How DHEA Supplements Affect Coagulation in Women Using Birth Control Pills

NCT ID: NCT03418363

Last Updated: 2020-01-23

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: PHASE4
• Total Enrollment: 15 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2018-01-16
• Study Completion Date: 2019-12-11

Brief Summary

A randomized study is to learn more about how a supplement called DHEA (dehydroepiandrosterone) affects clotting factors in women taking combined oral contraceptive pills. Current research suggests that the progestin hormone in a specific type of birth control pill may increase a woman's blood clot risk. However, it is unknown exactly how the progestin causes the increased risk. This study aims to learn if taking a daily dose of supplemental androgen (dehydroepiandrosterone, or DHEA) in addition to birth control pills containing DRSP affects proteins related to coagulation.

Detailed Description

While the pro-thrombotic effects of estrogens are well established in women using combined oral contraception (COC), controversy exists over whether the various synthetic progestogens (progestins) used in combination with ethinyl estradiol in COC formulations may modify the risk of venous thromboembolism (VTE). Several studies have demonstrated that different types of progestins used in COCs influence the magnitude of the estrogen-induced changes in coagulation pathway proteins. However, since hepatocytes do not express progesterone receptor, any activity of a progestin must be indirect. While all progestins on the market are strong agonists for the progesterone receptor (PR), most have variable affinity for the androgen receptor (AR), glucocorticoid receptor (GR), and mineralocorticoid receptor (MR). Generations of progestins have been developed, each successive generation exhibiting decreasing levels of androgenicity. Recent epidemiologic studies have suggested an increased risk of VTE in women using low-androgen progestins relative to those using levonorgestrel-containing products. Although no pattern of hepatic globulin changes has been validated as a surrogate marker for thrombosis risk, the overall magnitude of change in various hepatic proteins involved in coagulation is greater with the newer low-androgenic progestins compared to levonorgestrel, leading some experts to suggest that a progestin's androgenic profile may influence the risk of thrombosis. However, a series of well-designed large prospective cohort studies have not confirmed the increased risk of VTE with low-androgen progestins.

A major problem with reconciling the conflicting results from epidemiologic and prospective studies has been the lack of a clear mechanism, as no studies have demonstrated whether these observed changes are mediated through androgen receptor activity. We hypothesize that androgen receptor activity opposes the estrogen receptor-mediated increase in hepatic clotting factors in women using combined oral contraceptives. To test this hypothesis, we propose a randomized clinical trial in which we will enroll healthy women using combined oral contraception containing ethinyl estradiol (EE) with an antiandrogenic progestin (drospirenone, DRSP). Participants will be randomized to treatment with oral androgen (dehydroepiandrosterone, DHEA) or placebo, and we will collect whole blood samples to measure coagulation pathway-related hepatic globulins (APC-r, Protein S, SHBG) before and after treatment.

Conditions

Contraceptive Usage; Coagulation

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: BASIC_SCIENCE
• Blinding Strategy: TRIPLE

Study Groups

DHEA Oral Capsule

Subjects will take 100mg DHEA (dehydroepiandrosterone) daily

Group Type: ACTIVE_COMPARATOR

DHEA Oral Capsule

Intervention Type: DIETARY_SUPPLEMENT

Daily 100mg DHEA supplement

Placebo Oral Capsule

Group Type: PLACEBO_COMPARATOR

Placebo Oral Capsule

Intervention Type: OTHER

Daily oral capsule

Interventions

DHEA Oral Capsule

Daily 100mg DHEA supplement

Intervention Type: DIETARY_SUPPLEMENT

Placebo Oral Capsule

Daily oral capsule

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

• Women of reproductive age (18-44 years) in generally good health and with body mass index (BMI) between 18 and 35kg/m2
• Premenopausal, with uterus and at least one ovary intact
• Current users (at least 3 months) of combined oral contraception consisting of 0.02 mg (milligram) ethinyl estradiol and 3 mg drospirenone
• Willing to continue use of current combined oral contraception for the next three menstrual cycles
• Have a prescription for combined oral contraception consisting of ethinyl estradiol and drospirenone for the next four cycles
• Not currently using androgen supplementation
• Willing and able to sign the informed consent
• Willing to comply with the study requirements and visit schedule
• No desire to conceive during study participation, approximately 3 months

Exclusion Criteria

• Currently enrolled in another clinical trial
• Contraindications to androgen supplementation; history of polycystic ovarian syndrome (PCOS)
• Known or suspected pregnancy, pregnancy within 3 months before study enrollment, or desire to conceive during study participation
• Currently breastfeeding
• Known or suspected alcoholism or drug abuse

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 44 Years
• Eligible Sex: FEMALE
• Accepts Healthy Volunteers: Yes

Sponsors

Oregon Health and Science University

OTHER

Sponsor Role: lead

Responsible Party

Jeffrey Jensen

Professor

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Jeffrey Jensen, MD, MPH

Role: PRINCIPAL_INVESTIGATOR

Oregon Health and Science University

Locations

Oregon Health & Science University

Portland, Oregon, United States

Countries

United States

Other Identifiers

OHSU IRB# 17651

Identifier Type: -

Identifier Source: org_study_id