Abstract:
UNLABELLED:BACKGROUND; Combined oral contraceptives (COCs) reduce levels of androgen, especially testosterone (T), by inhibiting ovarian and adrenal androgen synthesis and by increasing levels of sex hormone-binding globulin (SHBG). Although this suppressive effect has been investigated by numerous studies over many years, to our knowledge no systematic review concerning this issue had been performed. This systematic review and meta-analysis was performed to evaluate the effect of COCs on concentrations of total T, free T and SHBG in healthy women and to evaluate differences between the various types of COCs (e.g. estrogen dose, type of progestin) and the assays used to assess total T and free T. METHODS:A review of the literature was performed using database searches (MEDLINE, EMBASE and the Cochrane Central Register of Clinical Trials) and all publications (from inception date until July 2012) investigating the effect of COCs on androgen levels in healthy women were considered eligible for selection. Three reviewers were involved in study selection, data extraction and critical appraisal. For the meta-analysis, data on total T, free T and SHBG were extracted and combined using random effects analysis. Additional subgroup analyses were performed to evaluate differences between the various types of COCs (e.g. estrogen dose, type of progestin) and the assays used to assess total T or free T. RESULTS:A total of 151 records were identified by systematic review and 42 studies with a total of 1495 healthy young women (age range: 18-40 years) were included in the meta-analysis. All included studies were experimental studies and 21 were non-comparative. Pooling of the results derived from all the included papers showed that total T levels significantly decreased during COC use [mean difference (MD) (95% confidence interval, CI) -0.49 nmol/l (-0.55, -0.42); P < 0.001]. Significantly lower levels of free T were also found [relative change (95% CI) 0.39 (0.35, 0.43); P < 0.001], with a mean decrease of 61%. On the contrary, SHBG concentrations significantly increased during all types of COC use [MD (95% CI) 99.08 nmol/l (86.43, 111.73); P < 0.001]. Subgroup analyses revealed that COCs containing 20-25 µg EE had similar effects on total and free T compared with COCs with 30-35 µg EE. In addition, suppressive effects on T levels were not different when comparing different types of progestins. However, subgroup analyses for the estrogen dose and the progestin type in relation to changes in SHBG levels did show significant differences: COCs containing second generation progestins and/or the lower estrogen doses (20-25 µg EE) were found to have less impact on SHBG concentrations. CONCLUSIONS:The current literature review and meta-analysis demonstrates that COCs decrease circulating levels of total T and free T and increase SBHG concentrations. Due to the SHBG increase, free T levels decrease twice as much as total T. The estrogen dose and progestin type of the COC do not influence the decline of total and free T, but both affect SHBG. The clinical implications of suppressed androgen levels during COC use remain to be elucidated.
journal_name
Hum Reprod Updatejournal_title
Human reproduction updateauthors
Zimmerman Y,Eijkemans MJ,Coelingh Bennink HJ,Blankenstein MA,Fauser BCdoi
10.1093/humupd/dmt038subject
Has Abstractpub_date
2014-01-01 00:00:00pages
76-105issue
1eissn
1355-4786issn
1460-2369pii
dmt038journal_volume
20pub_type
杂志文章,meta分析,评审abstract:BACKGROUND:Infertility affects ∼7% of all men. Despite much progress, mainly in genetics, its etiology remains obscure in ∼50% of cases. To fill this gap, imaging of the male genital tract (MGT) has progressively expanded, providing useful information in the assessment of MGT abnormalities. METHODS:A critical, systema...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/dmu042
更新日期:2015-01-01 00:00:00
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pub_type: 杂志文章
doi:10.1093/humupd/dmaa026
更新日期:2020-11-01 00:00:00
abstract::Pregnancy induces physiological alterations in thyroid function which may make difficult the interpretation of results of thyroid hormone measurement. A state of hyperstimulation of the thyroid gland is common in early pregnancy. In a few cases, thyroid hormone values will deviate from the normal range, which correspo...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/dmh008
更新日期:2004-03-01 00:00:00
abstract::Sperm transport from the cervix into the tube is an important uterine function within the process of reproduction. This function is exerted by uterine peristalsis and is controlled by the dominant ovarian structure via a cascade of endocrine events. The uterine peristaltic activity involves only the stratum subvascula...
journal_title:Human reproduction update
pub_type: 杂志文章
doi:10.1093/humupd/4.5.667
更新日期:1998-09-01 00:00:00
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journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/dmv058
更新日期:2016-04-01 00:00:00
abstract::Cryopreservation of testicular tissue might benefit prepubertal boys who must undergo chemotherapy or radiotherapy. Cryopreservation of testicular tissue and testicular cells for intracytoplasmic sperm injection (ICSI) is feasible and widely applied. Testicular tissue from prepubertal boys can also be frozen, by apply...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/7.4.378
更新日期:2001-07-01 00:00:00
abstract::Prior to the development of high-throughput methods for the analysis of differential gene expression, genes required for proper ovarian function were identified on a case-by-case basis. Recently, however, several techniques have been developed that enable investigators to study large-scale changes in gene expression u...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/dmh017
更新日期:2004-05-01 00:00:00
abstract:BACKGROUND:Ovarian hyperstimulation syndrome (OHSS) typically occurs when ovaries are primed with FSH/LH and subsequently exposed to hCG. The ultimate pathophysiological step underlying this clinical picture is increased vascular permeability (VP). METHODS:A search of the literature was carried out using PubMed and th...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/dmn008
更新日期:2008-07-01 00:00:00
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journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/dmh039
更新日期:2004-11-01 00:00:00
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journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/dmv030
更新日期:2015-09-01 00:00:00
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journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/dmk003
更新日期:2006-05-01 00:00:00
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journal_title:Human reproduction update
pub_type: 杂志文章
doi:10.1093/humupd/dmz004
更新日期:2019-07-01 00:00:00
abstract:BACKGROUND:Reproductive disorders and infertility are associated with the risk of obstetric complications and have a negative impact on pregnancy outcome. Affected patients often require assisted reproductive technologies (ART) to conceive, and advanced maternal age is a further confounding factor. The challenge is to ...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/dmv044
更新日期:2016-01-01 00:00:00
abstract:BACKGROUND:IUI for unexplained infertility can be performed in a natural cycle or in combination with ovarian stimulation. A disadvantage of ovarian stimulation is an increased risk of multiple pregnancies with its inherent maternal and neonatal complication risks. Stimulation agents for ovarian stimulation are clomiph...
journal_title:Human reproduction update
pub_type: 杂志文章,meta分析
doi:10.1093/humupd/dmz035
更新日期:2020-01-01 00:00:00
abstract:BACKGROUND:Hirsutism is the presence of excess body or facial terminal (coarse) hair growth in females in a male-like pattern, affects 5-15% of women, and is an important sign of underlying androgen excess. Different methods are available for the assessment of hair growth in women. METHODS:We conducted a literature se...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/dmp024
更新日期:2010-01-01 00:00:00
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journal_title:Human reproduction update
pub_type: 杂志文章,meta分析,评审
doi:10.1093/humupd/dmm005
更新日期:2007-07-01 00:00:00
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journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/dmx009
更新日期:2017-07-01 00:00:00
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journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/dmp045
更新日期:2010-03-01 00:00:00
abstract::Polychlorinated dioxins, furans and polychlorinated benzene constitute a family of toxic persistent environmental pollutants. In Europe, environmental concentrations increased slowly throughout this century until the late 1980s. Dioxins have been shown to be carcinogenic in animals and humans. In humans, excess risks ...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/7.3.331
更新日期:2001-05-01 00:00:00
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journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/5.4.280
更新日期:1999-07-01 00:00:00
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journal_title:Human reproduction update
pub_type: 杂志文章,meta分析,评审
doi:10.1093/humupd/dmq006
更新日期:2010-09-01 00:00:00
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pub_type: 杂志文章,评审
doi:10.1093/humupd/6.2.122
更新日期:2000-03-01 00:00:00
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journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/3.3.235
更新日期:1997-05-01 00:00:00
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journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/dmq025
更新日期:2011-01-01 00:00:00
abstract::The results of the Transnational Study on Oral Contraceptives and the Health of Young Women studies are reviewed, potential biases shown, and new analyses are presented. The initial finding was a slight increase in the risk of venous thromboboembolism (VTE) when users of third generation OC (containing the progestins ...
journal_title:Human reproduction update
pub_type: 杂志文章
doi:10.1093/humupd/5.6.707
更新日期:1999-11-01 00:00:00
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journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/4.6.904
更新日期:1998-11-01 00:00:00
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journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/dml040
更新日期:2007-01-01 00:00:00
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journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/4.5.565
更新日期:1998-09-01 00:00:00
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journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/dmq053
更新日期:2011-05-01 00:00:00
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journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/dmw021
更新日期:2016-09-01 00:00:00