European Society of Contraception Statement on Contraception in Obese Women

Abstract

The obesity 'epidemic' continues to increase, mostly but not only in developed countries. As overweight and obese women are at an increased risk for venous thromboembolism (VTE) at baseline and at a much higher risk during pregnancy, it is essential to help these women to plan pregnancies carefully and to use contraceptives with a positive ratio of benefits versus risks. The Expert Group on hormonal and molecular contraception of the European Society of Contraception convened to review the existing evidence and propose recommendations to the prescribers in line with most recent studies and with the Medical Eligibility Criteria of the World Health Organisation.

Progestin-only contraceptives: effects on weight

“…Reviews have suggested that DMPA and weight gain may be a concern for women who are already obese, whether they are adolescents (Curtis 2009) or adults (Merki-Feld 2015). The review with three studies on adolescents considered the quality of evidence to be fair for two studies.…”

“…Concern about contraceptive effectiveness among overweight women (Robinson 2013; Merki-Feld 2015) has led to questions about contraceptive usage by overweight or obese women. An analysis of medical records from 231 health centers examined contraceptive use among 147,336 US women, age 15 to 44 years (Kohn 2015).…”

“…The cost for POCs can be less than that of COCs in some areas, and many postpartum women can use them. Further, POCs are appropriate for women at increased risk for venous thromboembolism such as those who are obese (Merki-Feld 2015), which is important given the worldwide epidemic of obesity (Prentice 2006; Flegal 2012; Ogden 2014). Being overweight or obese increases also risk for Type 2 diabetes and other diseases and disorders.…”

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

“…Post-marketing observational studies reported an inverse association between obesity and effectiveness of COC use in the U.S., but not in European women 17,18. Most recently, the European Society of Contraception recently recommended to promote the use of hormonal contraceptives regardless of women's weight, but noted increased risks of unplanned pregnancy and venous thromboembolism associated with overweight or obese women 19. Public access to participant-level data in phase 3 clinical trials submitted to the FDA is limited.…”

The use of contraception for patients after bariatric surgery

“…Only using the combined pill raises some issues due to a slight increase in the risk of thrombotic complications of obese women (BMI ≥ 30 kg/m 2 ), compared with obese women not using the combined pill. The European Society of Contraception [26] advises that even women after bariatric surgery (without exclusion or combined surgery) can safely use combined pills, and patients treated by restrictive methods, after reaching a BMI < 30 kg/m 2 , should not use oral combined pills. However, there is limited evidence that hormonal contraception is less effective in obese women compared to women with normal body weight.…”