[Metabolic impact of current estrogen-progestins and cardiovascular consequences]

In recent years, reduction of estrogen and progestogen dosages and use of new progestogens with less androgenic activity (desogestrel-gestodene-norgestimate) have apparently allowed combined oral contraceptives (OCs) to be associated with less frequent undesirable vascular effects. From an epidemiologic viewpoint, the atherogenic impact of new low-dose OCs is less marked, including in users over 40 years of age, but thromboembolic effects still persist--though at a lower level than with standard-dose products. From a metabolic viewpoint, the adverse effects of the progestogens contained in current OCs on the lipoprotein profile and their atherogenic effect on the vessel wall seem effectively counterbalanced by the estrogen content of these new OCs. However, the progestin content seems still responsible for a low level of chronic insulin resistance, which might be related to vascular alterations potentially linked to syndrome-X. In conclusion, reduced metabolic effects of new low-dose OCs appear to decrease their atherogenic risk. However, thrombotic effects dose-related to the estrogen component of OCs are still persisting and seem less easily suppressible.