Agung Dewanto Oct 2017 Hormonal influences in metabolism Estrogen and lipid metabolisms in normal women Hormonal contraception COC in normal women Insulin and low estrogen level diabetes and ID: 1045287
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1. Hormonal contraception in women with DM and Thyroid diseaseAgung Dewanto Oct 2017
2. Hormonal influences in metabolismEstrogen and lipid metabolisms in normal womenHormonal contraception COC in normal womenInsulin and low estrogen leveldiabetes and dislipidemiaOCP and glucose level: pro and consEvidence-base hormonal contraception
3. Estrogen dan lipid metabolism in normal women
4. Hormonal influences in metabolismEstrogen and lipid metabolisms in normal womenHormonal contraception COC in normal womenInsulin and low estrogen levelDiabetes and dislipidemiaOCP and glucose level: pro and consEvidence-base hormonal contraception
5. Santosa et al, 2015Estrogen and progesteron-Lipid metabolism in women
6. Hormonal contraception COC-in normal womenMishel et al, 1972
7. Hormonal contraception COC-in normal womenMishel et al, 1972
8. EstrogenIncreases serum TG and HDL concentrationsLowers serum LDL cholesterol concentrationsThe progestinIncreases serum LDL CLowers serum HDLc concentrations (androgenic progestin Norgestrel and Levonorgestrel)Hormonal contraception-Lipid metabolism in normal women
9. Hormonal influences in metabolismEstrogen and lipid metabolisms in normal womenHormonal contraception COC in normal womenInsulin and low estrogen levelDiabetes and dislipidemiaOCP and glucose level: pro and consEvidence-base hormonal contraception
10. Insulin and low estrogen levelhuman studies in which estrogen-deficient men and women with Cyp19 aromatase deficiency and a male patient with ERš¼ deficiency exhibited insulin resistance, impaired glucose metabolism, and hyperinsulinemia .
11. Hormonal influences in metabolismEstrogen and lipid metabolisms in normal womenHormonal contraception COC in normal womenInsulin and low estrogen levelDiabetes and dislipidemiaOCP and glucose level: pro and consEvidence-base hormonal contraception
12. Diabetes and dislipidemia Many patients with type 2 diabetes have dyslipidemia and it is believed that this dyslipidemia is important in mediating the cardiovascular risk in diabetes Parhofer, 2015
13. I am confused!Jika estrogen berperan menurunkan lipogenesis, glukoneogenesis dan meningkatkan sensitifitas insulin maka seharusnya pemberian COC akan menurunkan hiperlipidemia pada pasien diabetes dan menurunkan kadar glukosa darah
14. Hormonal influences in metabolismEstrogen and lipid metabolisms in normal womenHormonal contraception COC in normal womenInsulin and low estrogen levelDiabetes and dislipidemiaOCP and glucose level: pro and consEvidence-base hormonal contraception
15. OCP and glucose level in normal woman: pro (?)Estrogen may lead to decreased fasting glucose levels by depressing hepatic glucose production ; estrogen may act as a glucagon antagonist by increasing the molar ratio of insulin to glucagon in the hepatic portal vein, reducing the basal activity of phosphoenol pyruvate carboxykinase, the key gluconeogenic enzymeKim et al, 2002
16. OCs found that current use of combination OCs was associated with significantly higher glucose levels and insulin responses compared with nonuse.Butā¦A larger proportion of women with polycystic ovary disease, as CARDIA participants were more obese; in women with polycystic ovary disease, OCs may suppress follicle- stimulating hormone and luteinizing hormone, in turn suppressing ovarian androgen secretion and thereby decreasing insulin resistance and glucose levelsOCP and glucose level:consKim et al, 2002
17. Hormonal contraception and diabetes
18. Grey area: why?the association between OCs and fasting insulin is believed to depend largely on the dose and type of progestogen, with hyperinsulinemic responses most evident with levonorgestrel and less common with norethindrone or desogestrel Kim et al, 2002
19. Sex hormone influences in metabolismEstrogen and lipid metabolisms in normal womenHormonal contraception COC in normal womenInsulin and low estrogen levelDiabetes and dislipidemiaOCP and glucose level: pro and consEvidence-base hormonal contraception
20. Evidence base: hormonal contraceptives and fat-glucose metabolism
21. Evidence base : : BMI and effectiveness
22. considerationsThe results of observational cohort studies, hormonal contraception interferes with carbohydrate and lipid metabolism, caution should be used when this contraceptive method is selected for DM patients. It is also important to point out that DM patients are more likely to lack contraception compared with women without DM.Hormonal contraception and diabetes
23. Patient considerationThat according to a wide range of factors: reproductive age in which the patient is, clinical history of gestational diabetes, the time of evolution and the type of DM, the presence or not of vascular disease (nephropathy, retinopathy, neuropathy), and other preexisting risk factors (cardiovascular, thrombotic or neoplastic).
24. Gestasional Diabetes and hormonal contraceptionGestasional diabetes mellitus ļ low-dose progestin and estrogen combination OCs did not appear to increase the risk of developing diabetes in these high risk womenThe use of a progrestin-only during breast feeding was associated with a nearly 3-fold increase in the incidence of diabetes compared with the non hormonal and COCKjos et al in Contraception and the risk of type 2 DM
25. MEC and diabetes
26. thyroidThe results suggest that the three DNG-containing and the LNG-containing low-dose OCs may increase T3, T4 and cortisol due to an elevated binding to serum globulins, while the free proportion of the hormones is not or only slightly changed.Therefore, these OCs have only minor effects on thyroid function, adrenal and blood pressure serum parameters.
27. Terima kasih
28. Progestin derivates
29. Metabolic effects of progestogens