Contraception in perimenopausal women with diabetes mellitus.
OBJECTIVE
To assess the effect of combined oral contraceptives (COCs) and intrauterine devices (IUDs) on carbohydrate and lipid metabolism and hemostasis in perimenopausal diabetic women.


METHODS
The open randomized study included a total of 113 diabetic women using COCs with different estrogen/progestogen profiles - ethinylestradiol (EE) 20 microg/desogestrel 150 microg, EE 30 microg/desogestrel 150 microg and EE 30 microg/gestodene 75 microg - and levonorgestrel-releasing or copper IUDs. Average daily insulin requirements, levels of glycosylated hemoglobin, total cholesterol, triglycerides, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol, the state of coagulation hemostatis and fibrinolytic activity were determined at baseline and after 3, 6, 9 and 12 months of contraception. The control group was composed of 40 age-matched diabetic women who did not use any methods of contraception.


RESULTS
Neither COCs nor IUDs influenced glycosylated hemoglobin and had little or no influence on the elevation in the requirements for insulin preparations. The majority of the preparations did not exert any unfavorable effect on the blood lipid profile. Taking COCs was accompanied by increased intravascular activation of blood platelets and to a lesser degree by alterations in parameters of hemostatic homeostasis. The use of IUDs had a neutral effect on blood coagulation and fibrinolysis systems.


CONCLUSIONS
Comparing lipid levels and hemostatic variables as a function of glycosylated hemoglobin level, we conclude that diabetes control has greater influence on these parameters than the type and dose of steroids involved in the contraceptive devices.
Grigoryan
Olga R
OR
Federal Facility Endocrinological Research Centre under the Russian Academy of Medical Sciences, Moscow, Russia. elena1778@mail.ru
Grodnitskaya
Elena E
EE
Andreeva
Elena N
EN
Shestakova
Marina V
MV
Melnichenko
Galina A
GA
Dedov
Ivan I
II
D000328:Adult; D001779:Blood Coagulation Factors / Q000187:drug effects; D050260:Carbohydrate Metabolism / Q000187:drug effects; D003267:Contraception / Q000009:adverse effects / Q000379:methods; D003277:Contraceptives, Oral, Combined / Q000008:administration & dosage / Q000009:adverse effects*; D048909:Diabetes Complications / Q000503:physiopathology*; D003920:Diabetes Mellitus / Q000503:physiopathology*; D005260:Female; D005342:Fibrinolysis / Q000187:drug effects; D006442:Glycated Hemoglobin / Q000187:drug effects; D006801:Humans; D007434:Intrauterine Devices / Q000009:adverse effects*; D016912:Levonorgestrel / Q000008:administration & dosage*; D050356:Lipid Metabolism / Q000187:drug effects; D008875:Middle Aged; D047648:Perimenopause / Q000187:drug effects / Q000502:physiology; D018709:Statistics, Nonparametric
D001779:Blood Coagulation Factors; D003277:Contraceptives, Oral, Combined; D006442:Glycated Hemoglobin; D016912:Levonorgestrel