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Archives of Medical Science
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abstract:
Letter to the Editor

Vitamin D serum levels in women using contraception containing drospirenone – a preliminary study

Michał Ciebiera, Marta Włodarczyk, Aneta Słabuszewska-Jóźwiak, Magdalena Ciebiera, Grażyna Nowicka, Grzegorz Jakiel

Arch Med Sci 2019; 15, 2: 554–557
Online publish date: 2017/10/20
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Vitamin D is a group of steroid compounds soluble in fats. Vitamin D has powerful, pleiotropic effects all over the human body. It is synthesized in human skin, but can also be found in dietary supplements and fortified foods. Vitamin D receptors (VDR) can be found in many tissues, as well as in the female reproductive tract [1, 2]. According to recent reports, it is believed that vitamin D has a beneficial effect on lowering the risk of various diseases, e.g. multiple forms of cancer, diabetes, cardiovascular diseases, metabolic syndrome, multiple sclerosis, inflammatory bowel diseases and uterine fibroids [1–6]. Vitamin D regulates cell proliferation and differentiation, inhibits angiogenesis and stimulates apoptosis [1, 2, 4, 5]. Vitamin D levels are mostly measured using serum 25-hydroxyvitamin D (25(OH)D) concentration, which is considered to be the best known marker of vitamin D obtained through both diet and body synthesis. According to Holick, the vitamin D level should be higher than 30 ng/ml [1].
Ethinylestradiol (EE2) is a derivative of 17-estradiol (E2), the major endogenous human estrogen. EE2 is used in many forms of combined oral contraception (COC) and is one of the most commonly used medications for this purpose. Ethinylestradiol is hormonally effective by activating the estrogen receptor and thus exerts its estrogenic effects [7].
Drospirenone is a steroidal progestin (of the spironolactone group) used in contraception and hormonal replacement therapy. It is also an aldosterone antagonist with potassium-sparing properties. It is an agonist of the progesterone receptor and an antagonist of the mineralocorticoid and androgen receptors, and hence a progestagen, antimineralocorticoid and antiandrogen. Drospirenone does not present any estrogenic or glucocorticoid or antiglucocorticoid activity. It has a potent antigonadotropic effect at sufficient dosages as a result of progesterone receptor activation. It has been stated that drospirenone has a pharmacological profile that is closely related to that of natural progesterone [8]. Drospirenone is about ten times more potent as an antimineralocorticoid in comparison to spironolactone [8–10]. The drospirenone antimineralocorticoid activity promotes sodium excretion and prevents water retention [10].
It is believed that contraceptives containing estrogens or estrogens combined with progestins may affect 25(OH)D serum concentrations. There is a lack of reports in this...


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