激素类避孕药可能会改变人体对碳水化合物（淀粉和糖）的处理方式。可能发生从食物中摄取糖的能力下降和人体胰岛素增多的问题。胰岛素是一种能帮助人体利用糖的激素。而血糖问题会增加患糖尿病和心脏病的风险。这些研究问题主要是针对含有雌激素的避孕方法提出的。

2014年4月，我们检索了研究使用激素类避孕方法时人体如何处理碳水化合物的随机试验。结局指标是血糖或胰岛素水平。避孕方法可以含有雌激素和黄体酮或只含有黄体酮。避孕方式可以是口服药、注射（注射剂）、皮下埋植剂（在皮肤下放置火柴棒大小的棒）、阴道环或宫内节育器（intrauterine device, IUD）。这些研究必须将两种类型的避孕方法或一种类型与安慰剂或“虚拟”方法比较。

我们纳入了31项试验。未有研究采用安慰剂对照。在34对避孕方法对照中，8对研究组表现出一定的差异。12项试验研究了去氧孕烯。少数差异不一致。三项试验观察了依托孕烯环。其中一项阴道环组的胰岛素水平低于口服药组。

八项试验研究了孕酮炔诺酮。使用炔诺酮药物的组比服用其他药物的组的血糖变化更少。在另一项研究中，使用“depo” 注射剂组（长效醋酸甲羟孕酮）比使用另一组血糖和胰岛素水平更高。

在五项新的试验中，有两项使用了不同的雌激素类型。在一项研究中，服用雌二醇戊酸酯的一组的血糖比服用标准药物的组低。另外两项试验比较了连续服（延长使用）和正常服用几个周期的药物。在一项使用地诺孕素口服药的试验中，延长使用组有更多的血糖变化。一项小型试验使用了两种左炔诺孕酮口服药，并观察了肥胖和正常体重的女性。这些组的结局指标并没有太大差异。

在非糖尿病的女性中，激素类避孕药对体内碳水化合物的利用几乎没有影响。很少有研究比较了相同类型的避孕措施。因此，我们不能得出明确结论。许多试验中女性样本量很少，并且许多女性退出了。较早的试验并没有报告所有的研究方法。许多试验并没有纳入超重的女性。

作者：Lopez LM, Grimes DA, Schulz KF；译者：张茜萍，武汉大学护理学院；审校：靳英辉，武汉大学中南医院循证与转化医学中心；编辑排版：索于思，北京中医药大学循证医学中心

相关文章链接

【Cochrane简语概要】哪种激素疗法对卵巢早衰的女性更有效？

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【Cochrane Plain Language Summary】Hormone contraceptives and how the body uses carbohydrates in women without diabetes

Hormone contraceptives may change how the body handles carbohydrates (starches and sugars). Changes may include lower ability to use sugar from food and more problems with the body's insulin. Insulin is a hormone that helps the body use sugar. Problems with blood sugar can increase risk for diabetes and heart disease. These issues have been raised mainly with birth control methods that contain the hormone estrogen.

In April 2014, we looked for randomized trials of how the body handles carbohydrates when using birth control methods with hormones. Outcomes were blood glucose or insulin levels. Birth control methods could contain estrogen and progestin or just progestin. The type could be pills, shots (injections), implants (matchstick-size rods put under the skin), the vaginal ring, or an intrauterine device (IUD). The studies had to compare two types of birth control or one type versus a placebo or 'dummy' method.

We included 31 trials. None had a placebo. Of 34 pairs of birth control methods compared, eight showed some difference by study groups. Twelve trials studied pills with desogestrel. The few differences were not consistent. Three trials looked at the etonogestrel ring. One showed the ring group had lower insulin than the pill group.

Eight trials looked at the progestin norethisterone. A group using norethisterone pills had less glucose change than those taking other pills. In another study, a group using the injectable ‘depo’ (depot medroxyprogesterone acetate) had higher glucose and insulin than the group using another injectable.

Of five new trials, two used different estrogen types. In one study, a group taking a pill with ethinyl valerate had lower glucose than a group taking a standard pill. Two other trials compared taking pills for several cycles without stopping (extended use) versus usual use. In one using a dienogest pill, the extended-use group had more glucose change. A small trial used two levonorgestrel pills, and looked at obese and normal weight women. The outcomes did not differ much between those groups.

In women without diabetes, hormone contraceptives have little effect on the body's carbohydrate use. Few studies compared the same types of birth control. Therefore, we cannot make strong statements. Many trials had small numbers of women, and many women dropped out. Older trials often did not report all the study methods. Many trials did not include overweight women.