Evaluation of routine diabetes and lipid screening after age 35 in candidates for or current users of oral contraceptives.

OBJECTIVE

To evaluate the efficacy of a diabetes and lipid screening program in women aged 35 or older who either were currently using a low-estrogen-dose oral contraceptive (OC) (0.03-0.04 ethinyl estradiol) or who desired to initiate low-dose OC therapy after using a non-OC method or following a recent pregnancy.

METHODS

Healthy women with no history of abnormal glucose tolerance, hypertension, or hyperlipidemia aged 35 years and older were routinely screened for diabetes (fasting and 2-hour values after 75 g glucose) and dyslipidemia (fasting total cholesterol, high-density lipoprotein [HDL] and low-density lipoprotein [LDL] cholesterol, and triglycerides). Three groups of women were studied: women currently using low-dose OCs (OC group), women desiring to change to OC therapy (non-OC group), and women within 3 months post-pregnancy (postpartum group).

RESULTS

The three groups were similar in age, parity, body mass index (BMI), and mean arterial pressure. The mean months of contraceptive use were not different between the OC group (30.2 months; 95% confidence interval [CI] 26.6-33.8) and the non-OC group (38.4 months; 95% CI 32.0-44.8). The mean fasting serum glucose, after adjusting for age and BMI, was significantly lower in the OC group (82.4 +/- 9.4 mg/dL) than in the non-OC and postpartum groups (87.2 +/- 12.5 and 86.8 +/- 13.0 mg/dL, respectively; P = .01). After adjustments, no differences between the groups were found in the 2-hour post-glucose levels, triglycerides, or HDL or LDL cholesterol levels. The non-OC group was found to have a significantly lower total cholesterol level (188.7 +/- 32.4 mg/dL) than the OC and postpartum groups (202.7 +/- 38.1 and 204.4 +/- 41.0 mg/dL; P = .02) after adjusting for age and BMI. This association lost its significance after applying multiple range tests, maintaining an alpha error of 0.05.

CONCLUSION

The absence of significant adverse metabolic markers in longer-term OC users over the age of 35, in comparison to similar-age control groups, does not support the routine use of lipid and diabetes screening before initiating or during the use of low-dose OCs.