A comparative study of contraceptive intrauterine device- MIRENA
and medroxyprogesterone acetate on carbohydrate metabolism during perimenopausal
N Öztürk Turhan, D Dogan
Fatih University, Department of Obstetrics and
Gynecology, Ankara, Turkey
Objectives To compare the effects of a
Levonorgestrel releasing intrauterine device (MIRENA) and medroxyprogesterone
acetate (MPA) on the insulin sensitivity and glucose tolerance in perimenopausal
Design and methods This prospective randomized, parallel-group study
was conducted to compare the effects of MIRENA used for contraception purpose
(n=40, LNG/EE group) with MPA 10 mg/day for 10 days/month (n=40, MPA/EE group)
in conjunction with ethinylestradiol (EE) 25 µg transdermal patch for relieving
the vasomotor symptoms on carbohydrate metabolism. Characteristics of the
patients (age, breast feeding condition) were similar. Oral glucose loading (OGTT),
insulin and glycosylated hemoglobin-HbA1c levels were evaluated at baseline and
at the end of 1 year.
Results After 1 year of treatment a small increase in
body weight was observed in the MPA/EE group while a statistically significant
slight increase occurred in the LNG/EE group. Fasting blood sugar and insulin
and HbA1c levels after a year treatment increased significantly in both groups.
The second hour glucose levels of 75 g OGTT did not change in the LNG/EE group
while a significant increase was observed in the MPA/EE group. Incidence of
adverse events were comparable in both groups.
Conclusions The role of steroid
hormones in modulating insulin sensitivity and glucose tolerance are of
increasing interest and importance because of the increasing prevalence of type
2 diabetes mellitus and the metabolic abnormalities associated with aging. The
results of this study revealed a slight deterioration of glucose tolerance and
an increase in plasma insulin levels in both treatments. Even used for a
contraception purpose perimenopausal women should be screened for glucose
tolerance and these therapies might be considered a relative contra- indication
in women with a history of gestational diabetes or of diabetes or in cases of
impaired glucose tolerance with a familial or obstetric history of diabetes.