Obesity and Contraception: Emerging Issues

Abstract

Obesity is increasing in prevalence worldwide. Obese women are at similar risk of unintended pregnancy as normal weight women, although limited data are available on the effects of obesity on the efficacy of contraception. Conflicting data exist regarding efficacy of oral contraceptives in obese women, although trends of oral contraceptive failure are no higher than compared with those of normal weight women. The risk of venous thromboembolism is increased with obesity, and this risk may be additive when using a combined hormonal method. Bariatric surgery can lead to increased fertility; postoperative recommendations include avoiding pregnancy in the first year. Contraceptive use patterns in these women are largely unknown. Surgeons need greater awareness of the need for use of effective long-acting methods, and consensus guidelines need to be established.

Obesity and Contraception

“…24 It has been hypothesized that the ring may offer higher hormone levels for obese women than oral contraceptives because the hormones are absorbed directly into the vaginal mucosa and do not go through the first-pass liver metabolism. 25 …”

Contraceptive needs of women following bariatric surgery

“…Fertility is negatively affected by obesity,16 but the rapid weight loss imposed by bariatric surgery means women will experience improved fertility,17 and be at risk of an unplanned pregnancy. There is no universal consensus on the timeframe, but the current advice to avoid pregnancy for at least 1 year, and possibly up to 2 years after surgery,7 9 is intended to reduce any theoretical risks to maternal and fetal health as a result of nutrient deficiencies and rapid weight loss.…”

Contracepção em mulheres com condições clínicas especiais. Critérios médicos e elegibilidade

“…4,60,61 Dados relativos ao impacto da obesidade sobre a eficácia dos contraceptivos orais são limitados, mas pode haver uma diminuição da eficácia nesses casos (categoria 2). 4,6 Estudos propuseram que o mecanismo pelo qual a obesidade interfere no metabolismo da droga está relacionado com as alteraç ões na absorção dos esteroides pelo aumento do metabolismo basal, pela degradação das enzimas hepáticas e pelo sequestro pelo tecido adiposo.…”