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Clinical and Metabolic Effects of 20 mcg Ethinylestradiol Contraceptive Pills
Introduction to Low-Dose Ethinylestradiol Pills
Low-dose contraceptive pills containing 20 mcg of ethinylestradiol (EE) have been developed to minimize estrogen-related adverse effects while maintaining contraceptive efficacy. These pills are often combined with various progestins, such as desogestrel or levonorgestrel, to enhance their effectiveness and manage side effects.
Contraceptive Efficacy and Cycle Control
Studies have shown that contraceptive pills containing 20 mcg EE, combined with progestins like desogestrel or levonorgestrel, provide effective cycle control and high contraceptive efficacy. Clinical trials involving these formulations have demonstrated good cycle control with a low incidence of irregular bleeding . However, some studies indicate that lower estrogen doses may lead to higher rates of early trial discontinuation and increased bleeding disturbances compared to higher estrogen doses .
Metabolic and Biochemical Effects
Lipid and Lipoprotein Changes
Research comparing pills with 20 mcg and 30 mcg EE combined with desogestrel has shown that both formulations can beneficially influence lipid profiles. Specifically, both doses increased high-density lipoprotein cholesterol (HDL-CH) and the HDL-CH/low-density lipoprotein cholesterol (LDL-CH) ratio, while only the 20 mcg EE formulation significantly decreased LDL-CH levels . These changes suggest a potentially advantageous effect on cardiovascular risk factors.
Coagulation Factors
The impact of low-dose EE pills on coagulation factors has also been studied. Pills containing 20 mcg EE and desogestrel were found to have minimal effects on haemostatic parameters, such as fibrinogen and fibrinopeptide A (FPA) levels, compared to higher estrogen doses . This suggests a reduced risk of thromboembolic events with lower estrogen doses.
Insulin and Glucose Metabolism
Importantly, the 20 mcg EE and desogestrel combination did not significantly alter fasting insulin and glucose levels or their response to an oral glucose tolerance test (OGTT), indicating a neutral effect on glucose metabolism.
Side Effects and Safety Profile
Common Side Effects
The most commonly reported side effect of low-dose EE pills is headache, experienced by approximately 17.3% of users in clinical trials. Other minor side effects typically associated with oral contraceptives, such as nausea and breast tenderness, were infrequent with the 20 mcg EE formulation.
Bone Health
Interestingly, studies have shown that both 20 mcg and 30 mcg EE pills can reduce bone resorption markers, suggesting a protective effect on bone health. This is particularly relevant for young women, as maintaining bone density is crucial during the post-adolescent years.
Conclusion
Contraceptive pills containing 20 mcg of ethinylestradiol, combined with progestins like desogestrel or levonorgestrel, offer effective contraception with a favorable safety profile. They provide good cycle control, beneficial effects on lipid profiles, minimal impact on coagulation factors, and a neutral effect on glucose metabolism. While they may lead to higher rates of bleeding disturbances compared to higher estrogen doses, their overall benefits make them a viable option for many women seeking contraception.
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