Hormonal contraceptives for contraception in overweight or obese women

Obesity and Contraception

“…A Cochrane review suggests overweight women (BMI > 25 kg/m 2 ) are significantly more likely to get pregnant on oral contraceptives. 26 However some studies have shown there is no overall difference in failure rates according to BMI and body weight. 21,27 Although data is conflicting, overall conclusions suggest unintended pregnancy rates among overweight women using oral contraceptives are similar or slightly higher than that among non-overweight women.…”

The relationship between unplanned pregnancy and maternal body mass index 2009–2012

“…Another possible weakness of the study is the lack of comparative information regarding the contraceptive methods used by the general population analysed by BMI category during the same four-year period. However, obesity is often considered a relative contraindication to oestrogenic hormonal contracep- tion leading to exclusion of obese (particularly severely obese) women, from studies of their pharmacokinetics and efficacy 26 . Thus, one might expect women in the obese category to have fewer, not more, cases of unsuccessful hormonal contraception due to a lower prevalence of use among obese women.…”

“…Hormonal contraceptive effectiveness may vary depending on the type and dose of hormone, the route of administration and the level of obesity 34,35 . Whether there is reduced efficacy in obese women remains uncertain as there is a dearth of high quality studies 26 . Most pharmacokinetic studies and trials of new hormonal contraception exclude women who are greater than 130% of their ideal body weight and few are powered to evaluate outcomes such as pregnancy 26,36 .…”

“…Whether there is reduced efficacy in obese women remains uncertain as there is a dearth of high quality studies 26 . Most pharmacokinetic studies and trials of new hormonal contraception exclude women who are greater than 130% of their ideal body weight and few are powered to evaluate outcomes such as pregnancy 26,36 . Many studies are limited by BMI calculations based on self-reporting, and calculations that occur at the time contraception was initiated and not at the time the method failed.…”

Contraception in the Setting of Obesity and Bariatric Surgery

“…Serum levels of DMPA following IM injection of 150 mg are equivalent in normal weight and obese women during the fi rst 12 weeks of use [ 96 ], and remain equivalent following subsequent doses [ 101 ]. Serum levels of DMPA-SC are lower in obese compared to normal weight women, but do not approach the contraceptive threshold for ovulation suppression (200 pg/mL) in women with BMI < 40 kg/m 2 [ 101 -103 ].…”