Former long-term use of combined hormonal contraception and glucose metabolism  disorders in perimenopausal women: A prospective, population-based cohort study

Maria-Elina Mosorin; Meri-Maija Ollila; Tanja Nordström; Jari Jokelainen; Terhi Piltonen; Juha Auvinen; Laure Morin-Papunen; Juha Tapanainen

doi:10.1111/aogs.14636

Contraception · Oral Contraceptives

Former long-term use of combined hormonal contraception and glucose metabolism disorders in perimenopausal women: A prospective, population-based cohort study

Mosorin ME, Ollila MM, Nordström T, Jokelainen J, Piltonen T, Auvinen J, Morin-Papunen L, Tapanainen J

Published November 2023 Acta Obstetricia Et Gynecologica Scandinavica, 102(11), 1488-1495

DOI 10.1111/aogs.14636 PMID 37568273 PMC PMC10577621

RRM Academy Synopsis

Past combined hormonal contraception over 10 years tied to prediabetes

Past combined hormonal contraceptive use for over 10 years was associated with prediabetes. Among 46-year-old women in a Finnish birth cohort, past users of over 10 years had 3.9 times the odds of prediabetes after adjustment. The comparison group had no hormonal contraception history. Newly found type 2 diabetes was not associated with over 10 years of past use.

Key Findings

After adjustment, women with over 10 years of past combined hormonal contraceptive use had 3.9 times the odds of prediabetes of women with no hormonal contraception history (95% CI 1.6–9.2).
Prediabetes occurred in 39 of 339 (11.5%) with over 10 years of past use and 19 of 253 (7.5%) with no history. The unadjusted odds ratio was 1.5 (95% CI 0.9–2.7).
For past use under 5 years the adjusted odds ratio for prediabetes was 1.7 (95% CI 0.8–3.9), and for 5 to 10 years it was 1.8 (95% CI 0.8–4.1).
Newly found type 2 diabetes was not associated with over 10 years of past use: 3 of 339 (0.9%) versus 9 of 253 (3.6%), adjusted odds ratio 0.5 (95% CI 0.1–2.9).
Past use of progestin-only contraceptives, in 52 women, was not associated with prediabetes or new type 2 diabetes.

Interpretation

The Northern Finland Birth Cohort 1966 is a population-based group followed from pregnancy to age 46. Contraceptive history came from a questionnaire at age 46. Prediabetes was identified by an oral glucose tolerance test. The design shows an association, and the authors note that other factors may explain it. The women were 46 years old and Caucasian. The authors list self-reported use, unknown timing of stopping, unknown contraceptive formulations, and a progestin-only group too small for firm conclusions. Results held after excluding women who reported polycystic ovary syndrome (PCOS, now also called polyendocrine metabolic ovarian syndrome, PMOS).

RRM Context

Combined hormonal contraceptives are suppressive medications that hold back ovulation while taken. Restorative reproductive medicine looks for the cause of cycle and blood sugar problems together. The authors cite a Swedish study that found a two-fold increased risk of prediabetes in former users. Other studies found no association. The authors suggest the finding could indicate a need for glucose screening in these women.

Our editorial summary of this paper, not the article's abstract.

Abstract

Introduction

Current use of combined hormonal contraceptives worsens glucose tolerance and increases the risk of type 2 diabetes mellitus at late fertile age, but the impact of their former use on the risk of glucose metabolism disorders is still controversial.

Materials and Methods

This was a prospective, longitudinal birth cohort study with long-term follow-up consisting of 5889 women. The cohort population has been followed at birth, and at ages of 1, 14, 31 and 46. In total, 3280 (55.7%) women were clinically examined and 2780 also underwent a 2-h oral glucose tolerance test at age 46. Glucose metabolism indices were analyzed in former combined hormonal contraceptive users (n = 1371) and former progestin-only contraceptive users (n = 52) and in women with no history of hormonal contraceptive use (n = 253).

Results

Compared with women with no history of hormonal contraceptive use, those who formerly used combined hormonal contraceptives for over 10 years had an increased risk of prediabetes (odds ratio [OR] 3.9, 95% confidence interval [CI]: 1.6-9.2) but not of type 2 diabetes mellitus. Former progestin-only contraceptive use was not associated with any glucose metabolism disorders. The results persisted after adjusting for socioeconomic status, smoking, alcohol consumption, parity, body mass index and use of cholesterol-lowering medication.

Conclusions

Former long-term use of combined hormonal contraceptives was associated with a significantly increased risk of prediabetes in perimenopausal women, which potentially indicates a need of screening for glucose metabolism disorders in these women.

Topics

Contraception › Oral Contraceptives › Metabolic Effects · Therapeutics › Hormonal Agents › Estrogen Preparations

Maria-Elina Mosorin, Meri-Maija Ollila, Tanja Nordström, Jari Jokelainen, Terhi Piltonen, Juha Auvinen, Laure Morin-Papunen, Juha Tapanainen

M Mosorin, M Ollila, T Nordström, J Jokelainen, T Piltonen, J Auvinen, L Morin-Papunen, J Tapanainen

PMID 37568273 37568273 DOI 10.1111/aogs.14636 10.1111/aogs.14636 Mosorin et al. 2023, Mosorin 2023

Keywords

Contraceptives, Oral, Combined, Contraceptives, Oral, Hormonal, Progestins