Oral contraception (OC) in the premenopause has been recently proposed as treatment for control and prevention of the putative symptoms typical of this period of life. Indeed, menstrual cycle disturbances and climacteric symptoms frequently occur at this age. The major aim of normal contraception is resultant maintenance of normal sexual activity. The effects of one OC containing 20 mcg ethinylestradiol and 150 mcg desogestrel (EE/DOG) were studied. Treatment did not significantly modify both lipid metabolism (triglycerides, total cholesterol, HDL, LDL, Apo A, Apo B) and clotting system (fibrinogen, PT, PTT, antithrombin III, fibrinopeptide A). No significant modifications of oral glucose tolerance test (OGGT) occurred after EE/DOG treatment. Also, bone density was not modified during estro-progestinic administration. From our experience, if there are no risk factors such as smoking, obesity or hypertension, the OCs could be used until menopause for absolute contraceptive efficacy, good tolerance and lack of side effects. PIP: At Cagliari Hospital in Italy, the department of obstetrics and gynecology studied the efficacy and safety of a combined oral contraceptive (OC) containing 20 mcg of ethinyl estradiol and 150 mcg of desogestrel in 61 nonsmoking women aged 41-48. The women were followed for up to five years. After the second cycle of treatment, the mean length of the menstrual cycle and menses standardized at 26 and 4 days, respectively. By 12 months of OC treatment, the slight side effects either had disappeared or had significantly declined. No woman gained weight. Blood pressure did not change significantly. Lipid metabolism did not change significantly. There were only small insignificant increases in high and low density lipoprotein cholesterol, triglycerides, and apolipoproteins A. After 6, 12, and 24 months of OC treatment, sex hormone binding globulin levels increased significantly (1.83 vs. 3.6 mcg/dl; p 0.05). The OC did not significantly affect blood coagulation markers (fibrinogen, prothrombin time, partial thromboplastin time, antithrombin III, and fibrinopeptide A). It had no effect on fasting blood glucose and insulin levels and their response to the oral glucose tolerance test. The researchers conducted bone density measurements in the lumbar spine (L2-L4) of 37 women aged 45-48. The OC did not alter bone density. These results suggest that this low-estrogen-dose combined OC is a safe and effective contraceptive in perimenopausal women and has good acceptability and good cycle control without considerable side effects. The OC also exhibited the capability of further minimizing the thrombogenic effects of low-dose OCs.
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