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BCP and diabetes/insulin resistanceFrom: Victoria (anonymous@obgyn.net)Wed, 11 Dec 2002 17:58:09 -0500
This was from a post I made in regards to the pill and PCOS on April 29, 2002 on a couple of PCOS forums in regards to misconceptions of the pill: 1) BCP page: Journal of Clinical Endocrinology and Metabolism's Vol. 80 no. 11 article on pages 3327-34 about the 'Metabolic effects of oral contraceptives in women with polycystic ovary syndrome'. This article says that a reduction in insulin resistance happened. There is also a good article from S. Nader, M. Riad-Gabriel, and M. Saad on, 'The effect of a desogestrel-containing oral contraceptive on glucose tolerance and leptin concentrations in hyperandrogenic women' in the Journal of Clinical Endocrinology and Metabolism, Year 1997, issue 82, pages 3074-307. There are health benefits of contraception. http://www.arhp.org/betcho.htm Dr. Leon Speroff's book: A Clinical Guide for Contraception, 2nd edition. (Medical library call number: WP 630 5749c 1996 c.1. He states that levonorgestrel monophasics have a 'negative impact' or don't work well on those with carbohydrate intolerances. Also that low doses have small but basically ignorable effects on carbohydrate metabolism and insulin resistance. (Pg 56 - 59.) Dr. Leon Speroff is a well respected author of ob/gyn and reproductive endocrinology related material. This article talks about the (http://www.arhp.org/clinical/cpmyths.htm) myths about oral contaceptives if you are interested. 2) Dr. Speroff webpage: (Dr. Leon Speroff, "Clinical Gynecologic Endocrinology and Infertility", published 1999 by Lippincott, Williams & Wilkins). The numbers in parenthesis are page references. The best OC/BCP contains desogestrel, gestodene, and norgestimate, but this is not always proven in studies (544). If you are in Europe, Cyproterone Acetate in Diane/Diane-35/Dianette (OC/BCP) works very well for hirsutism (545). There is little to no problems with using low dose OC/BCP, because there is little to no measureable difference in insulin resistance. Spironolactone and flutamide don't cause any insulin resistance problems either (508-9). (898) The low dose pills appear to not have the effect of worsening insulin resistance. He does state that changes in how carbs work are in the non-diabetic range. Although there are changes, Dr. Speroff states they are minimal. (899) (544) The best OC/BCP contains desogestrel, gestodene, and norgestimate, but this is not always proven in studies. (Personal note: PCO women have better luck with the desogestrel types of OC/BCP, at least from what has been said over a period of time on several email lists.) These are the same pills that *supposedly* caused diabetes in 2 out of 16 women in the http://www.mja.com.au/public/issues/nov16/kidson/kidson.html Kidson study. The study has noted it was uncontrolled, meaning that other factors that contribute to getting diabetes were not ruled out and there is no way to prove an absolute link to BCP and diabetes. SHBG and IR: (46) "an important mechanism for a reduction in circulating SHBG levels is insulin resistance and hyperinsulemia (independant of age and weight). This relationship between the levels of insulin and SHBG is so strong that SHBG concentrations are a marker for hyperinsulinemic insulin resistance and a low level of SHBG is a predictor for the development of Type II diabetes.". (The pill affects SHBG l evels, and I'll be looking up the official citation for this.) 3) I had a discussion previously with Christine DeZarn, head of PCOSA on the pill and PCOS. PCOSA does list the pill as a possible treatment of PCOS. When I talked with her concerning this, the following is an excerpt of what she had to say. While I am not aware of an oral contraceptive directly causing diabetes, I don't want people to ever think that PCOSA only lists treatments that carry no risk with them. All treatments carry both benefit and risk. Some oral contraceptives have been shown to slightly increase insulin resistance in some studies. Others have not. But a pill is not a pill is not a pill. There are actually several different types of oral contraceptives, some of them with entirely different ingredients than others, so this accounts for the varying results. But no drug is without risk, and all of those listed as "treatments" for PCOS carry risk as well. Women with PCOS need to educate themselves about all of the different types of oral contraceptives on the market, and the research that goes with them, then select the best choice for them. That being said, endometrial cancer is a much greater risk than a slight increase in insulin resistance. Even if insulin resistance is slightly raised by an OC, oral contraceptives irrefutably protect against endometrial cancer - the more immediate life-threatening risk. What women really need to understand is that they must treat the insulin resistance *in addition* to protecting themselves against endometrial cancer. Too many doctors just tell a woman to take the pill and that's it. But that's not enough. The IR absolutely must be treated. We know that insulin resistance is treatable with diet, exercise and/or insulin sensitizers. If we are treating the insulin resistance, then a slight increase in IR from the pill will be addressed anyway. It's always a balance of benefit and risk, and an educated decision is what is needed. In addition, I made this post on the women's health discussion list at obgyn.net. The original post was made on the pcos medication forum there, so I sent it to another doctor for an opinion. (This is a post of mine.) Date: Wed, 15 May 2002 08:56:09 -0500 (CDT) From: William McIntosh, MDSubject: Re: Question for doctor http://forums.obgyn.net/womens-health/WHF.0205/1139.html Most PCOS patients do NOT have frank Diabetes, they have varying degrees of insulin resistance, not any sort of contraindication to OCP use. Also, see http://www.medscape.com/viewarticle/434446, Diabetes Care, Oral Contraceptive Use and Association With Glucose, Insulin, and Diabetes in Young Adult Women: The CARDIA Study, Catherine Kim, MD, MPH, David S. Siscovick, MD, MPH, Stephen Sidney, MD, MPH, Cora E. Lewis, MD, MSPH, Catarina I. Kiefe, MD, PHD, Thomas D. Koepsell, MD, MPH Objective. We studied the associations between 1) current use of oral contraceptives (OCs) and 2) glucose levels, insulin levels, and diabetes in young women. 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. Victoria
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