Hormonal contraceptives for contraception in overweight or obese women

Lopez, Laureen M; Bernholc, Alissa; Chen, Mario; Grey, Tom; Otterness, Conrad; Westhoff, Carolyn; Edelman, Alison; Helmerhorst, Frans M.

doi:10.1002/14651858.cd008452.pub4

Cited by 74 publications

(48 citation statements)

References 84 publications

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“…Second, the mean BMI of the studied population was relatively normal, which was lower than that in some other ethnic PCOS populations (Legro et al, 2014b), such that there may have been relatively increased serum levels of synthetic hormones (Edelman et al, 2009). However, a recent Cochrane meta-analysis did not find increasing BMI that impacted the effectiveness of hormonal contraceptives (Lopez et al, 2016). The applicability of our results to obese PCOS women needs to be confirmed in future studies.…”

Section: Discussionmentioning

confidence: 47%

Effect of pretreatment with oral contraceptives and progestins on IVF outcomes in women with polycystic ovary syndrome

Wei

Shi

et al. 2016

Hum. Reprod.

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STUDY QUESTION: Do oral contraceptives (OCs) and progestins impact live birth rate of IVF when used for cycle scheduling in women with polycystic ovary syndrome (PCOS)?SUMMARY ANSWER: OCs used for scheduling IVF cycle were associated with lowered rates of pregnancy and live birth after fresh embryo transfer, whereas progestins used for this purpose yield higher rates of pregnancy and live birth than OCs.WHAT IS KNOWN ALREADY: Due to oligo-menorrhea in PCOS, OCs and progestin are extensively used to schedule the start of an IVF cycle in women with PCOS. Little is known about the effect of such pretreatments on outcomes, especially, the rate of live birth.STUDY DESIGN, SIZE, DURATION: This was a nested cohort study and secondary analysis of a multicenter randomized trial, which was designed to compare live birth rate after fresh embryo transfer vs frozen embryo transfer (FET) in women with PCOS (Frefro-PCOS). A total of 1508 women were enrolled from 14 centers between June 2013 and May 2014. PARTICIPANTS/MATERIALS, SETTING, METHODS:At the discretion of local investigators, subjects were instructed to wait for spontaneous menses (Control group, n = 323), or were prescribed progestins (P group, n = 283) or OCs (OCs group, n = 902) to induce menstruation prior to the start of ovarian stimulation. GnRH antagonist protocol was initiated at Day 2 or 3 of induced or spontaneous menses cycle. The rates of pregnancy, pregnancy loss and live birth after either fresh embryo transfer or FET were compared among these three groups.MAIN RESULTS AND THE ROLE OF CHANCE: With fresh embryo transfer, women with OC-induced menses had lower rates of clinical pregnancy (48.8% vs 63.6%, relative rate (RR): 0.77, 95% CI: 0.66-0.89) and live birth (36.1% vs 48.1%, RR: 0.75, 95% CI: 0.61-0.92) than women with spontaneous menses. With freeze-all and deferred FET, women with OC-induced menses had a similar pregnancy rate but a higher pregnancy loss rate (27.7% vs 13.0%, RR: 2.13, 95% CI: 1.28-3.52) after FET than women with spontaneous menses. The live birth rate after FET in women with OC-induced menses, progestin-induced menses and spontaneous menses was 49.4%, 50.7% and 60.2%, respectively (P = 0.06). Progestin-induced menses was associated with similar rates of pregnancy, pregnancy loss and live birth after transfer © The Author 2016. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com of either fresh or frozen embryos compared with spontaneous menses. Multivariate logistic regression analysis showed that OCs used for menses induction was associated with lower rate of live birth. LIMITATIONS, REASONS FOR CAUTION:The methods for menses induction were not assigned randomly, thus selection bias was highly likely because of the study design and significant differences that were observed in the baseline characteristics of the women in the different groups. The mean BMI in this study population was relative...

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Section: Discussionmentioning

confidence: 47%

Effect of pretreatment with oral contraceptives and progestins on IVF outcomes in women with polycystic ovary syndrome

Wei

Shi

et al. 2016

Hum. Reprod.

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“…Weight gain is usually controlled by dietary restrictions; OCP discontinuation is rarely the only way to control weight (20).…”

Section: Resultsmentioning

confidence: 99%

A Review of Recent Findings for Obstetricians about Combined Oral Contraceptive Pills

Aminimoghaddam

2017

J Obstet Gynecol Cancer Res

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Combined oral contraceptive pills (OCPs) contain estrogen (ethinylestradiol) and progesterone (first-generation levonorgestrel and fourthgeneration drospirenone). Progesterone has peripheral effects on the endometrium, fallopian tubes, and cervix and can promote contraception. These pills are used to prevent pain caused by Mittelschmerz syndrome and endometriosis and to treat hyperandrogenism. To prescribe contraceptives, it is adequate to take the patient's medical history and blood pressure. In the absence of risk factors, patients should be followed-up by history-taking, blood pressure measurement, urinalysis, Pap smear test, and examination of breasts, pelvis, and liver. The risk of venous thrombosis in new OCPs is twice higher than that of older generations and usually occurs in the first year of consumption. The only absolute contraindications for the use of new OCPs include chronic and acute cholestatic liver diseases. In fact, use of new OCPs increases the risk of liver adenoma, but not hepatocellular carcinoma. On the other hand, in female patients with genital tract cancers, risk of endometrial and ovarian epithelial cancers decreases following the use of OCPs. However, the risk of cervical adenocarcinoma increases after 5 years of consumption due to cervical eversion and impaired vitamin metabolism. These pills are contraindicated in women above 35 years who smoke more than 15 cigarettes daily or have uncontrolled hypertension, venous thromboembolism, migraine aura, severe hyperglycemia, breast cancer (diagnosed or suspected), or diabetes mellitus associated with cardiovascular diseases.

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“…Recent LARC failures have been attributed to a patient's BMI [25][26][27]. The increased cell density requires a greater concentration of progesterone to be effective and is inversely related to the patient's body weight [12,[25][26][27]. Nexplanon product information includes a disclaimer outlining decreased LARC efficacy in overweight women [12,16].…”

Section: Discussionmentioning

confidence: 99%

Unintended Pregnancy with Implantable Subdermal Contraceptive Device (Nexplanon): A Case Report

Rezai¹,

Patel²,

Hughes³

et al. 2018

OGIJ

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Background: In 2006, Implanon (68 mg), a synthetic subcutaneous progestin etonogestrel eluting capsule, was approved for use in the U.S. to provide longacting reversible contraception (LARC). The next generation LARC, Nexplanon (68 mg), a progestin-only etonogestrel subdermal implant, was available in 2001. Currently, Nexplanon is advertised to provide 99% effective contraception, up to 4 years. Removal of the capsule will revert back to normal menstruation and fertility. Unlike Implanon, cases of unintended uterine pregnancy with proper and successful insertion have not been reported using Nexplanon. Case:A 24-year-old female, G2P1001, with obstetrical history of one spontaneous vaginal delivery (2015), and gynecological history of low grade squamous intraepithelial lesion (LSIL) on Pap smear (2014), was found to have an intrauterine pregnancy while using Nexplanon. Initially, urine pregnancy testing assured that she was not pregnant before placement of the Nexplanon. Nexplanon was inserted ~2 months post-partum after the birth of her first child.17 months post-Nexplanon insertion, patient experienced irregular spotting, cramping, and reported positive home pregnancy test. Transvaginal ultrasound confirmed an intrauterine pregnancy at 9 weeks and 3 days. The Nexplanon implant was removed intact. Routine prenatal care was initiated and no issues were identified. Conclusion:Newer LARCs provide an alternative to lifestyle adaptive contraception, with ease of use and compliance. Although LARCs prove to be more effective, known factors linked to human error during placement, cytochrome P450 induction, and BMI, have shown to decrease their efficacy, leading to failed contraception. be associated with an unintended uterine pregnancy with proper and successful insertion. Keywords:Contraindications for the implant include; known or suspected pregnancy, current or past history of thrombosis or thromboembolic disorders, liver tumors (benign or malignant), active liver disease, undiagnosed abnormal genital bleeding, known or suspected breast cancer, personal history of breast cancer, other progestin-sensitive cancer and allergies to the components of Nexplanon [12,13]. Side effects of Nexplanon include; irregular menses, headache, vaginitis, breast pain, weight gain, acne, abdominal pain, and pharyngitis [12,13]. Although Nexplanon is used to prevent pregnancy, if the implant fails, there is an increased risk for ectopic pregnancy [12]. We present the first case of intrauterine pregnancy while using Nexplanon [14]. Case ReportThis patient is a 24-year-old female, G2P1001, with past medical history of asthma controlled with albuterol, asthmatic bronchitis treated with amoxicillin, and iron deficiency anemia was found to have an intrauterine pregnancy while using Nexplanon. Obstetrical history is significant for one spontaneous vaginal delivery in 2015, and gynecological history includes low grade squamous intraepithelial lesion (LSIL) on pap smear in 2014, with no further abnormal pap smears. She had used Nexplanon ...

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Hormonal contraceptives for contraception in overweight or obese women

Abstract: et al. The effect of age, parity and body mass index on the efficacy, safety, placement and user satisfaction associated with two low-dose levonorgestrel intrauterine contraceptive Systems: subgroup analyses of data from a Phase III trial.

Cited by 74 publications

References 84 publications

Effect of pretreatment with oral contraceptives and progestins on IVF outcomes in women with polycystic ovary syndrome

Effect of pretreatment with oral contraceptives and progestins on IVF outcomes in women with polycystic ovary syndrome

A Review of Recent Findings for Obstetricians about Combined Oral Contraceptive Pills

Unintended Pregnancy with Implantable Subdermal Contraceptive Device (Nexplanon): A Case Report

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