title: Effects of progestin-only long-acting contraception on metabolic markers in obese women.
abstract: BACKGROUND
  The metabolic effects of progestin-only long-acting reversible contraception [levonorgestrel-releasing intrauterine system (LNG-IUS) and etonogestrel implant (ENG-I)] have been studied in normal-weight women but not in obese [body mass index≥30kg/m(2)] women.
  
  
  METHODS
  A nonrandomized open-label prospective trial of healthy obese, reproductive-age women desiring to use long-acting reversible contraception (LARC) or nonhormonal contraception (NHC). At baseline, 3 months and 6 months, homeostasis model assessment insulin resistant (HOMA-IR) score, insulin sensitivity (HOMA-%S) and β-cell function (HOMA-%B) were calculated based on fasting insulin and glucose values. In addition, components of metabolic syndrome [fasting glucose (FG), high density lipoprotein cholesterol and triglycerides, systolic and diastolic blood pressure, abdominal circumference] were measured. Twenty-four subjects total (8 in each arm) were needed to detect a 1.0 difference in HOMA-IR with 80% power and a two-sided alpha of 0.05.
  
  
  RESULTS
  We present data on eight NHC, eight ENG-I and nine levonorgestrel intrauterine system (LNG-IUS) users. FG increased, and insulin sensitivity decreased over time among ENG-I users to a greater extent than among LNG-IUS users when compared to women using a nonhormonal method [FG change over 6 months=9.4mg/dL, 4.6mg/dL and -2.1mg/dL, respectively; p=.01); (HOMA-%S change over 6 months=-29.9%, -14.8% and 19.3%, respectively; p=.02)], while β-cell function and insulin resistance did not change significantly (p>.05).
  
  
  CONCLUSIONS
  While changes in FG and insulin sensitivity were seen in the present study among obese progestin-only contraceptive users, either progestin-only LARC method may be safely used clinically.
authors: Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA 90033, USA.
authors: Nicole M
authors: NM
authors: Bender
authors: Penina
authors: P
authors: Segall-Gutierrez
authors: Sandy Oliver Lopez
authors: SO
authors: Najera
authors: Frank Z
authors: FZ
authors: Stanczyk
authors: Martin
authors: M
authors: Montoro
authors: Daniel R
authors: DR
authors: Mishell
mesh_terms: D000818:Animals; D015415:Biomarkers; D001786:Blood Glucose / Q000032:analysis; D001794:Blood Pressure; D008076:Cholesterol, HDL / Q000097:blood; D003271:Contraceptive Agents, Female / Q000008:administration & dosage / Q000009:adverse effects*; D017135:Desogestrel / Q000008:administration & dosage; D005215:Fasting; D005260:Female; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D050417:Insulin-Secreting Cells / Q000187:drug effects / Q000502:physiology; D007436:Intrauterine Devices, Medicated; D016912:Levonorgestrel / Q000008:administration & dosage; D024821:Metabolic Syndrome / Q000503:physiopathology*; D009765:Obesity / Q000150:complications*; D011372:Progestins / Q000008:administration & dosage / Q000009:adverse effects*; D011446:Prospective Studies; D055105:Waist Circumference
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D008076:Cholesterol, HDL; D003271:Contraceptive Agents, Female; D007328:Insulin; D011372:Progestins; C044815:etonogestrel; D016912:Levonorgestrel; D017135:Desogestrel
keywords: Beta-cell function; Body mass index; Contraception; Contraceptive devices; Etonogestrel; Insulin resistance; Intrauterine; Obesity