Abstract
Purpose: Combined hormonal contraceptive therapy has been associated with negative bone mineral density outcomes that may be route-dependent [i.e., combined oral contraception (COC) vs. contraceptive vaginal ring (CVR)] and involve the hepatic growth hormone (GH)/insulin-like growth factor-I (IGF-I) axis. The objective of the pilot study was to assess the impact of route of contraceptive administration on IGF-I and procollagen type I N-terminal propeptide (PINP) responses to an IGF-I Generation Test. We hypothesized that the peak rise in IGF-I and PINP concentration and area under the curve (AUC) would be attenuated following COC, but not CVR, use.Methods: Healthy, premenopausal women not taking hormonal contraception were recruited. Women were enrolled in the control group (n = 8) or randomly assigned to COC (n = 8) or CVR (n = 8) for two contraceptive cycles. IGF-I Generation Tests were used as a probe to stimulate IGF-I release and were completed during the pre-intervention and intervention phases. Serum IGF-I and PINP were measured during both IGF-I Generation Tests. The study was registered at ClinicalTrials.gov (NCT02367833).Results: Compared to the pre-intervention phase, peak IGF-I concentration in response to the IGF-I Generation Test in the intervention phase was suppressed in the COC group (p < 0.001), but not the CVR or Control groups (p > 0.090). Additionally, compared to the pre-intervention phase, PINP AUC during the intervention phase was suppressed in both COC and CVR groups (p < 0.001), while no difference was observed in the control group (p = 0.980).Conclusion: These data suggest that changes in recombinant human GH-stimulated hepatic IGF-I synthesis in response to combined hormonal contraception (CHC) use are dependent on route of CHC administration, while the influence on PINP is route-independent. Future research is needed to expand these results with larger randomized control trials in all age ranges of women who utilize hormonal contraception.Clinical Trial Registration: www.ClinicalTrials.gov registration NCT02367833.
Highlights
Since the first oral contraceptive pills were approved in the 1960s, combined hormonal contraceptives (CHCs) have been used by millions of women worldwide
Compared to the pre-intervention phase, peak insulin-like growth factor-I (IGF-I) concentration in response to the IGF-I Generation Test in the intervention phase was suppressed in the COC group (p < 0.001), but not the contraceptive vaginal ring (CVR) or Control groups (p > 0.090)
Compared to the pre-intervention phase, procollagen type I N-terminal propeptide (PINP) area under the curve (AUC) during the intervention phase was suppressed in both COC and CVR groups (p < 0.001), while no difference was observed in the control group (p = 0.980)
Summary
Since the first oral contraceptive pills were approved in the 1960s, combined hormonal contraceptives (CHCs) have been used by millions of women worldwide. In a study of oligoamenorrheic athletes, those randomized to COC use (30 μg EE and 150 μg desogestrel) experienced a decrease in PINP with no change in N-terminal cross-linked telopeptides of collagen I (NTx) over 12 months, while those randomized to a transdermal 17β-estradiol patch (with cyclic micronized progesterone) demonstrated a smaller reduction in PINP and no change in NTx [13, 14]. Based on these conflicting findings, further efforts to understand the potentially detrimental effects of COC use on bone are critically important
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