Impact of oral contraceptives on sex hormone-binding globulin and androgen levels: a retrospective study in women with sexual dysfunction.
BACKGROUND
Oral contraceptives (OCs) have been the preferred method of birth control because of their high rate of effectiveness. OC use, however, has been associated with women's sexual health complaints and androgen insufficiency. OC use is associated with a decrease of androgen ovarian synthesis and an increase in the production of sex hormone-binding globulin (SHBG). There have been limited studies assessing SHBG values after discontinuation of OC use.


OBJECTIVE
To retrospectively investigate SHBG levels before and after discontinuation of OC use.


METHODS
Sex hormone-binding globulin values were compared at baseline, while on the OC, and well beyond the 7-day half-life of SHBG at 49-120 (mean 80) days and >120 (mean 196) days after discontinuation of OCs.


METHODS
A total of 124 premenopausal women with sexual health complaints for >6 months met inclusion/exclusion criteria. Three groups of women were defined: (i) "Continued-Users" (N = 62; mean age 32 years) had been on OCs for >6 months and continued taking them; (ii) "Discontinued-Users" (N = 39; mean age 33 years) had been on OCs for >6 months and discontinued them; and (iii) "Never-Users" (N = 23; mean age 36 years) had never taken OCs.


RESULTS
Sex hormone-binding globulin values in the "Continued-Users" were four times higher than those in the "Never-User" group (mean 157 +/- 13 nmol/L vs. 41 +/- 4 nmol/L; P < 0.0001). Despite a decrease in SHBG values after discontinuation of OC use, SHBG levels in "Discontinued-Users" remained elevated in comparison with "Never-Users" (N = 26; P < 0.0001 for >120 days).


CONCLUSIONS
In women with sexual dysfunction, SHBG changes in "Discontinued-Users" did not decrease to values consistent with "Never-Users." Long-term sexual, metabolic, and mental health consequences might result as a consequence of chronic SHBG elevation. Does prolonged exposure to the synthetic estrogens of OCs induce gene imprinting and increased gene expression of SHBG in the liver in some women? Prospective research is needed.
Panzer
Claudia
C
Department of Endocrinology, Boston University Medical Center, Boston, MA, USA. clandreas@msn.com
Wise
Sarah
S
Fantini
Gemma
G
Kang
Dongwoo
D
Munarriz
Ricardo
R
Guay
Andre
A
Goldstein
Irwin
I
D000328:Adult; D000728:Androgens / Q000097:blood* / Q000172:deficiency; D003277:Contraceptives, Oral, Combined / Q000494:pharmacology*; D005260:Female; D006207:Half-Life; D006801:Humans; D017697:Premenopause; D012189:Retrospective Studies; D012738:Sex Hormone-Binding Globulin / Q000187:drug effects / Q000378:metabolism*; D012735:Sexual Dysfunction, Physiological / Q000097:blood*; D018709:Statistics, Nonparametric; D016387:Women's Health
D000728:Androgens; D003277:Contraceptives, Oral, Combined; D012738:Sex Hormone-Binding Globulin