The goal of this study is to learn about potential reversible effects of combined oral contraceptive (COC) use on the serotonergic brain system. The main question it aims to answer is:
\- If COC discontinuation results in an increase in serotonin 4 receptor binding in caudate, putamen, and hippocampus measured with Positron Emission Tomography from baseline to follow-up ≥ week 8 after discontinuation.
The secondary question it aims to answer is:
\- Over what timeframe the serotonin 4 receptor binding is restored after COC discontinuation to the level previously seen in a group of premenopausal women who had not used hormonal contraception before.
Researchers will compare discontinuation with continuation of a 2nd generation COC containing 150 ug levonorgestrel and 30 microgram to see if COC discontinuation results in an increased serotonin 4 receptor level in the brain.
\-
Participants will:
* Be randomized to discontinue or continue their COC use for 1-52 weeks. * Undergo an investigational program including brain scans, biological sampling, and neuropsychological testing at baseline and at follow-up.
The study uses a group sequential design with two sequential analyses planned, including an interim analysis after 60% of the brain scans have been acquired, which will be used to decide the timing of the last 40% of the scans - this is performed to best determine when the recovery of the serotonin 4 receptor level occurs.
Healthy women (assigned female at birth) at 18-39 years of age
Currently using a second-generation combined oral contraceptive containing 150 ug levonorgestrel and 30 ug ethinylestradiol for at least 3 months
Current or previous neurological or psychiatric disease, severe somatic disease, or consumption of medical drugs (including psychoactive medication) likely to influence the test results
Non-fluent in Danish or pronounced visual or auditory impairments
Current or past learning disability
Pregnancy within the last year or previous pregnancy lasting into second or third trimester
Parallel
Discontinuation of 2nd generation combined oral contraceptive use
DrugDiscontinuation of 2nd generation combined oral contraceptive use
Continuation of 2nd generation combined oral contraceptive use
DrugContinuation of 2nd generation combined oral contraceptive use
Change in global serotonin 4 receptor (5-HT4R) brain binding across caudate, putamen, and hippocampus
Serotonin 4 receptor (5-HT4R) brain binding is measured with positron emission tomography. Change in global 5-HT4R brain binding is estimated using a latent variable model with a latent variable pooling the change in log-transformed binding potentials from baseline to follow-up across caudate, putamen, and hippocampus after adjustment for change in injected tracer mass per kg body weight.
Change in total Verbal Affective Memory Test-24 (VAMT-24) score
Verbal Affective Memory task 24 (VAMT-24) total recall score is calculated as the average score across the immediate (0-24), short- (0-24), and long-term (0-24) recall with higher scores representing better performance.
Difference in hippocampal activation during memory encoding
Hippocampal blood-oxygen-level-dependent (BOLD) activation during a memory encoding paradigm.
Change in brain insulin sensitivity
Hypothalamic blood flow response to oral glucose, used as a proxy for brain insulin sensitivity.
Change in hypothalamic blood-oxygen-level-dependent response to oral glucose
Hypothalamic blood-oxygen-level-dependent response to oral glucose.
Change in area under the curve of glucose during an oral glucose tolerance test (OGTT)
Change in area under the curve during OGTT for glucose from baseline to follow-up.
Change in area under the curve of insulin during an oral glucose tolerance test (OGTT)
Change in area under the curve during OGTT for insulin from baseline to follow-up.
Change in area under the curve of c-peptide during an oral glucose tolerance test (OGTT)
Change in area under the curve during OGTT for c-peptide from baseline to follow-up.
Change in Hba1C
Change in Hba1C from baseline to follow-up
Click on the lead sponsor to view all of their trials.
