Safety and efficacy of contraception—Why should the obese woman be any different?

Abstract

The public health impact of obesity and unintended pregnancy is profound with far reaching consequences. Obese women are less likely to use contraception due to a variety of self-induced and systems-based barriers but their risk of becoming pregnant is similar to their normal weight counterparts. However, pregnancy-associated risks for obese women are higher than that of normal weight women and thus, pregnancy generally outweighs the risks of contraceptive use. Adequate counselling to prevent and/or plan for pregnancy is imperative for these women. Research that investigates the relationship between obesity and contraceptive use is urgently needed.

Contraception and the obese woman

“…Determining the size and direction of the uterus and completely visualizing the cervix can be more difficult in obese women. The use of ultrasound may be helpful (Weisberg, ), as well as an examination table with a higher weight capacity and longer instruments (Amitasrigowri, ; Rodriguez & Edelman, ), along with insertion by a skilled practitioner with experience with IUD insertions.…”

“…Laparoscopic tubal ligation, a highly effective option for all women, however, is associated with increased risk of complications among obese women (RR 1.7; 95% CI, 1.2–2.6; Jamieson et al, 2000). Associated common surgical complications among this population include difficulty in the delivery of anesthesia and visualization of the fallopian tubes, technical failure in fallopian tube occlusion, lengthier operation time, intra‐abdominal organ damage, wound infection, hematoma and hemorrhage, and prolonged hospitalization (Cochrane, Gebbie, & Loudon, ; Rodriguez & Edelman, ).…”

“…The use of a self‐adjusting, soft sleeve‐type, self‐retaining tissue retractor adapting to variations in wound depth makes this a more effective and less difficult procedure to perform among obese women (Pelosi & Pelosi, ). Sterilization of male partners, a highly effective method with minimum risks, may be another option for obese women who have completed their families (Rodriguez & Edelman, ; Weisberg, ).…”

Estudo da absorção do anticoncepcional hormonal combinado oral após o bypass gástrico com reconstrução em Y-de-Roux

“…(49,51) A obesidade exerce influência na absorção, biodisponibilidade, metabolismo hepático (reduzindo a atividade das enzimas do citocromo P450), metabolismo biliar, clearance renal, ligação a proteínas, volume de distribuição da droga e excreção, podendo modificar a sua resposta terapêutica. (21,23,48,52,53) O aumento do débito cardíaco, um maior fluxo sanguíneo para o trato gastrointestinal e um esvaziamento gástrico mais acelerado contribuem para uma absorção mais rápida e um menor tempo para a droga atingir a sua concentração plasmática máxima. (47) No entanto, drogas transdérmicas e intramusculares podem apresentar absorção mais lenta por conta do aumento do tecido adiposo.…”

“…(50) A distribuição da droga depende da quantidade de tecido adiposo, de massa magra, do fluxo sanguíneo tecidual, de proteínas ligadoras plasmáticas e teciduais. (47,48,53) A obesidade aumenta o volume de distribuição para drogas hidrofóbicas, como é o caso dos hormônios esteróides. (47) Ocorre também redução da produção hepática de SHBG, glicoproteína que se liga aos estrógenos endógenos, andrógenos e progestágenos sintéticos, interferindo na fração livre e ligada dos homônios sexuais e contribuindo, portanto, com a sua distribuição.…”