Impact of Oral Contraceptives on Cholesterol Levels
Yes, oral contraceptives can increase cholesterol levels, with studies showing increases in total cholesterol, LDL cholesterol, and triglycerides, though the effects vary based on formulation. 1
Effects on Specific Lipid Parameters
Oral contraceptive users experience significantly greater increases in triglycerides (20-30% on average, but up to 57% in some populations), total cholesterol, very-low-density lipoprotein (VLDL) cholesterol, and high-density lipoprotein (HDL) cholesterol compared to non-hormonal contraceptive users 1, 2
Total cholesterol levels can increase from baseline levels (studies show increases from 218.49 mg/dL to 242.92 mg/dL in users versus non-users) 3
LDL cholesterol levels may increase by approximately 15% with certain formulations, though some newer formulations containing desogestrel may actually reduce LDL by up to 14% 4, 3
Triglyceride increases are consistently observed across multiple studies, with levels typically 20-30% higher in OC users compared to non-users 1
Variations by Contraceptive Formulation
The lipid metabolic effects of oral contraceptives vary based on their estrogen and progestin content 1
Older generation OCs with higher estrogen doses showed more pronounced effects on lipid profiles compared to newer formulations with lower estrogen content (15-35 μg of ethinyl estradiol) 1, 4
Progestin-only formulations have only minor metabolic effects on lipid profiles compared to combined hormonal contraceptives 4
Orally administered exogenous estrogens increase triglyceride levels, whereas exogenously administered progestins tend to ameliorate this estrogen-induced hypertriglyceridemia 1
Temporal Patterns and Reversibility
High-density lipoprotein (HDL) cholesterol can decrease significantly during one contraceptive cycle in women and rise again to the initial value during pill-free days 5
Women who discontinue oral contraceptives typically experience normalization of their lipid profiles, with decreases in VLDL and LDL cholesterols and increases in HDL cholesterol 6
The unfavorable lipid profile associated with OC use is generally not apparent upon discontinued use 6
Clinical Significance and Recommendations
Despite these changes, screening for hyperlipidemia before initiation of hormonal contraceptives is not necessary according to guidelines, due to the low prevalence of undiagnosed disease in women of reproductive age 1
The clinical significance of OC-induced changes in lipid levels remains unclear, with studies showing mixed results about the effects of hormonal methods on lipid levels 1
For postmenopausal women with hypertriglyceridemia who require hormone preparations, switching to transdermal preparations may blunt the triglyceride increases observed with oral compounds 1
For women with hyperlipidemias, combined hormonal contraceptives should be used with caution (U.S. MEC 2/3, depending on the type and severity of the hyperlipidemia and presence of other cardiovascular risk factors) 1
Practical Considerations
The time of blood sampling during the cycle is important when interpreting lipid profiles in women using oral contraceptives due to fluctuations throughout the cycle 5
Women with abnormal lipid levels at baseline were not found to have increased risk for adverse changes to their lipid profile when using hormonal methods 1
For women with hypertriglyceridemia who develop it while taking oral contraceptive therapy, lower estrogen-containing preparations or other forms of contraception should be considered 1
Progestin-only pills or combinations containing desogestrel or low-dose norethindrone are associated with the most favorable lipid profiles 4