. Author manuscript; available in PMC: 2009 Nov 12.

Published in final edited form as: J Midwifery Womens Health. 2008 Jul–Aug;53(4):362–375. doi: 10.1016/j.jmwh.2008.01.006

Table 3.

Metabolic Changes Associated with Contraceptive Hormones, HIV Disease, and Antiretroviral Medications

Contraceptive Method or HIV-Related Disorder	Glucose Metabolism	Insulin	HDL	LDL	Triglycerides	BMD
Estrogen use	Intolerance^a	Resistance^a	Increased	Decreased	Elevated	Increased
Progestin use						Unclear^b
Gonane	Intolerance^c	Resistance^c	Decreased^d	Increased (first-generation)	Increased^e Decreased^f
Estrane	Minimal influence^g	Minimal influence^g	Increased—minimal influence	Minimal influence	May decrease	—
Drospirenone	Minimal influence	Minimal influence	Decreased—minimal influence	Minimal influence	Minimal influence	—
DMPA use	Intolerance	Resistance	Decreased	Increased	Increased	Decreased
HIV disease	Intolerance	Resistance^h	Decreased (host response)	Decreasedⁱ	Increased^j	Decreased^k
HIV-related lipodystrophy	Intolerance	Resistance	—	N/A	Increased	—
Use of antiviral medications				N/A		Unclear
Nucleoside reverse transcriptase inhibitors	Intolerance	Resistance	Minimal influence	—	May increase	—
Non-nucleoside reverse transcriptase inhibitors	Minimal influence	Minimal influence	Increased	—	Increased^l	—
Protease inhibitors	Intolerance^l	Resistance^l	Minimal influence^m	—	Increased^l	—

BMD = bone mineral density; DMPA = depot medroxyprogesterone acetate; HDL = high-density lipoprotein; LDL = low-density lipoprotein.

With supplemental estrogen, as in oral contraceptive preparations.

In combined formulations, the impact is unclear. Progestin-only formulations appear to have negative impact with prolonged use.

The third-generation gonane progestins, gestodene and desogestrel, have a less negative impact.

May be increased with third-generation gonane progestins.

Desogestrel and gestodene.

Levonorgestrel.

May contribute to glucose intolerance and/or insulin resistance in women with multiple risk factors for metabolic dysregulation.

Untreated HIV disease causes increased insulin sensitivity.

ⁱ

A decrease is seen in untreated HIV. The increase in LDL that may be seen in individuals on antiretroviral therapy is thought to reflect a return to health rather than a side effect of treatment.

With onset of AIDS.

HIV-disease overall is associated with decreased BMD, but whether it is the HIV-disease itself, antiretroviral therapy, or some other factor is unknown.

Individual drugs within the class may not have identical effects or may not have the same magnitude of effect.

Minimal influence directly, but may indirectly cause decrease, through the increase in triglyceride levels.