Elsevier

Contraception

Volume 80, Issue 6, December 2009, Pages 583-590
Contraception

Clinical Guidelines
Contraceptive considerations in obese women

https://doi.org/10.1016/j.contraception.2009.08.001Get rights and content

Abstract

Contraceptive failure is the primary cause of unintended pregnancy in the United States. With obesity rates at epidemic proportions, any association between obesity and strategies that prevent undesired pregnancies constitutes a significant public health and economic concern. Unfortunately, the relationship between obesity and contraception has not been extensively studied. Evidence from several epidemiological studies suggests that obesity may increase failure of some hormonal contraceptives resulting in unplanned pregnancies. Obesity may make procedure-dependent contraceptive methods (i.e., sterilization and intrauterine devices) more technically challenging for the provider to perform. Hormonal contraceptives, on the whole, do not appear to adversely affect body weight and provide important noncontraceptive benefits (i.e., cancer protection). Some surgical interventions to treat bariatric issues may compromise the efficacy of orally dosed contraceptive methods. Overall, the Society of Family Planning strongly encourages the use of both hormonal and nonhormonal methods of contraception in obese women desiring pregnancy prevention with very few restrictions. Further studies are needed to determine the interrelationship between obesity and contraception. In addition, future contraceptive efficacy studies need to include women of differing BMIs to better reflect the population of women using these methods.

Section snippets

Background

The rate of obesity worldwide is at epidemic proportions with 1 billion and 300 million adults meeting the criteria for overweight and obese, respectively [1]. Currently, the obesity rate in Europe and the United States is approximately 30% and rising [1], [2]. The prevalence of unintended pregnancy rivals that of obesity. Forty-nine percent of all pregnancies per year in the United States are unintended (3.1 million), and roughly half a million of these are related to oral contraceptive

1. Are obese women at increased risk for pregnancy as compared to their normal BMI counterparts?

Abnormalities in metabolism and extremes in body weight can adversely affect the reproductive system. Obesity is a known risk factor for reduced fertility because of menstrual abnormalities, anovulation, polycystic ovarian disease and insulin resistance [40], [41]. However, the majority of women, both thin and obese, ovulate on a regular basis and are at risk for pregnancy [40].

The rate of sexual activity and use of contraception also affect the risk of pregnancy. Many assume that obese women

Conclusions and recommendations

The following recommendation is based on good and consistent scientific evidence (Level A):

  • Use of contraception prevents more pregnancies in women regardless of BMI than nonuse of contraception.

The following recommendation is based on limited or inconsistent scientific evidence (Level B):

  • Obese women, both adults and adolescents, appear to be at increased risk for pregnancy as compared to their normal BMI counterparts due to higher rates of contraceptive nonuse.

  • Effectiveness of oral

Important questions to be answered

Although contraception has been scrutinized since its inception, there are many unanswered questions in regard to obesity and contraception. Previous contraceptive studies have deliberately excluded obese women. This practice is no longer conscionable, as obese individuals make up a significant portion of our population. Future contraceptive studies, in particular efficacy studies, must be a better reflection of our current population.

References (89)

  • DiebenT. et al.

    Efficacy, cycle control, and user acceptability of a novel combined contraceptive vaginal ring

    Obstet Gynecol

    (2002)
  • HuberJ.

    Pharmacokinetics of Implanon®: An integrated analysis.

    Contraception

    (1998)
  • JainJ. et al.

    Contraceptive efficacy and safety of DMPA-SC

    Contraception

    (2004)
  • JamiesonD. et al.

    Complications of interval laparoscopic tubal sterilization: findings from the United States Collaborative Review of Sterilization

    Obstet Gynecol

    (2000)
  • HeinemannL.A.J. et al.

    Range of published estimates of venous thromboembolism incidence in young women

    Contraception.

    (2007)
  • TrussellJ. et al.

    Much ado about little: obesity, combined hormonal contraceptive use and venous thrombosis

    Contraception

    (2008)
  • LarsenT.B. et al.

    Maternal smoking, obesity, and the risk of thromboembolism during pregnancy and the puerperium: a population-based nested control study

    Thromb Res

    (2007)
  • JickS.S. et al.

    Risk of nonfatal venous thromboembolism in women using a contraceptive transdermal patch and oral contraceptives containing norgestimate and 35 μg of ethinyl estradiol

    Contraception

    (2006)
  • JickS. et al.

    Further results on the risk of nonfatal venous thromboembolism in users of the contraceptive transdermal patch compared to users of oral contraceptives containing norgestimate and 35 μg of ethinyl estradiol

    Contraception

    (2007)
  • BrintonL. et al.

    Reproductive, menstrual, and medical risk factors for endometrial cancer: results from a case-control study

    AJOG

    (1992)
  • CurtisK.M. et al.

    Neoplasia with use of intrauterine devices

    Contraception

    (2007)
  • HassanD.F. et al.

    Weight variation in a cohort of women using copper IUD for contraception

    Contraception

    (2003)
  • O'ConnellK.J. et al.

    Measured and reported weight change for women using a vaginal contraceptive ring vs. a low-dose oral contraceptive

    Contraception

    (2005)
  • RosenbergM.

    Weight change with oral contraceptive use and during the menstrual cycle: results of daily measurements

    Contraception

    (1998)
  • BahamondesL. et al.

    Comparison of weight increase in users of depot medroxyprogesterone acetate and copper IUD up to 5 years

    Contraception

    (2001)
  • ManganS.A. et al.

    Overweight teens at increased risk for weight gain while using depot medroxyprogesterone acetate

    J Pediatr Adolesc Gynecol

    (2002)
  • TaneepanichskulS. et al.

    Comparative study of weight change between long-term DMPA and IUD acceptors

    Contraception

    (1998)
  • VictorA. et al.

    Oral contraceptive absorption and sex hormone binding globulins in obese women: effects of jejunoileal bypass

    Gastroenterol Clin North Am

    (1987)
  • World Health Report 2002. Overweight, obesity, and high body mass, p 60. Accessed and downloaded 1.27.09....
  • HedleyA.A. et al.

    Overweight and obesity among US children, adolescents, and adults, 1999–2002

    JAMA

    (2004)
  • FinerL.B. et al.

    Disparities in rates of unintended pregnancy in the United States, 1994 and 2001

    Perspect Sex Reprod Health

    (2006)
  • RodeL. et al.

    Obesity-related complications in Danish single cephalic term pregnancies

    Obstet Gynecol

    (2005)
  • NohrE. et al.

    Prepregnancy obesity and fetal death: a study within the Danish national birth cohort

    Obstet Gynecol

    (2005)
  • CatalanoP.M. et al.

    The short- and long-term implications of maternal obesity on the mother and her offspring

    BJOG

    (2006)
  • BoneyC.M. et al.

    Metabolic syndrome in childhood: association with birth weight, maternal obesity, and gestational diabetes mellitus

    Pediatrics

    (2005)
  • WhitakerR.C.

    Predicting preschooler obesity at birth: the role of maternal obesity in early pregnancy

    Pediatrics

    (2004)
  • World Health Organization

    Endometrial cancer and combined oral contraceptives: the WHO Collaborative Study of Neoplasia and Steroid Contraceptives

    Int J Epidemiol

    (1988)
  • Depot-medroxyprogesterone acetate (DMPA) and risk of endometrial cancer

    Int J Cancer

    (1991)
  • GuleriaK. et al.

    Evaluation of endometrial steroid receptors and cell mitotic activity in women using copper intrauterine device: Can Cu-T prevent endometrial cancer?

    J Obstet Gynaecol Res

    (2004)
  • VarmaR. et al.

    Non-contraceptive uses of levonorgestrel-releasing hormone system (LNG-IUS)—A systematic enquiry and overview

    Eur J Obstet Gynecol Reprod Biol

    (2005)
  • CohenS.S. et al.

    Obesity and screening for breast, cervical, and colorectal cancer in women: a review

    Cancer

    (2008)
  • HoltV. et al.

    Body mass index, weight, and oral contraceptive failure risk

    Obstet Gynecol

    (2005)
  • NorrisP. et al.

    Oral abstract presentation: contraceptive failure in overweight patients taking combination oral contraceptive pills

    (2003)
  • Brunner HuberL.R. et al.

    The association between body weight, unintended pregnancy resulting in a livebirth, and contraception at the time of conception

    Matern Child Health J

    (2005)
  • Cited by (51)

    • An overview of contraception in women with obesity

      2023, Best Practice and Research: Clinical Obstetrics and Gynaecology
    • Choosing the Right Oral Contraceptive Pill for Teens

      2017, Pediatric Clinics of North America
    • Assessment of contraceptive needs in women undergoing bariatric surgery

      2016, Contraception
      Citation Excerpt :

      The early postoperative period presents unique risks because of continued morbid obesity and associated comorbidities as well as new nutritional and metabolic changes that raise concerns for maternal morbidity and fetal development [4,8]. Further compounding this problem is that unintended pregnancy risk may increase after bariatric surgery due to restoration of normal ovulation and enhanced fertility, and obese women are less likely to use contraception compared to women with normal BMI [6,7]. Oral contraceptives are commonly used but are suboptimal as they may fail more frequently after malabsorptive bariatric procedures [7,8,9,10].

    View all citing articles on Scopus
    View full text