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ORIGINAL ARTICLE
Year : 2022  |  Volume : 25  |  Issue : 2  |  Page : 47-51

Association between hormonal contraceptive use and derangement of lipid profile among women attending Muhoza Health Center, Rwanda


Department of Biomedical Laboratory Sciences, INES Ruhengeri Institute of Applied Sciences, Musanze, Rwanda

Date of Submission16-Jun-2020
Date of Decision31-Aug-2020
Date of Acceptance12-Sep-2020
Date of Web Publication22-Aug-2022

Correspondence Address:
Dr. Callixte Yadufashije
Department of Biomedical Laboratory Sciences, INES Ruhengeri Institute of Applied Sciences, Musanze
Rwanda
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/smj.smj_70_20

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  Abstract 


Background: Contraception is a method used to prevent unwanted pregnancies and child spacing. Although the method is beneficial in over birth control and stabilization of population explosion, the hormonal components of used drugs have been shown to generate many sides' effects among users. Aim and Objective: This study was conducted to investigate the effect of hormonal contraceptives (HCs) on lipid profile among women attending family planning services at Muhoza Health Center, Rwanda. Materials and Methods: This was a cross-sectional study and purposive sampling was used to select study participants among HC users, although simple random sampling was used to select study participants of nonusers. A total of 88 participants were recruited and among them, 57 were HC users, while 31 were nonusers known as controls. Blood sample was collected after the consent of the participant accepting to participate in the study. Collected blood samples were analyzed to evaluate parameters of the lipid profiles, including high-density lipoprotein (HDL), triglycerides (TG), total cholesterol (TC), and low-density lipoprotein (LDL) by using Humalyzer plus at INES-Ruhengeri clinical biochemistry laboratory. Results: Findings of this study show a high risk of developing abnormal lipid profile among the exposed group compared to controls. Association was found in LDL-cholesterol (LDL-C) (odds ratio [OR] = 11 > 1), TC (OR = 14 > 1) and TG (OR = 2.8 > 1). The high risk of developing abnormal lipid profile among users compared to controls was observed in LDL-C and TC. HDL-cholesterol (OR = 0.8 < 1) showed that there is no risk of developing abnormal lipid profile among users and controls. Implant (χ2 = 10, df = 3, P = 0.018397 < 0.05) was statistically significant to affect all studied lipid profile parameters while TC (χ2 = 20.88, df = 3, P = 0.000111 <0.05) was statistically significant to be affected by all HCs studied among users. Conclusion: Lipid profile is affected by HCs among users. Most of the studied lipid profile parameters were seen to be affected by HC use. HC users should be followed up as dyslipidemia could lead to different health conditions.

Keywords: High-density lipoprotein, hormonal contraceptives, lipid profile, total cholesterol


How to cite this article:
Habyarimana T, Yadufashije C, Mukantwali V, Nshimiyinana A, Niyonzima F, Yamukujije C, Mucumbitsi J. Association between hormonal contraceptive use and derangement of lipid profile among women attending Muhoza Health Center, Rwanda. Sahel Med J 2022;25:47-51

How to cite this URL:
Habyarimana T, Yadufashije C, Mukantwali V, Nshimiyinana A, Niyonzima F, Yamukujije C, Mucumbitsi J. Association between hormonal contraceptive use and derangement of lipid profile among women attending Muhoza Health Center, Rwanda. Sahel Med J [serial online] 2022 [cited 2022 Nov 30];25:47-51. Available from: https://www.smjonline.org/text.asp?2022/25/2/47/354189




  Introduction Top


Contraception is a birth control method by means of the use of various ways such as pills, injections, implants, and intrauterine devices. The purpose is child spacing, limiting number of children and to preventing unwanted pregnancy between couples for better living of families and healthy reproductive health life of couples, but also to avoid overpopulation in some countries of the world.[1] Since the last few decades, overpopulation started being a serious problem facing the globe, and contraceptive methods have been put in place as a global response to unplanned pregnancies and birth limitation among couples, but various researches showed that the use of the contraceptive method has benefits but also have some side effects too.[2]

Since its discovery in 1960, hormonal contraceptive (HC) methods have been used in its both types; estrogen and progesterone contained birth control pills.[3] Despite the good safety profile of contraceptives methods on the country policy of over birth control and preventing unwanted pregnancies, hormonal components containing the used drugs may lead to serious side effects, including effects in lipid metabolism. Previous studies highlighted that the widespread use of such contraceptive methods is the leading cause of cardiovascular diseases (CVD), and higher doses of estrogen have been assessed to be the reducer of the concentrations of Ethinyl estradiol <50 μg on the combine three generations.[4]

Previous findings show that synthetic progesterone has a diverse effect on both catabolism and anabolism of lipid profile parameters because of its ability of restraining changes caused by estrogen in low-density lipoprotein-cholesterol (LDL-C) and high-density lipoprotein-cholesterol (HDL-C) and total cholesterol (TC) levels.[5] However, the metabolic process of glucose was seen to be affected where it increases with the occurrence of the dominance of progesterone.[6] The manufactured steroidal hormones cause lipid metabolism impairment, but also inhibit the ovulation by feedback mechanisms of end products cascades of, brain master, pituitary gland.[7] Due to the fact HC) alter lipid profile, it was seen and understood that it leads to dyslipidemia and later cause CVD risks.[8]

The difference of the lipid profile among HC users and nonusers was investigated by various scientists where the mean differences showed that HC users are in high risk of developing derangement in lipid profile parameters.[9] Depo-Provera, which is an injectable contraceptive method and oral contraceptives (OC) were seen to have an impact on high- and low-density lipoprotein (LDL) levels.[10] Number of different studies have been conducted on hormonal contraception effect on lipid profile, including the one done in Uganda on dyslipidemias among women underuse of HCs showed that 16% of the women were found to have obesity and was associated with alterations in lipid profile levels.[11]


  Materials and Methods Top


Study area

This study was carried out at Muhoza health center located in the Northern Province of Rwanda, Musanze District, and Muhoza Sector. Samples were collected from the family planning and maternity services department of Muhoza health center, and additionally laboratory examinations were performed in the INES Clinical Biochemistry laboratory.

Study design

This study was a cross-sectional, correlational and case–control that included all women attending family planning service at Muhoza health center who met the inclusion criteria from October 25 to November 21, 2019.

Study population

In this study, all women who attended family planning program at Muhoza health center within the study period from October to November 2019 being, users and nonusers of contraceptives constituted the study population.

Sample size

Purposive sampling was used to recruit 57 HC users and SRS was used to recruit 31 women who did not use HCs, this group of nonusers was used as a control group.

Sample collection

Blood samples were collected from women attended the family planning program within the study period. In this case, a blood specimen for lipid profiles analysis was collected using routine blood collection method as follows; 4 ml of the venous blood sample was collected in dry tube first after addressing and locate the client. From there, the tourniquet was put on the patient about 3–4' above the venipuncture site, then veins were located either median cubital vein if not accessible: cephalic vein, or the basic vein. After finding the vein, 70% alcohol was used to clean the blood collection site. The blood samples were withdrawn in dry tubes.

Laboratory analysis

The samples were brought in the INES-Ruhengeri clinical biochemistry laboratory, where they were analyzed for lipid profiles using Humalyzer plus. 4 ml venous blood samples collected from each woman was centrifuged to obtain serum for testing parameters of the lipid profile such as LDL, high-density lipoprotein (HDL), TC, and triglycerides (TG). The data were recorded using a data collection sheet for further analysis.

Ethical consideration

Both ethical committees of INES Ruhengeri and Ruhengeri Referral Hospital approved the study to be conducted before the beginning and after the completion of the report. However, this study kept safe the information of the participants and ensured the anonymous data.

Statistical analysis

Data analysis was performed using SPSS version 22 (New York, USA) and Microsoft Excel to determine the anticipated changes in lipid profiles and the statistical significance of the analyzed parameters from those adopting the widespread use of the contraceptive method and those who do not.


  Results Top


Social demographic characteristic of participants

As indicated in [Table 1], the study recruited 88 women, among them 57 (64.8%) were using any type of contraceptive, whereas 31 were taken as control group. Participants were grouped into four groups within both users and controls. The mean age in users was 32.82 ± 7.08 and in controls was 29.2 ± 6.6. The most prevalent age groups were 31–40 with 30 (52.6%) and 21–30 with 16 (51.6%) in both users and control group, respectively.
Table 1: Social demographic characteristics of participants

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Type of contraceptive drugs used at muhoza health center

There are different types of contraceptives used worldwide. In this study, the most contraceptives were implant, Depo-Provera, progesterone, and combined (estrogen and progestin). [Table 2] shows the most types of contraceptive drugs used at Muhoza health center.
Table 2: Types of contraceptive drugs used at Muhoza health center

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The implant and Depo-Provera were seen to be the most used contraceptive at this health center as they account for 42.1% and 40.4%, respectively. Whereas progesterone and combined account the remaining 8.8% each.

Measurement of effect level of lipid profile among cases and control

The optimal level of lipid profile considered

  • LDL-C: <130 mg/dl or <3.36 mmol/L
  • HDL-C: >60 mg/dl or >1.55 mmol/L
  • TG: <150 mg/dl or <1.69 mmol/L
  • TC: <200 mg/dl or <5.2 mmol/L.


[Table 3] shows the lipid profile situation among HCs users and controls. Odds ratios (ORs) were used to measure the association of the HCs and lipid profiles. This also shows the level of the HCs effects on users comparing to the control group. TC and LDL showed the high effect among the exposed group compared nonexposed group with OR = 14 and OR = 11, respectively. TG was the last to show the effect of HCs compared to the first twos with OR = 0.2.8; however, HDL did not show effect of HCs compared to nonusers. Commonly the common OR = 3.8 shows clearly high difference between lipid profile among users and users, which is a measure of the association of lipid profile variation among users.
Table 3: Measurement of effect level of lipid profile among cases and control

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Effects of each used contraceptive drugs on lipid profiles among users

[Table 4] contains findings of the effect level for each studied HC on lipid profile parameters among the exposed group. It also figures out the most affected lipid profile parameters among women under HC use. Implant was the most HC affecting lipid profile, it was statistically significant with (χ2 = 10, df = 3, P = 0.018397 <0.05). On the other side, TC was the most lipid profile parameter affected by HC as it was statistically significant with (χ2 = 20.88, df = 3, P = 0.000111). Other HCs were not significant.
Table 4: Effects of each used contraceptive drugs on lipid profiles among users

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  Discussion Top


The present study was conducted to analyze the effect level of HC methods on the lipid profile. Blood samples were collected on both exposed and nonexposed group to measure the risk of users compared to nonusers. TC and LDL revealed to be the most affected lipid profile parameters in both exposed (cases) and nonexposed (controls) group with OR = 14 and OR = 11, respectively, but also TG showed the high association despite the high difference between the first two parameters. The difference made between parameter effects from HCs does not mean safety of the HCs as each one has its own effect [Table 3]. The same findings were reported on the study conducted to investigate the side effect of HC methods on lipid profile parameters and how they influence CVD conditions, found that lipid profile parameters are affected by HC methods. Both exposed and nonexposed group were used and TC among both group were 4.07 ± 0.91 mmol/L for exposed and 3.35 ± 0.62 mmol/L for nonexposed with significance level (P = 0.002 <0.05).[8] This shows how cholesterol becomes abnormal among HC users, which confirms clearly similarities with the current study. In the same findings, the level of LDL-C was studied among both groups; it showed that the level of LDLC is different in both group with 1.74 ± 0.57 mmol/L for nonexposed group and 2.38 ± 0.84 mmol/L for the exposed group with a significance level (P = 0.003).[8] The level of LDLC among users and nonusers showed that the abnormal LDLC increases among users, which is the same to findings of the current study regarding OR, which is OR = 11. The study conducted to compare lipid profile levels among users and nonusers of OC showed a high difference of lipid profile parameters among users and nonuser. Lipid profile among users is was statistically significant compared to nonusers. TC was found to be affected among OC users compared to nonuser with 242.92 ± 2.842 mg/dL and 218.49 ± 1.762 dL−1.[9] For other parameters, no high effect was observed between users and nonusers; however, some lipid profiles of OC users were observed in the intermediate level of lipid profile tending to abnormal. The mean value of lipid profile parameters was used to measure differences between OC users and nonusers. Serum cholesterol mean value in both exposed and nonexposed was reported as 193.48 ± 14.49 mg% for exposed and 184.46 ± 13.58 mg% for nonexposed with significance level (P = 0.001 <0.05), Serum TG mean value was also reported among exposed (91.16 ± 11.04 mg%) and nonexposed group (85.26 ± 11.03 mg%) with significance level (P < 0.01).[12] Other lipid profile parameters were also studied; commonly what was seen is that there is a big difference between OC users and nonusers among women targeted by the study. This shows no differences with the current study. The current study investigated and evaluated the effect of each used HC on lipid profile among users. Implant has been significant (χ2 = 10, df = 3, P = 0.018397) to have an effect to all lipid profile parameters. TC also was statistically significant to be affected by all HCs (χ2 = 20.88 df = 3, P = 0.000111). Despite the only implant that was statistically significant significant to affect all profile parameters among HC users, it does not mean safety of the remaining HCs as each one has its own the effect to each lipid profile. To understand well effect level of other remaining HC effect on lipid profile, taking a look to statistical evidence should not be neglected [Table 4]. Abnormal lipid profile is also known as dyslipidemia. The study conducted at Mulago Hospital in Uganda on Dyslipidemia among women under HCs showed that 63.3% of all study participants (HC users) are affected by dyslipidemia.[11] This shows that HCs affect the lipid profiles at more than 50% of users. This study is not far from the current study findings despite short differences. In its objectives, the current study investigated HC effects on each parameter of the lipid profile while compared study looked at the entire burden of HCs. This confirms what discussed above that even if other HCs (Progestogen, Depo-Provera, Combined) was statistically significant, it does not mean that their high level in the blood is safe as each affects lipid profile partially. The study conducted on the investigation of the effect level of the two OC combined showed the rise of HDL but also revealed a decrease in LDL.[13] This is similar to the current study where by the effect difference was observed in different HCs among participants. The similarity of both studies is clear; the current study showed HDL-C to be higher than LDLC among users, as it was shown by the findings of the compared study. The study conducted on the level of the effect of the two OC combined on the lipid profile parameters of the serum revealed that there was the increase of HDL and plasma TG, but also Plasma LDL and TC were lowered by the two combined OC.[14] The contradiction on some lipid profile parameters was observed in the current study where findings showed the increase of TC while there was a decrease of it in the compared study. However, this depends on a number of factors including dose consumed and other health conditions among users.


  Conclusion Top


This study pointed out the level of effect of HC methods on parameters of the lipid profile at Muhoza health center. It showed that majority of the participants were under 40-year-old. HCs used for birth control affected parameters of the lipid profile, mainly TG, and LDL-C, and TC comparing case and control groups. Although, the implant has been significant to affect all lipid profile parameters, cholesterol is was statistically significant to be the most affected lipid profile parameter among users.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Rakhi J, Sumathi M. Contraceptive methods: Needs, options and utilization. J Obstet Gynecol India 2011;61:626-34.  Back to cited text no. 1
    
2.
Siddique YH, Afzal M. Evaluation of genotoxic potential of synthetic progestichlormadinone acetate. Toxicol Lett 2014;153:221-5.  Back to cited text no. 2
    
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Burkman R, Bell C, Serfaty D. The evolution of combined oral contraception: Improving the risk-to-benefit ratio. Contraception 2011;84:19-34.  Back to cited text no. 3
    
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Agha S. Intentions to use contraceptives in Pakistan: Implications for behavior change campaigns. BMC Public Health 2010;10:450.  Back to cited text no. 4
    
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Lete I, Chabbert-Buffet N, Jamin C, Lello S, Lobo P, Nappi RE, et al. Haemostatic and metabolic impact of estradiol pills and drospirenone-containing ethinylestradiol pills vs. levonorgestrel-containing ethinylestradiol pills vs. levonorgestrel-containing ethinylestradiol pills: A literature review. Eur J Contracept Reprod Health Care 2015;20:329-43.  Back to cited text no. 5
    
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Saadi RK, Hussein AA, Salman ST. Effect of combined oral contraception on coagulation profiles in women attending fertility control clinic in Baqubah City-Iraq. J Fac Med 2018;60:47-51.  Back to cited text no. 6
    
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Al-Zayadi TF. Contraceptive effects in hematological and biochemical parameters of healthy women at Al-Samawah city. J Chem Biol Phys Sci 2019;1:389-95. [doi: 10.24214/jcbps.B.8.2.38995].  Back to cited text no. 7
    
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Asare GA, Santa S, Ngala RA, Asiedu B, Afriyie D, Amoah AG. Effect of hormonal contraceptives on lipid profile and the risk indices for cardiovascular disease in a Ghanaian community. Int J Womens Health 2014;6:597-603.  Back to cited text no. 8
    
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Naz F, Akhatar N, Siddique YH, Jyoti S, Afzal M. Lipid profile of women using oral contraceptive pills. Pak J Biol Sci 2012;15:47-50.  Back to cited text no. 9
    
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Samson ME, Adams SA, Merchant AT, Maxwell WD, Zhang J, Bennett CL, et al. Cardiovascular disease incidence among females in South Carolina by type of oral contraceptives, 2000–2013: A retrospective cohort study. Arch Gynecol Obstet 2016;294:991-7.  Back to cited text no. 10
    
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Bakesiima B, Pauline BK, James KT, Joan NK, Gloria N, Irene N, et al. Dyslipidaemias in women using hormonal contraceptives: A cross sectional study in Mulago Hospital Family Planning Clinic, Kampala, Uganda. BMJ Open 2018;8:e022338. [doi: 10.1136/bmjopen-2018-022338].  Back to cited text no. 11
    
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Attri HK, Singh T. Effect of oral contraceptives on lipid profile in premenopausal Indian women. J Med Sci Clin Res 2010;6:2455-0450.  Back to cited text no. 12
    
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Klipping C, Marr J. Effects of two combined oral contraceptives containing ethinyl estradiol 20 microg combined with either drospirenone or desogestrel on lipids, hemostatic parameters and carbohydrate metabolism. Contraception 2005;71:409-16.  Back to cited text no. 13
    
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Mustafa MT, Zabeen S, Monirujjaman M, Bashar T. Effect of two combined oral contraceptives on serum lipid profile. Bangladesh Med J 2011;40:61-3.  Back to cited text no. 14
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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