56 Usha Verma and Neil Verma
OCP with ≥ 50 μg of estrogen. Prescribing OCP with < 50 μg of estrogen is
safe in regards to myocardial infarction or ischemic stroke [135]. Women who
used OCP with EE at a dose of 30 to 40 μg had a risk of arterial thrombosis
that was 1.3 to 2.3 times as high as the risk among nonusers, and women who
used pills with EE at a dose of 20 μg had a risk that was 0.9 to 1.7 times as
high, with only small differences according to progestin type [136].
There is insufficient data with regard to longer-term past OCP use and
subsequent cardiovascular disease in the post-menopausal period. Stampfer et
al. [132] reported a lower RR for adverse coronary disease events of 0.8 (95%
CI: 0.6 to 1.0) among the past OCP users compared with non-prior users in
119,061 women followed for 8 years. A quantitative meta-analysis of 13
studies reported an estimated RR associated with past OCP use of 1.01 (95%
CI: 0.91 to 1.13), suggesting that past OCP use had little or no impact on
subsequent cardiovascular disease [137].
Terauchi et al. in their study evaluated the effects of oral estradiol and
LNG on cardiovascular risk markers in postmenopausal women. They
assessed the changes in cardiovascular risk markers induced by low (1.0 mg)
and ultra-low (0.5 mg) doses of oral estradiol combined with LNG. In
conclusion hormone therapy using 1.0 or 0.5 mg of EE and LNG lowers the
serum levels of Total cholesterol, HDL-C, LDL-C, and TG without
significantly affecting coagulation/fibrinolysis parameters [138].
Several studies have reported on the cardiovascular disease risk markers
and metabolic effects in LNG-IUD users [139-143]. LNG-IUD use was not
associated with adverse effects on blood pressure, lipid profile,CRP levels or
insulin sensitivity, compared with users of nonhormonal contraception.
Regarding glucose tolerance, one study described slightly increased fasting
blood glucose in premenopausal women, however, impaired glucose tolerance
was not diagnosed [139]. Ferreira et al. in randomized controlled trial
evaluated the cardiovascular risk markers associated with endometriosis and
the influence of the LNG intrauterine device (LNG-IUD) compared with the
GnRH analogue (GnRHa) leuprolide acetate on these risk markers after 6
months of treatment. This study showed that some cardiovascular risk markers
are influenced by both GnRHa and the LNG-IUD, but the latter had a greater
positive impact on the lipid profile, which could lead to a favorable effect
during long-term treatment. Both treatments had no effect on blood pressure.
LNG-IUD users had lower total cholesterol and triglyceride values [140].