Effect of obesity on the effectiveness of hormonal contraceptives: an individual participant data meta-analysis

Yamazaki, Masayoshi; Dwyer, Kate; Sobhan, Mahboob; Davis, Daniel; Kim, Myong‐Jin; Soule, Lisa; Willett, Gerald; Yu, Chenglong

doi:10.1016/j.contraception.2015.07.016

Cited by 93 publications

(27 citation statements)

References 34 publications

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“…Another study, a recent pooled analysis of the original data from seven phase III trials submitted to the US Food and Drug Administration (FDA), noted a small but statistically higher COC failure rate among women with obesity: women with a BMI ≥30 kg/m 2 had a slightly increased risk of contraceptive failure compared to those with a BMI <30 kg/m 2 (adjusted hazard ratio (aHR) 1.44; 95% CI 1.06–1.95). The magnitude of the difference reported (Pearl Index of 3.14 in users with obesity vs 2.53 in users with normal weight) is unlikely to be clinically important 135. This study may be biased due to limited control for confounding variables, no information about pill compliance, and pooling of data where women were exposed to COC containing different progestogens.…”

Section: Suitability Of Contraceptive Methods For Women Who Are Ovementioning

confidence: 90%

“…A pooled analysis of phase III clinical trials between 2000 and 2012 submitted to the US FDA included one trial of an EE/NGMN patch (n=1523), with the same dosing as Evra 135. This study found that when adjusted for age and race, women with obesity (n=152) using the patch were at increased risk for contraceptive failure compared to women without obesity (aHR 8.8; 95% CI 2.54–30.5).…”

Section: Suitability Of Contraceptive Methods For Women Who Are Ovementioning

confidence: 99%

See 1 more Smart Citation

FSRH Guideline (April 2019) Overweight, Obesity and Contraception

2019

BMJ Sex Reprod Health

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Section: Suitability Of Contraceptive Methods For Women Who Are Ovementioning

confidence: 90%

Section: Suitability Of Contraceptive Methods For Women Who Are Ovementioning

confidence: 99%

FSRH Guideline (April 2019) Overweight, Obesity and Contraception

2019

BMJ Sex Reprod Health

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“…A recent metaanalysis found a 44% higher pregnancy rate for obese women (BMI > 30 kg/m 2 ) taking COCs than for women with a normal BMI (Yamazaki et al, 2015). Obese women require a longer period of time to achieve a steady state of contraception.…”

Section: Obesitymentioning

confidence: 98%

Practice Guideline: Contraception for Adolescents with Chronic Illness

Hall¹,

Rende²

2017

Journal of Pediatric Health Care

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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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Effect of obesity on the effectiveness of hormonal contraceptives: an individual participant data meta-analysis

Cited by 93 publications

References 34 publications

FSRH Guideline (April 2019) Overweight, Obesity and Contraception

FSRH Guideline (April 2019) Overweight, Obesity and Contraception

Practice Guideline: Contraception for Adolescents with Chronic Illness

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

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