October 1990 Am J Obstet Gynecol

Thomas and Vankrieken

sibility that follicular activity was initiated in some women, as observed in a few of our volunteers, during the third and sixth treatment cycles, raised the problem of the ideal length of the pill-free interval. The 7-day pill-free interval should be considered the maximum permitted. This problem is all the more acute because of the forgetfulness of some users. On the other hand, it has been shown that a 2-day interruption in the intake of this formulation failed to produce any marked increase in ovarian activity.' 3. The strong inhibition of ovarian secretion is also reflected by total suppression of all luteal activity, even in the few patients in whom the initiation of follicular maturation was observed. 4. Finally, it was remarkable to observe that the normal hormonal profile was completely restored during the immediate posttreatment cycle.

women, effectively inhibits the hypophysial-ovarian axis, thus providing absolute contraceptive security despite the low dosage of the components. REFERENCES 1. Spona], Huber J. Pharmacological and endocrine profiles of gestodene. Int] Fertil 1987;32(suppl):6-14. 2. Stickland ], Tolowinska IY, Anthony F, Dennis KJ. The suppression of ovarian function by the new oral contraceptive-Femodene. Contraception 1987;35:44756. 3. Rabe T, Runnebaum B, Grunwald K, et al. Metabolic effects of a gestodene-containing low-dose oral contraceptive pill. In: Breckwoldt M, Diisterberg B, eds. Gestoden, a new direction in oral contraception. London: Parthenon Publishing,1988:31-46. 4. Diisterberg B, Hassan SH, Matthes H. Plasma concentrations of gestoden and endogenous sexual hormones in a 21-day treatment cycle with the new oral contraceptive and in two further treatment cycles with defined 2-day breaks in treatment in 6 young women. Arch Gynecol 1985; 237(suppl):67.

Comment Our data show that the gestodene-ethinyl estradiol combination, when correctly administered in healthy

Effects of oral contraceptives on lipid metabolism Jan A. Gevers Leuven, MD, PhD, Marianne C. Dersjant-Roorda, Frans M. Helmerhorst, MD, PhD, Rinse de Boer, MD, Angela Neymeyer-Leloux, MD, and Louis M. Havekes, PhD Leiden and Hertogenbosch, The Netherlands A randomized, comparative study of two low-dose oral contraceptives was carried out in 60 nonpregnant women for 12 cycles. Twenty-eight women took a preparation containing 150 f.lg of desogestrel and 30 f.lg of ethinyl estradiol; 32 took 75 f.lg of gestodene and 30 f.lg of ethinyl estradiol. Baseline values in the two groups were in good agreement. During the first three cycles, serum cholesterol levels remained unchanged, but triglyceride and high-density lipoprotein cholesterol levels increased significantly and to the same extent (about 20%). Low-density lipoprotein cholesterol levels decreased slightly. Apolipoproteins A, and A2 and lOW-density lipoprotein B increased significantly and similarly. Except for continued increases in low-density lipoprotein B, no further changes were noted during subsequent cycles. We concluded that the two contraceptives have the same impact on lipid metabolism, with all lipid and apolipoprotein values remaining within the normal range. The changes with both pills reflect a mild estrogenic dominance. Implications for coronary artery atherosclerosis appear to be minimal. (AM J OBSTET GVNECOL 1990;163:1410-3.)

Key words: Atherosclerosis, desogestrel, ethinyl estradiol, gestodene, lipid metabolism, oral contraceptives

From the Gaubius Institute, The Netherlands Organization for Applied Scientific Research, and Academic Hospital, and Groot Zieken Gasthuisd. Reprint request: Jan A. Gevers Leuven, Gaubius Institute TNO, P.O. Box 612,2300 AP Leiden, The Netherlands. 610123637

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Increased levels of low-density and high-density lipoprotein cholesterol are associated with a high and low incidence of ischemic heart distress, respectively. 1.2 Low-density lipoprotein cholesterol can cause the disease. Evidence that high-density lipoprotein cho-

Effects of oral contraceptives on lipid metabolism

Volume [63 !\umber 4, Part 2

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