Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, PO Box 140, 00029 Helsinki, Finland.
Department of Obstetrics and Gynecology, University of Oulu, Oulu University Hospital and Medical Research Centre PEDEGO Research Unit, PO Box 5000, 90014 Oulu, Finland.
J Clin Endocrinol Metab. 2022 Jun 16;107(7):e3008-e3017. doi: 10.1210/clinem/dgac150.
Limited studies have compared the effects of combined oral contraceptives (COCs) containing natural estrogens and synthetic ethinylestradiol (EE) on reproductive hormones.
To compare estradiol valerate (EV) + dienogest (DNG), EE + DNG, and DNG alone (active control) on levels of follicle stimulating hormone (FSH), luteinizing hormone, anti-Müllerian hormone (AMH), ovarian steroids, sex hormone binding globulin (SHBG), and the free androgen index (FAI).
This spin-off study from a randomized trial enrolled 59 healthy, 18 to 35-year-old ovulatory women, outpatients at Helsinki and Oulu University Hospitals, Finland, who were randomized to EV 2 mg + DNG 2-3 mg (n = 20); EE 0.03 mg + DNG 2 mg (n = 20); and DNG 2 mg (n = 19) for 9 weeks. Blood samples were drawn at baseline, and at 5 and 9 weeks. Age and BMI were comparable between groups; 3 women discontinued.
EV + DNG suppressed FSH by -27% (-51% to -3%) (median [95% CI]) vs EE + DNG, -64% (-78 to -51), P = 0.04, but AMH levels decreased similarly by -9% (-18 to -0.1) vs -13% (-28 to 0.2), P = 0.38, respectively. EV + DNG increased SHBG levels by 56% (30% to 82%) and EE + DNG by 385% (313% to 423%), P < 0.001. Total testosterone decreased by 16% (-27% to -5%) in the EV + DNG group but it did not decrease in the EE + DNG group, whereas the FAI decreased by -39% (-54% to -25%) vs -72% (-78% to -67%), P < 0.001. DNG alone did not induce changes in any of these parameters.
Compared with EE + DNG, treatment with EV + DNG resulted in milder pituitary downregulation and reduced induction of hepatic SHBG synthesis-potentially carrying more beneficial health effects.
已有研究比较了含天然雌激素和合成炔雌醇（EE）的复方口服避孕药（COC）对生殖激素的影响。
比较戊酸雌二醇（EV）+地诺孕素（DNG）、EE+DNG 和 DNG 单药（阳性对照）对卵泡刺激素（FSH）、促黄体生成素、抗苗勒管激素（AMH）、卵巢甾体激素、性激素结合球蛋白（SHBG）和游离雄激素指数（FAI）的影响。
本项随机试验的衍生研究纳入了 59 名年龄 18 至 35 岁、有排卵的健康女性，她们均为芬兰赫尔辛基和奥卢大学医院的门诊患者，被随机分配至 EV 2 mg+DNG 2-3 mg（n=20）；EE 0.03 mg+DNG 2 mg（n=20）；和 DNG 2 mg（n=19）组，共 9 周。于基线、第 5 周和第 9 周采集血样。各组间年龄和 BMI 相似；3 名女性退出研究。
与 EE+DNG 相比，EV+DNG 使 FSH 降低 -27%（-51%至-3%）（中位数[95%CI]），P=0.04，但 AMH 水平分别下降相似，-9%（-18 至-0.1）与-13%（-28 至 0.2），P=0.38。EV+DNG 使 SHBG 水平升高 56%（30%至 82%），EE+DNG 使 SHBG 水平升高 385%（313%至 423%），P<0.001。EV+DNG 组总睾酮降低 16%（-27%至-5%），而 EE+DNG 组未降低，而 FAI 降低-39%（-54%至-25%）与-72%（-78%至-67%），P<0.001。DNG 单药未引起这些参数的任何变化。
与 EE+DNG 相比，EV+DNG 治疗导致垂体下调更温和，肝 SHBG 合成的诱导减少，可能具有更有益的健康影响。
