Hormonal contraception and obesity

Abstract

The rising rate of overweight and obesity is a public health crisis in the United States and increasingly around the globe. Rates of contraceptive use are similar among women of all weights, but because contraceptive development studies historically excluded women over 130% of ideal body weight, patients and providers have a gap in understanding of contraceptive efficacy for obese and overweight women. Because of a range of drug metabolism alterations in obesity, there is biologic plausibility for changes in hormonal contraception effectiveness in obese women. However, these pharmacokinetic changes are not linearly related to body mass index or weight, and it is unknown what degree of obesity begins to affect pharmacokinetic or pharmacodynamics processes. Overall, most studies of higher quality do not demonstrate a difference in oral contraceptive pill effectiveness in obese compared with non-obese women. However, data are scant for women in the highest categories of obesity, and differences by progestin type are incompletely understood. Effectiveness of most non-oral contraceptives does not seem to be compromised in obesity. Exceptions to this include the combined hormonal patch and oral levonorgestrel emergency contraception, which may have lower rates of effectiveness in obese women. The purpose of this review is to summarize evidence on contraceptive use in women with obesity, including differences in steroid hormone metabolism, contraceptive effectiveness, and safety, compared with women of normal weight or body mass index using the same methods.

Modification of the Associations Between Duration of Oral Contraceptive Use and Ovarian, Endometrial, Breast, and Colorectal Cancers

“…15,16 Although we assessed BMI in late life, our BMI results indicate that OC use may help maintain endometrial health among obese women, despite increased risk for this cancer and concerns about hormonal contraceptive effectiveness. 8,17 We identified attenuated risks for breast cancer relative to those from the AHRQ report's meta-analysis (any use odds ratio, 1.08; 95% CI, 1.00-1.17). 3 This may be explained by the high proportion of postmenopausal women in our population, many of whom likely stopped using OCs years before enrollment.…”

Correlation of Interpersonal Factors, Situational with Cervical Cancer Prevention in Woman of Childbearing Age

“…Forty-seven respondents used contraception <5 years and 47 respondents used contraception for 5-10 years. Hormonal contraception can cause adverse effects on reproductive disorders and weight-gain issues, pushing the respondents to make visits to the healthcare service (Simmons & Edelman, 2016;Wiebe, Brotto, & MacKay, 2011).…”

Contraception in women with obesity with special reference to gastric bypass surgery

“…Theoretically, obesity may have an impact on the effect of hormonal contraceptives as well as on other pharmacological treatments. Historically, contraceptive clinical trials have excluded women whose body weight is over 130% of the ideal level, with the consequence that there is a gap in the knowledge about contraceptive efficacy in this population (53). Despite indications of a variation in the pharmacokinetics of COC depending on BMI (54,55), ovulation seems to be adequately suppressed in COC users with obesity (56)(57)(58).…”

“…Despite indications of a variation in the pharmacokinetics of COC depending on BMI (54,55), ovulation seems to be adequately suppressed in COC users with obesity (56)(57)(58). Several studies, including a Cochrane Review from 2016, have not found an association between increased BMI and decreased effectiveness of combined hormonal contraceptives (53,56,59,60). However, even if differences in pharmacokinetic profiles do not seem to result in ovulation or unintended pregnancies (57, 61, 62) many obese women using COC seem to have a considerable ovarian follicular activity, although they have shown no overt evidence of ovulation (58).…”

“…Despite the differences in the metabolism of contraceptive hormones in women with obesity, the effectiveness of the studied contraceptive methods does not seem to be compromised. However, it should be emphasised that the combined hormonal patch and LNG-containing emergency contraception may have a lower rate of effectiveness in obese women, although superior to barrier methods or no method at all (53).…”