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Contraception counseling for obese women


The prevalence of obesity is increasing in children, adolescents, and adults in developed countries worldwide. In the United States, it is estimated that more than one-third of adults are obese [1]. The personal and societal costs of obesity are significant since obesity is associated with an increased risk of several medical disorders and pregnancy complications [2]. (See "Health hazards associated with obesity in adults" and "The impact of obesity on female fertility and pregnancy".)

Use of safe and effective contraception by women not wishing to conceive is of the utmost importance for preventing unintended pregnancy. Because women with chronic conditions like obesity are at higher risk of pregnancy-related complications, proper contraceptive use and avoidance of unintended pregnancy are especially important in this population. In addition, some contraceptive methods offer noncontraceptive medical benefits, such as reduction in risk of endometrial and ovarian cancer and decreased menstrual bleeding. Nevertheless, one study reported that obese sexually active women were more likely to report contraceptive nonuse than normal weight women [3]. Of note, obesity is not significantly associated with sexual orientation, age at first intercourse, frequency of heterosexual intercourse, or the number of lifetime or current male partners [4].

Counseling obese women about their contraceptive options can be challenging. Historically, contraceptive research has excluded obese and overweight women from clinical trials resulting in a limited body of evidence regarding contraceptive effectiveness and safety in obese and overweight women [2,5].

It is important to explore all of the factors that can contribute to contraceptive failure, not just the effect of weight, since approximately one-half of all pregnancies are unintended and one-half of these occur in women using some form of contraception [6]. In large groups of women, the overall rate of contraceptive failure is related to the inherent effectiveness of the method, compliance, fecundity of the population, and sexual behavior (eg, rare versus frequent sexual intercourse). There is no evidence that obesity affects compliance [7] or frequency of sexual intercourse [4]. Obesity can affect fecundity, but the majority of obese women ovulate regularly. There is some evidence that, compared to normal weight women, the risk of contraceptive failure is higher in obese women using the contraceptive patch [2,8], combined oral contraceptive pills [9,10], and contraceptive implants [11]; however, the magnitude of excess risk is unclear [12]. However, data from the 2002 National Survey of Family Growth do not support an association between obesity and unintended pregnancy [13]. This makes it difficult to properly inform overweight and obese women of their risk of pregnancy when using hormonal methods.

As a general guideline, the emotional aspects of unintended conception and the health risks of pregnancy should be weighed against the risks and disadvantages associated with a specific contraceptive method and the risk of contraceptive failure.


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Literature review current through: Mar 2014. | This topic last updated: Feb 20, 2014.
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  1. Centers for Disease Control and Prevention. Adult obesity facts. (Accessed on January 11, 2013).
  2. Grimes DA, Shields WC. Family planning for obese women: challenges and opportunities. Contraception 2005; 72:1.
  3. Chuang CH, Chase GA, Bensyl DM, Weisman CS. Contraceptive use by diabetic and obese women. Womens Health Issues 2005; 15:167.
  4. Kaneshiro B, Jensen JT, Carlson NE, et al. Body mass index and sexual behavior. Obstet Gynecol 2008; 112:586.
  5. Lopez LM, Grimes DA, Chen M, et al. Hormonal contraceptives for contraception in overweight or obese women. Cochrane Database Syst Rev 2013; 4:CD008452.
  6. Kost K, Singh S, Vaughan B, et al. Estimates of contraceptive failure from the 2002 National Survey of Family Growth. Contraception 2008; 77:10.
  7. Society of Family Planning, Higginbotham S. Contraceptive considerations in obese women: release date 1 September 2009, SFP Guideline 20091. Contraception 2009; 80:583.
  8. Zieman M, Guillebaud J, Weisberg E, et al. Contraceptive efficacy and cycle control with the Ortho Evra/Evra transdermal system: the analysis of pooled data. Fertil Steril 2002; 77:S13.
  9. Holt VL, Scholes D, Wicklund KG, et al. Body mass index, weight, and oral contraceptive failure risk. Obstet Gynecol 2005; 105:46.
  10. Holt VL, Cushing-Haugen KL, Daling JR. Body weight and risk of oral contraceptive failure. Obstet Gynecol 2002; 99:820.
  11. Gu S, Sivin I, Du M, et al. Effectiveness of Norplant implants through seven years: a large-scale study in China. Contraception 1995; 52:99.
  12. Trussell J, Schwarz EB, Guthrie K. Obesity and oral contraceptive pill failure. Contraception 2009; 79:334.
  13. Kaneshiro B, Edelman A, Carlson N, et al. The relationship between body mass index and unintended pregnancy: results from the 2002 National Survey of Family Growth. Contraception 2008; 77:234.
  14. Edelman AB, Cherala G, Stanczyk FZ. Metabolism and pharmacokinetics of contraceptive steroids in obese women: a review. Contraception 2010; 82:314.
  15. Edelman AB, Carlson NE, Cherala G, et al. Impact of obesity on oral contraceptive pharmacokinetics and hypothalamic-pituitary-ovarian activity. Contraception 2009; 80:119.
  16. Westhoff CL, Torgal AH, Mayeda ER, et al. Pharmacokinetics of a combined oral contraceptive in obese and normal-weight women. Contraception 2010; 81:474.
  17. Edelman AB, Cherala G, Munar MY, et al. Prolonged monitoring of ethinyl estradiol and levonorgestrel levels confirms an altered pharmacokinetic profile in obese oral contraceptives users. Contraception 2013; 87:220.
  18. Owen OE, Kavle E, Owen RS, et al. A reappraisal of caloric requirements in healthy women. Am J Clin Nutr 1986; 44:1.
  19. Speerhas R. Drug metabolism in malnutrition and obesity: clinical concerns. Cleve Clin J Med 1995; 62:73.
  20. Ravussin E, Burnand B, Schutz Y, Jéquier E. Twenty-four-hour energy expenditure and resting metabolic rate in obese, moderately obese, and control subjects. Am J Clin Nutr 1982; 35:566.
  21. Stadel BV, Sternthal PM, Schlesselman JJ, et al. Variation of ethinylestradiol blood levels among healthy women using oral contraceptives. Fertil Steril 1980; 33:257.
  22. Fishman J, Boyar RM, Hellman L. Influence of body weight on estradiol metabolism in young women. J Clin Endocrinol Metab 1975; 41:989.
  23. Westhoff CL, Torgal AH, Mayeda ER, et al. Ovarian suppression in normal-weight and obese women during oral contraceptive use: a randomized controlled trial. Obstet Gynecol 2010; 116:275.
  24. Samama MM. An epidemiologic study of risk factors for deep vein thrombosis in medical outpatients: the Sirius study. Arch Intern Med 2000; 160:3415.
  25. Nightingale AL, Lawrenson RA, Simpson EL, et al. The effects of age, body mass index, smoking and general health on the risk of venous thromboembolism in users of combined oral contraceptives. Eur J Contracept Reprod Health Care 2000; 5:265.
  26. Vessey M. Oral contraceptive failures and body weight: findings in a large cohort study. J Fam Plann Reprod Health Care 2001; 27:90.
  27. Brunner Huber LR, Toth JL. Obesity and oral contraceptive failure: findings from the 2002 National Survey of Family Growth. Am J Epidemiol 2007; 166:1306.
  28. Burkman RT, Fisher AC, Wan GJ, et al. Association between efficacy and body weight or body mass index for two low-dose oral contraceptives. Contraception 2009; 79:424.
  29. McNicholas C, Zhao Q, Secura G, et al. Contraceptive failures in overweight and obese combined hormonal contraceptive users. Obstet Gynecol 2013; 121:585.
  30. Speroff L, Darney PD. A Clinical Guide For Contraception, 54th ed, Lippincott Williams & Wilkins, Philadelphia 2011.
  31. Funk S, Miller MM, Mishell DR Jr, et al. Safety and efficacy of Implanon, a single-rod implantable contraceptive containing etonogestrel. Contraception 2005; 71:319.
  32. Xu H, Wade JA, Peipert JF, et al. Contraceptive failure rates of etonogestrel subdermal implants in overweight and obese women. Obstet Gynecol 2012; 120:21.
  33. Mornar S, Chan LN, Mistretta S, et al. Pharmacokinetics of the etonogestrel contraceptive implant in obese women. Am J Obstet Gynecol 2012; 207:110.e1.
  34. Gu SJ, Du MK, Zhang LD, et al. A 5-year evaluation of NORPLANT contraceptive implants in China. Obstet Gynecol 1994; 83:673.
  35. Grubb GS, Moore D, Anderson NG. Pre-introductory clinical trials of Norplant implants: a comparison of seventeen countries' experience. Contraception 1995; 52:287.
  36. Sivin I, Wan L, Ranta S, et al. Levonorgestrel concentrations during 7 years of continuous use of Jadelle contraceptive implants. Contraception 2001; 64:43.
  37. Westhoff CL, Torgal AH, Mayeda ER, et al. Pharmacokinetics and ovarian suppression during use of a contraceptive vaginal ring in normal-weight and obese women. Am J Obstet Gynecol 2012; 207:39.e1.
  38. Dragoman M, Petrie K, Torgal A, et al. Contraceptive vaginal ring effectiveness is maintained during 6 weeks of use: a prospective study of normal BMI and obese women. Contraception 2013; 87:432.
  39. Edelman A, Cherala G, Lim JY, Jensen JT. Contraceptive failures in overweight and obese combined hormonal contraceptive users. Obstet Gynecol 2013; 122:158.
  40. Chi IC, Wilkens L. Interval tubal sterilization in obese women--an assessment of risks. Am J Obstet Gynecol 1985; 152:292.
  41. Chi IC, Wilkens LR, Reid SE. Prolonged hospital stay after laparoscopic sterilization. IPPF Med Bull 1984; 18:3.
  42. Chi I, Mumford SD, Laufe LE. Technical failures in tubal ring sterilization: Incidence, perceived reasons, outcome, and risk factors. Am J Obstet Gynecol 1980; 138:307.
  43. Jamieson DJ, Hillis SD, Duerr A, et al. Complications of interval laparoscopic tubal sterilization: findings from the United States Collaborative Review of Sterilization. Obstet Gynecol 2000; 96:997.
  44. Jain J, Jakimiuk AJ, Bode FR, et al. Contraceptive efficacy and safety of DMPA-SC. Contraception 2004; 70:269.
  45. Segall-Gutierrez P, Taylor D, Liu X, et al. Follicular development and ovulation in extremely obese women receiving depo-medroxyprogesterone acetate subcutaneously. Contraception 2010; 81:487.
  46. Rosenberg MJ, Waugh MS, Meehan TE. Use and misuse of oral contraceptives: risk indicators for poor pill taking and discontinuation. Contraception 1995; 51:283.
  47. Kaunitz AM. Injectable depot medroxyprogesterone acetate contraception: an update for U.S. clinicians. Int J Fertil Womens Med 1998; 43:73.
  48. Pelkman CL, Chow M, Heinbach RA, Rolls BJ. Short-term effects of a progestational contraceptive drug on food intake, resting energy expenditure, and body weight in young women. Am J Clin Nutr 2001; 73:19.
  49. Bonny AE, Ziegler J, Harvey R, et al. Weight gain in obese and nonobese adolescent girls initiating depot medroxyprogesterone, oral contraceptive pills, or no hormonal contraceptive method. Arch Pediatr Adolesc Med 2006; 160:40.
  50. Clark MK, Dillon JS, Sowers M, Nichols S. Weight, fat mass, and central distribution of fat increase when women use depot-medroxyprogesterone acetate for contraception. Int J Obes (Lond) 2005; 29:1252.
  51. Bonny AE, Britto MT, Huang B, et al. Weight gain, adiposity, and eating behaviors among adolescent females on depot medroxyprogesterone acetate (DMPA). J Pediatr Adolesc Gynecol 2004; 17:109.
  52. Mangan SA, Larsen PG, Hudson S. Overweight teens at increased risk for weight gain while using depot medroxyprogesterone acetate. J Pediatr Adolesc Gynecol 2002; 15:79.
  53. Pantoja M, Medeiros T, Baccarin MC, et al. Variations in body mass index of users of depot-medroxyprogesterone acetate as a contraceptive. Contraception 2010; 81:107.
  54. Goldzieher JW, Moses LE, Averkin E, et al. A placebo-controlled double-blind crossover investigation of the side effects attributed to oral contraceptives. Fertil Steril 1971; 22:609.
  55. Gallo MF, Lopez LM, Grimes DA, et al. Combination contraceptives: effects on weight. Cochrane Database Syst Rev 2014; 1:CD003987.
  56. Coney P, Washenik K, Langley RG, et al. Weight change and adverse event incidence with a low-dose oral contraceptive: two randomized, placebo-controlled trials. Contraception 2001; 63:297.
  57. Edelman A, Jensen JT, Bulechowsky M, Cameron J. Combined oral contraceptives and body weight: do oral contraceptives cause weight gain? A primate model. Hum Reprod 2011; 26:330.
  58. Merhi ZO. Impact of bariatric surgery on female reproduction. Fertil Steril 2009; 92:1501.
  59. Gosman, GG. Reproductive health of women electing bariatric surgery. Fertil Steril 2009; :. [Epub ahead of print].
  60. Teitelman M, Grotegut CA, Williams NN, Lewis JD. The impact of bariatric surgery on menstrual patterns. Obes Surg 2006; 16:1457.
  61. Gerrits EG, Ceulemans R, van Hee R, et al. Contraceptive treatment after biliopancreatic diversion needs consensus. Obes Surg 2003; 13:378.
  62. Victor A, Odlind V, Kral JG. Oral contraceptive absorption and sex hormone binding globulins in obese women: effects of jejunoileal bypass. Gastroenterol Clin North Am 1987; 16:483.
  63. American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 105: bariatric surgery and pregnancy. Obstet Gynecol 2009; 113:1405.
  64. Ciangura C, Corigliano N, Basdevant A, et al. Etonorgestrel concentrations in morbidly obese women following Roux-en-Y gastric bypass surgery: three case reports. Contraception 2011; 84:649.
  65. Hillman JB, Miller RJ, Inge TH. Menstrual concerns and intrauterine contraception among adolescent bariatric surgery patients. J Womens Health (Larchmt) 2011; 20:533.
  66. Medical Eligibility Criteria for Contraceptive Use (UK MEC 2005/2006), Faculty of Family Planning and Reproductive Health Care, London (2006).
  67. Centers for Disease Control and Prevention (CDC). U S. Medical Eligibility Criteria for Contraceptive Use, 2010. MMWR Recomm Rep 2010; 59:1.
  68. (Accessed on February 06, 2008).
  69. U.S. Medical Eligibility Criteria for Contraceptive Use, 2010. Adapted from the World Health Organization Medical Eligibility Criteria for Contraceptive Use, 4th edition. (Accessed on August 03, 2011).
  70. Abdollahi M, Cushman M, Rosendaal FR. Obesity: risk of venous thrombosis and the interaction with coagulation factor levels and oral contraceptive use. Thromb Haemost 2003; 89:493.
  71. Effect of different progestagens in low oestrogen oral contraceptives on venous thromboembolic disease. World Health Organization Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception. Lancet 1995; 346:1582.
  72. Lidegaard Ø, Edström B, Kreiner S. Oral contraceptives and venous thromboembolism: a five-year national case-control study. Contraception 2002; 65:187.
  73. Trussell J, Guthrie KA, Schwarz EB. Much ado about little: obesity, combined hormonal contraceptive use and venous thrombosis. Contraception 2008; 77:143.
  74. Tsai AW, Cushman M, Rosamond WD, et al. Cardiovascular risk factors and venous thromboembolism incidence: the longitudinal investigation of thromboembolism etiology. Arch Intern Med 2002; 162:1182.
  75. ACOG Committee on Practice Bulletins-Gynecology. ACOG practice bulletin. No. 73: Use of hormonal contraception in women with coexisting medical conditions. Obstet Gynecol 2006; 107:1453.
  76. Riphagen FE, Fortney JA, Koelb S. Contraception in women over forty. J Biosoc Sci 1988; 20:127.