Modern Medical Quandary: Polycystic Ovary Syndrome, Insulin Resistance, And Oral Contraceptive Pills | The Journal Of Clinical Endocrinology & Metabolism | Oxford Academic
The polycystic ovary syndrome (PCOS) is a complex clinical entity for the clinician, a scientific challenge for the investigator, and a frustrating personal and social experience for approximately 3.55.0 million women in the United States. It is classically defined by chronic anovulation and hyperandrogenism, but it has become apparent that insulin resistance plays a prominent role in the disorder. The discovery of the central role of insulin resistance in PCOS is important from several points of view, including the possibility that the traditional management of the disorder may have untoward long-term consequences. The aims of this report are to highlight why insulin resistance should be considered in the formulation of chronic treatment strategies of PCOS, to perhaps suggest a more judicious use of oral contraceptive pills (OCPs) in the chronic treatment of the disorder, and to issue a call for more rigorous and critical studies of the metabolic effects of both OCPs and insulin-sensitizing drugs in women with PCOS. For many decades OCPs have been standard therapy for women with PCOS not seeking pregnancy. There have been several advantages of treatment with OCPs, including foremost protection from the development of endometrial carcinoma, regularization of menses, and amelioration of hirsutism and acne. There is no disputing the importance of these benefits. However, what has been lacking is a critical examination of whether OCPs might also exert adverse metabolic effects with long-term consequences, especially in a group of women with known insulin resistance and predisposition to type 2 diabetes and cardiovascular disease. PCOS: a general health disorder linked to insulin resistance Numerous studies have documented that both lean and obese women with PCOS are insul Continue reading >>
Oral Contraceptives, Insulin Resistance And Cardiovascular Risk Profile In Pre-menopausal Women
You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. Oral Contraceptives, Insulin Resistance and Cardiovascular Risk Profile in Pre-Menopausal Women The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. ClinicalTrials.gov Identifier: NCT01475513 Recruitment Status : Active, not recruiting Information provided by (Responsible Party): Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information Birth control pills are the most commonly used method of birth control. The purpose of this research study is to examine whether birth control pills change heart disease risk and how the body handles blood sugar when given to different women. Insulin Sensitivity Cardiovascular Risk Perimenopausal Disorder The oral contraceptive pill is the most commonly used birth control method. It is debated whether the birth control pill affects how the body handles insulin and sugar, or whether the pill changes heart disease risk. The goal of this study is to evaluate whether certain factors, such as how the body processes hormones, and demographic factors (e.g. body weight and race), influence how the pill affects the handling of insulin and sugar, and heart health. Oral Contraceptives, Insulin Resistance and Cardiovascular Risk Profile in Pre-Menopausal Women Ethinyl estradiol 35 mcg and norgestimate 0.25 mg (oral) will be taken as one tablet daily for 21 days per month followed by a 7-day pill-free period per cycle. Duration of the study is for 6 cycles of this birth control pill. Ethinyl e Continue reading >>
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Type 2 Diabetes And Birth Control
Some methods of contraception can have an effect on your blood sugar. Learn about birth control options for women with type 2 diabetes. A woman who has type 2 diabetes, formerly called adult-onset diabetes or non-insulin-dependent diabetes, has to face the same issues that confront most women, such as choosing a birth control method. However, unlike women who don’t have diabetes, she must take into account about how the form of contraception she chooses will affect her blood sugar levels, as well as the rest of her body. Type 2 Diabetes and Birth Control Pills In the past, birth control pills weren’t usually recommended for women with diabetes because of the hormonal changes the medication could cause. High doses of hormones can have a dramatic effect on blood sugar levels, making it harder for women to control their diabetes. However, research into new formulations has resulted in many different, lighter combinations of hormones. These new pills are safer for many women, not just those with diabetes. According to Brian Tulloch, MD, endocrinologist at Park Plaza Hospital and Medical Center and clinical associate professor at the University of Texas Medical School at Houston, a woman with type 2 diabetes who chooses to use birth control pills should take the lowest possible dose that is still effective in order to help limit the effects the medication has on the diabetes. One thing women taking birth control pills should remember is that there is still an increased risk for heart attack or stroke among women who use this form of contraception. Since people with diabetes also have an increased risk of heart disease, this is something that women should discuss with their doctors. Type 2 Diabetes and Other Hormonal Contraception Birth control pills aren’t the only way Continue reading >>
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Diabetes And The Pill
This is the 50th anniversary of the birth control pill; a tiny thing that has revolutionized society. Taking the pill does tend to increase blood glucose levels so it might be useful to consider the ramifications of using this pregnancy avoidance tool while managing one’s diabetes. The pill essentially consists of some combination of the hormones estrogen and progesterone. These hormones provide important instructions to reproductive tissues in a carefully timed fashion. Birth control pills create a hormonal state that makes the body think it is already pregnant and blocks any new eggs developing. Thus actual pregnancy is avoided. Probably the first thing you have focused on is this increase in blood glucose. How much are we talking about? Actually – not much. The amount of increase in non-diabetic women is considered by the American Diabetes Association not enough to be concerned about. For women with diabetes, however, the debate is spirited. One school of thought is that any increase in blood sugar is an increase in risk and should be concerning. The other school of thought, of course, is that the benefits of avoiding an unwanted pregnancy outweigh the minimal risk. We have known for quite some time that birth control pills decrease insulin sensitivity and this is caused entirely by progesterone. The mechanism appears to be complicated in that progesterone seems to act at multiple levels in the insulin signaling pathway. Interestingly, the progesterone receptor, upon binding progesterone, travels to the nucleus of the cell and regulates the expression of numerous genes. Several of these genes target the insulin signaling pathway in a variety of ways suggesting that this is a very deliberate piece of evolutionary integration. About a decade ago, a progesterone onl Continue reading >>
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Injectable And Oral Birth Control Do Not Adversely Affect Glucose And Insulin Levels, Study Shows
Injectable and oral birth control do not adversely affect glucose and insulin levels, study shows University of Texas Medical Branch at Galveston Fasting glucose and insulin levels remain within normal range for women using injectable or oral contraception, with only slight increases among women using depot medroxyprogesterone acetate (DMPA), commonly known as the birth control shot, according to new research. Fasting glucose and insulin levels remain within normal range for women using injectable or oral contraception, with only slight increases among women using depot medroxyprogesterone acetate (DMPA), commonly known as the birth control shot, according to new research from the University of Texas Medical Branch (UTMB Health) in Galveston. The study, published in the January 2011 issue of Obstetrics and Gynecology and conducted over three years, is the largest to measure fasting glucose and insulin levels among women using DMPA, oral (desogestrel) contraception and non-hormonal (bilateral tubal ligation, condom or abstinence) methods. Researchers found that DMPA users' glucose levels increased steadily during the first 30 months of use, with the greatest increase occurring during the first six months. The observed increases, which were less than those reported in previous studies, were not significant enough to cause concern. There are 62 million women of reproductive age in the United States. More than two million American women use DMPA, including approximately 400,000 teens, and more than 11 million use oral contraception. "Previous studies were limited in scope and offered conflicting results, which led physicians to question whether hormonal contraception could lead to diabetes," says lead author Dr. Abbey Berenson, professor, Department of Obstetrics and Gynec Continue reading >>
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Hormone Contraceptives And How The Body Uses Carbohydrates In Women Without Diabetes
Plain language summary Hormone contraceptives may change how the body handles carbohydrates (starches and sugars). Changes may include lower ability to use sugar from food and more problems with the body's insulin. Insulin is a hormone that helps the body use sugar. Problems with blood sugar can increase risk for diabetes and heart disease. These issues have been raised mainly with birth control methods that contain the hormone estrogen. In April 2014, we looked for randomized trials of how the body handles carbohydrates when using birth control methods with hormones. Outcomes were blood glucose or insulin levels. Birth control methods could contain estrogen and progestin or just progestin. The type could be pills, shots (injections), implants (matchstick‐size rods put under the skin), the vaginal ring, or an intrauterine device (IUD). The studies had to compare two types of birth control or one type versus a placebo or 'dummy' method. We included 31 trials. None had a placebo. Of 34 pairs of birth control methods compared, eight showed some difference by study groups. Twelve trials studied pills with desogestrel. The few differences were not consistent. Three trials looked at the etonogestrel ring. One showed the ring group had lower insulin than the pill group. Eight trials looked at the progestin norethisterone. A group using norethisterone pills had less glucose change than those taking other pills. In another study, a group using the injectable ‘depo’ (depot medroxyprogesterone acetate) had higher glucose and insulin than the group using another injectable. Of five new trials, two used different estrogen types. In one study, a group taking a pill with ethinyl valerate had lower glucose than a group taking a standard pill. Two other trials compared taking pill Continue reading >>
The Effects Of Hormonal Contraceptives On Glycemic Regulation
The effects of hormonal contraceptives on glycemic regulation 1Departamento de Ciencias Qumicas y Biolgicas, Universidad Bernardo O'Higgins, Santiago, Chile 2Reproductive Health Research Institute, Santiago, Chile 3Liceo Experimental Manuel de Salas, Universidad de Chile, uoa, Chile 4Programa de Magster en Educacin en Salud y Bienestar Humano, Universidad Metropolitana de Ciencias de la Educacin, Santiago, uoa, Chile 1Departamento de Ciencias Qumicas y Biolgicas, Universidad Bernardo O'Higgins, Santiago, Chile 2Reproductive Health Research Institute, Santiago, Chile 3Liceo Experimental Manuel de Salas, Universidad de Chile, uoa, Chile 4Programa de Magster en Educacin en Salud y Bienestar Humano, Universidad Metropolitana de Ciencias de la Educacin, Santiago, uoa, Chile Copyright Catholic Medical Association 2014 This article has been cited by other articles in PMC. A number of side effects have been linked to the use of hormonal contraceptives, among others, alterations in glucose levels. Hence, the objective of this mini-review is to show the main effects of hormonal contraceptive intake on glycemic regulation. First, the most relevant studies on this topic are described, then the mechanisms that might be accountable for this glycemic regulation impairment as exerted by hormonal contraceptives are discussed. Finally, we briefly discuss the ethical responsibility of health professionals to inform about the potential risks on glycemic homeostasis regarding hormonal contraceptive intake. Keywords: Glycemic homeostasis, Hormonal contraception, Insulin resistance, Impaired glucose tolerance Since the early 1950s, when Mexican chemist Luis. E. Miramontes and co-researchers carried out the synthesis of norethisterone (norethindrone), the first oral contraceptive ( Miramontes Continue reading >>
Oral Contraceptive Use And Association With Glucose, Insulin, And Diabetes In Young Adult Women
Abstract OBJECTIVE— We studied the associations between 1) current use of oral contraceptives (OCs) and 2) glucose levels, insulin levels, and diabetes in young women. RESEARCH DESIGN AND METHODS—Subjects were women (n = 1,940) in the Coronary Artery Risk Development in Young Adults (CARDIA) study, a prospective observational study of African-Americans and whites aged 18–30 years at enrollment in 1985–1986. We analyzed the cross-sectional associations between 1) current use of OCs and 2) fasting glucose, fasting insulin, and presence of diabetes using generalized estimating equations to adjust for repeated measures. We also examined the effect of current use of OCs on incident diabetes at year 10 of the study. RESULTS—In unadjusted analyses, current use was associated with lower fasting glucose levels [–3.1 mg/dl, 95% CI (−3.7, −2.5)] and reduction in the odds of diabetes [odds ratio 0.56 (0.32, 0.97)], but not lower fasting insulin levels [−0.01 μU/ml (−0.03, 0.02)], compared with nonuse in both African-American and white women. After adjustment for covariates, current use of OCs was still associated with lower fasting glucose levels [–1.8 mg/dl (−2.4, –1.3)] and lower odds of diabetes [odds ratio 0.56 (0.33, 0.95)], although the associations were attenuated. After adjustment, current use of OCs was associated with higher insulin levels [0.12 μU/ml (0.006, 0.23)]. No association existed between pattern of use of OCs and incident diabetes at year 10, although the total number of new persons with diabetes at year 10 was small (n = 17). CONCLUSIONS—Current use of OCs is associated with lower glucose levels in young African-American and white women and may be associated with lower odds of diabetes. Given the increasing incidence of type 2 diab Continue reading >>
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Contraceptives And Diabetes
In North America, many women are often prescribed birth control medication (often known as oral contraceptive pills or hormonal pills) for treating various conditions as well as preventing unplanned pregnancy. However, as contraceptive treatments become available without a prescription in the United States, many women lack the knowledge of the risks and side effects of these methods. For women who are in the prediabetes category or already suffering from type 1 or type 2 diabetes, these treatments cause severe problems with the blood glucose management. To better educate women about how contraceptive methods affect the blood glucose level and various diabetes symptoms, this article will be covering these topics below: How Does Hormonal Contraceptive Work? In order to explain how hormonal contraceptives affect the blood glucose level and other diabetes symptoms, it is imperative that we explain how a woman becomes pregnant and how the hormonal contraceptives work: What Happens When A Woman Becomes Pregnant? In order for pregnancy to occur, 2 things need to happen: 1. an egg is released from the ovaries during the ovulation period and is transported to the fallopian tube, and 2. a man’s sperm has successfully fertilized the egg. Once these two events occur, the fertilized egg will attach to the inside of the uterus. (from medical standpoint, pregnancy begins the moment the fertilized egg is attached to the uterus wall). This event allows the egg to receive nourishment from the mother so that it develop into a baby. In order to shut off the egg production and to sustain the fetus’ development, the secretion of estrogen and progesterone are highly elevated. As a result, some women develop gestation diabetes during their pregnancy. I advise you to read the following arti Continue reading >>
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Birth Control & Type 1
Note: This article is part of our Daily Life library of resources. To learn more about the many things that affect your health and daily management of Type 1, visit here. The subject of birth control with relation to Type 1 diabetes has always been a tricky subject, with inconsistent results. Hormones have been known to have an impact on blood glucose levels, but hormones affect everyone differently, so in terms of contraception, what works for one person might be completely wrong for another. Here are some observations and facts to keep in mind when considering your birth control options while managing your Type 1! IUDs There are a couple of different types of IUDs that will interact with the body differently. The first type is a copper IUD, which is inserted by your doctor, and can last for up to ten years. It is the copper itself that kills the sperm, preventing pregnancy. The other type of IUD (Mirena) is plastic, and it is a hormonal IUD. It contains the progestin hormone levonorgestrel, which is also used in the “morning after pill,” and it can last up to five years – half the time span of a copper IUD. There have been many reports of the hormones in Mirena causing severe blood sugar changes as well as acne, weight gain, and mood swings. IUDs in general are not recommended for women who contract pelvic infections easily. Women with Type 1 diabetes with higher A1Cs can be more susceptible to such infections, so it is important to be in excellent control of your Type 1 before considering any IUD. The Ring The ring is a flexible device that is inserted into the vagina and worn for three weeks. It is then replaced after one week of not wearing one. The hormones in the ring are absorbed directly into the vagina, therefore bypassing the digestive system all togeth Continue reading >>
Contraception
Birth control in an important issue as there are greater risks for you and your baby if the pregnancy is unplanned All contraceptive options are the available for you, your partner and your doctor to choose from. In the past, women with type 1 diabetes were advised to avoid taking the birth control pill because of an effect on blood glucose and the risk for heart disease and stroke. However, changes to the level of hormones in the pill in the last few decades have greatly decreased the risk of these problems. Blood glucose fluctuations are more likely with combination pills, and some doctors may suggest progestin-only (‘mini’) pills to avoid this issue. There was also concern that IUDs (also known as the coil) might pose an increased risk of pelvic infection or trauma to the uterine wall, and women with type 1 diabetes might be particularly vulnerable to these infections. The new generation of coils appear to be safe in this respect. Using a diaphragm does not affect blood glucose levels but you be have an increased risk of yeast infections. Speak with your doctor and healthcare team about suitable contraception options. Continue reading >>
Birth Control And Diabetes
Birth control is an important issue for a woman with diabetes, as there are greater risks to the woman and her baby if the pregnancy is unplanned. Knowing the options and choosing the best birth control method is critical to ensure good reproductive health. The following contraceptive options should be considered for women who have diabetes. Combined hormonal contraception options Oral contraceptives (birth control pill) The use of oral contraceptives may cause an increase – although a small one – in blood sugar levels. This risk has decreased in the last few decades due to the changes in the level of hormones that are contained in the pill. However, women should perform blood glucose testing to see if there are any changes in blood sugar levels after starting oral contraception, in case an adjustment to their diabetes medication might be needed. Changes in blood sugar levels are more likely with combination pills (ones that contain both estrogen and progesterone). Because the estrogen component is largely responsible for the change in blood sugar levels, it is advisable to choose the pill with the lowest possible estrogen level. In fact, some doctors may suggest pills that contain only progestin to avoid this issue. However, even with these pills, some women may experience increased blood sugar levels. Women who have prediabetes or diabetes should monitor their blood sugar levels carefully while taking oral contraceptive pills. Also, women taking combination birth control pills should remember that there is still an elevated risk for heart attack or stroke when using this form of contraception. Since people with diabetes also have an increased risk of heart disease, this should be discussed with your healthcare team. The World Health Organization also advises that Continue reading >>
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Can Birth Control Pills Cause Insulin Resistance?
Can birth control pills cause insulin resistance? Can birth control pills cause insulin resistance? Taking oral contraceptives may promote insulin resistance, particular in those with diabetes or prediabetes. Oral contraceptives contain synthetic forms of the reproductive hormones estrogen and progesterone. A 2014 review by Cortes, et al, concluded that taking these synthetic hormonesespecially estrogenappears to contribute to insulin resistance, making blood sugar control more difficult. If you feel that you've become more insulin resistant as a result of taking birth control pills, you may want to speak with your doctor about switching to a formulation that contains less estrogen. Answered By dLife Expert: Franziska Spritzler, RD, CDE Certified diabetes educator and registered dietitian living in Southern California. The content of this website, such as text, graphics, images, and other material on the site (collectively, Content) are for informational purposes only. The Content is not intended to be a substitute for, and dLife does not provide, professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this site. If you think you may have a medical emergency, call your doctor or 911 immediately. dLife does not recommend or endorse any specific tests, physicians, products, procedures, opinions, or other information that may be mentioned on this site. Reliance on any information provided by dLife, its employees and other contributors or visitors to this site is done solely at your own risk. Any information you submit to dLife or this Continue reading >>
Ask D'mine: The Best Birth Control For Fwds Is...
Need help navigating life with diabetes? Ask D'Mine! That would be our weekly advice column, hosted by veteran type 1, diabetes author and educator Wil Dubois. This week, Wil's done some serious homework on a women-specific issue: Birth Control. But don't fear, men, this isn't just a post for those Females With Diabetes (FWDs). There's something in it for everyone. So, don't be afraid to read on! (Or print out and read later — this one's a doozy!) {Got your own questions? Email us at [email protected]} Kathleen, type 2 from Texas, asks: What do you think of Mirena as a birth control option for diabetics, especially those on insulin? Wil@Ask D'Mine answers: Seriously? The new-style intrauterine device (IUD) that's implanted into the wall of the uterus? You know I'm a man, right? And as such, I only have the vaguest of idea of where the uterus is in the first place. But even though I'm out of my league, and out of my gender, your question piqued my interest. I mean, come on, sex and diabetes—what more could I want to totally make my day? So I read up on Mirena, then I started calling all the female diabetes docs I know. They told me that there's no nationwide standard recommendation for birth control for female diabetes patients, and no one agrees on what's best. It turns out that the entire subject of birth control for FWDs is more complex than you'd think. In fact, birth control options for any female are more complex than I had realized, so we're going to devote today's entire column to the subject. Not just Mirena, but the full spectrum of options for my diabetic sisters. Mirena and Garden Variety IUDs But since you asked about Mirena, we'll start there. It's an IUD, a small plastic device that looks a bit like a boat anchor. I should make some sort of jok Continue reading >>
Diabetes & Birth Control
Diabetes & birth control at a glance Birth control pills, patches, implants, injections, and rings are generally considered to be safe forms of contraception for diabetic women, according to the American Diabetes Association (ADA). However, the estrogen in birth control pills can raise blood glucose levels, which increase a diabetic’s resistance to insulin and may require an adjustment in the insulin she receives. Because of the effects of estrogen, some physicians do not prescribe hormone-based birth control for some diabetic women. The ADA says that combination birth control pills containing synthetic estrogen and norgestinate are best for women with diabetes. The effect of birth control on diabetes The inconclusive results of various research studies have led to controversy over the potential harmful effect of birth control pills for diabetic women. Some studies show that women who take birth control pills or other methods containing estrogen have higher blood glucose levels and blood cholesterol levels. Other studies show no differences in those levels between women taking birth control pills and women who don’t. Factors to consider Higher glucose levels resulting from the estrogen in birth control pills may require an increase in a diabetic woman’s need for insulin. Higher cholesterol levels increase the risk of heart attack, and diabetics already have an increased risk of heart attack. Some physicians recommend that diabetic women take birth control pills with the lowest dose of estrogen possible for effective contraception. Other birth control methods that employ estrogen, such as implants, patches, injections and vaginal rings, can also affect a woman’s diabetes. Studies indicate that diabetic women who take birth control pills for more than two years ma Continue reading >>
