Lipoprotein changes may be minimized by proper composition of a combined oral contraceptive.

Lipids, high-density lipoprotein (HDL) cholesterol, and sex hormone-binding globulin (SHBG) were determined in 98 women treated with combined oral contraceptives containing ethinylestradiol (EE) and levonorgestrel (NG) in the following combinations: 20/250, 30/250, 30/150, and a so-called three-phase drug. The EE/NG ratios were 0.08, 0.12, 0.20, and 0.35, respectively. The HDL cholesterol and the HDL cholesterol to cholesterol ratios were markedly reduced by 20/250 and 30/250, whereas 30/150 and the three-phase drug caused only minor reductions. The mean change in HDL cholesterol showed a good correlation with the mean changes in SHBG (r = 0.916) and with the EE/NG ratios (r = 0.979). It is concluded that SHBG may be used as an index of estrogenicity of a combined oral contraceptive agent and that EE and NG may be balanced in such a way that undesirable effects on lipid metabolism are minimized.