Hormonal contraception in women with the metabolic syndrome: A narrative review

Abstract

Objective The metabolic syndrome (MS) is a set of five cardiovascular and metabolic risk factors: elevated waist circumference, fasting plasma glucose, triglycerides and blood pressure; and reduced HDL-cholesterol. The prevalence of the MS is rising worldwide, and is linked to two diagnoses in young women: polycystic ovary syndrome (PCOS) and gestational diabetes mellitus (GDM).

Methods This narrative review focuses on hormonal contraceptive choices available for women in Europe with features of the MS.

Results The levonorgestrel-intrauterine system and progestogen-only pills containing desogestrel or levonorgestrel have no significant effects on MS parameters. Combined oestrogen-progestogen methods do not appear to increase waist circumference or the incidence of glucose intolerance in women with PCOS or a history of GDM; their effect on HDL-cholesterol and triglycerides is comparable with that observed in women without the MS, while the effect on blood pressure remains inconclusive. The etonogestrel implant does not affect body weight, triglycerides and blood pressure but mildly reduces insulin sensitivity and HDL-cholesterol in healthy women. Depot medroxyprogesterone acetate increases body weight and truncal fat deposition, and lowers glucose tolerance in women with previous GDM.

Conclusions Low-dose hormonal contraception is safe for many women with the MS, but high-dose progestogens must be avoided.

KEYWORDS:

• Blood pressure
• Gestational diabetes mellitus
• HDL-cholesterol
• Insulin resistance
• Obesity
• Polycystic ovary syndrome
• Triglycerides
• Waist circumference

Declaration of interest: The author reports participating in expert meetings organised by Bayer Schering and Merck Serono, and receiving honoraria for consultancy and lectures from Bayer Schering, Merck Serono and Schering Plough. The author alone is responsible for the content and the writing of the paper.