CONTRACEPTIONOBesity Project

“Obese women are at a higher risk of pregnancy

complications.”

Problems with Interpretation of Research

• Usually underpowered for obesity

• Usually retrospective

• Self reporting of BMI

• Weight underreported and height over reported

• Underreporting of unintended pregnancies ending in abortion

• Many studies done before obesity increases

• Done where obesity less and/or contraceptive use is better

Importance of Contraception

• Obese patients less likely to use effective contraception

• Unclear whether related to patient, provider or a system issue

• Obese women are more likely to be:

• Older, black, hispanic, married, less educated, and underinsured

Importance of Contraception

• Although obese women have decreased fertility, most ovulate regularly

• Obese women engage in sexual activity as frequently as all other weight categories

• Contraception will always prevent more pregnancies than no contraception

Importance of Contraception

• Obese adolescents

• Earlier coital debut

• Higher rates of unprotected intercourse

• Obese adult and adolescent women

• Similar or increased risk of pregnancy as normal BMI

Obesity and Contraceptive Effectiveness

• Oral contraceptives

• Conflicting studies on effectiveness in obese women

• Obese women are as compliant as normal BMI women in taking pills

• Overall, obese women appear to have a similar or slightly higher risk of pregnancy on oc’s

• Bariatric surgery may decrease effectiveness due to decrease in absorption

Obesity and Contraceptive Effectiveness

• Etonogestrel(Implanon) contraceptive implant

• No information available for women >130% ideal body weight

• Sterilization: Laparoscopic and hysteroscopic (Essure, Adiana)

• No change in effectiveness but procedures may be more difficult

Deep Venous Thrombosis (VTE) and Estrogen Containing Contraceptives

• Low dose estrogen

• Incidence increases from 5-10 cases in nonusers to 15-30 cases in users per 10,000 women per year

• At baseline, obesity doubles the risk of VTE compared to normal BMI

Deep Venous Thrombosis (VTE) and Estrogen Containing Contraceptives

• VTE risk with OCPs still remains below pregnancy/postpartum

• Contraceptive patch risk of VTE has conflicting risks but still below the risk of pregnancy/postpartum

• No good information on risks in patients with co-morbidities like hypertension, hypercholesterolemia, or diabetes

• No safety information in women with BMI >40

Contraceptive Benefits

• Prevention of unplanned pregnancy in a high risk population

• Hormonal contraception has been shown to decrease the risk of endometrial hyperplasia and cancer

• OC’s reduce risk of Ovarian Cancer

Contraception and Body Weight

• Combined hormonal- no associated weight gain

• Levonorgestrel-releasing IUD-small weight increase

• Etonogestrol Implant-probably no increase

• Depo Medroxyprogesterone acetate-more likely gain than loss, especially in obese teens

• Non-hormonal-no weight increase

• Non hormonal Contraception-no change in weight

Contraceptive Points to Remember

• CONTRACEPTION IS SAFER THAN PREGNANCY

• Little information is available about safety of contraceptive use in women with a BMI=/> 40 kg/M2

• Pregnancy responsible for more permanent weight gain than contraception

• Use of procedural methods highest in women with BMI > 25

• Hormonal contraception highest in women with BMI <25