-
Hemostatic effects of a novel estradiol-based oral contraceptive: an open-label, randomized, crossover study of estradiol valerate/dienogest versus ethinylestradiol/levonorgestrel.Drugs R D. 2011;11(2):159-70. doi: 10.2165/11591200-000000000-00000. Drugs R D. 2011. PMID: 21679006 Free PMC article. Clinical Trial.
-
Review of the safety, efficacy and patient acceptability of the combined dienogest/estradiol valerate contraceptive pill.Int J Womens Health. 2010 Aug 24;2:279-90. doi: 10.2147/IJWH.S6954. Int J Womens Health. 2010. PMID: 21151673 Free PMC article.
-
Effects of hormone replacement therapy on coagulation and fibrinolysis in postmenopausal women.Int J Hematol. 2002 Aug;76 Suppl 2:44-6. doi: 10.1007/BF03165085. Int J Hematol. 2002. PMID: 12430899 Review.
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Miscellaneous