Popping pills. The combined oral contraceptive pill and its acute effects on glucose metabolism, cardiometabolic health, appetite, and satiety

Abstract

Introduction Despite widespread use of the oral contraceptive pill (OCP) worldwide and in New Zealand by women of childbearing age, little is known about the acute effects it has on glucose metabolism, cardiometabolic health, appetite, and satiety. The combined OCP contains ethinylestradiol in combination with a synthetic progesterone, and whilst endogenous female hormones are suggested to cause adverse fluctuations in glucose regulation and food intake across the menstrual cycle, our understanding of whether synthetic hormones such as those in the OCP could also have this same effect remains lacking. As too does our understanding of the changes in metabolic and appetite profile that may occur after withdrawal of the OCP- as routinely occurs during one week of every monthly pill cycle. Aim: This study therefore aimed to explore the acute effects of the combined, monophasic OCP on metabolic profile, glucose metabolism, appetite, and satiety in both the fasted state and in response to a glucose load; in doing so broadening the scientific understanding of the impacts that the OCP has on women’s health. Conclusion: As hypothesised, the OCP had a negative effect on glucose metabolism, as seen in the elevated glucose and insulin response to the glucose load. However it is possible that further OCP effects were masked by an insufficiently long withdrawal time period prior to the inactive phase measurements. Nevertheless, this potentially adverse influence of the OCP on glucose handling is of concern, particularly in light of the high prevalence of OCP use and the increasing commonplace prolonged active pill usage (i.e., with no inactive, withdrawal phase) that may continue for months, years or even decades. This continual usage may lead to accumulated metabolic load over time, presenting a clear risk for the development of impaired glucose tolerance and diabetes, as such warrants considerable future attention.