Plasma lipid changes and medroxyprogesterone acetate

Progestogens may have profound effects on lipid metabolism. Effects are generally dose-related and are more pronounced with 19-nor testosterone derivatives. Progestogens suppress circulating levels of high-density lipoprotein cholesterol (HDL-C) and increase circulating low-density lipoprotein cholesterol. Therefore, over a long period of time, the risk of atherosclerosis may increase. Although contraceptive use of depot medroxyprogesterone acetate (DMPA) reduced HDL-C levels by 15-20%, the levels generally remain within the normal range. Progestogens such as DMPA usually do not have any influence on fasting triglyceride levels. Some progestogens produce changes in the composition of phospholipids, but not DMPA. Progestogen effects on lipid metabolism are different from estrogen effects alone or estrogen-progestogen combinations. Increased risk of cardiovascular disease in longterm DMPA users is probably very small, but may become more significant when coupled with high risk factors. 10 years ago, most of the undesirable metabolic changes associated with the use of oral contraceptives were attributed to the estrogen component. 2 recent findings illustrate that certain progestogens can create metabolic havoc. 1) There is a strong association between depressed circulating levels of HDL-C and risk of serious cardiovascular disesase. 2) Certain progestogens are capable of substantially depressing the circulating levels of HDL-C, whereas estrogen actually elevates HDL-C. This does not prove that progestogens cause cardiovascular disease, but this possibility should be considered.