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DOI: 10.1055/s-0030-1248141
Obesity and Contraception: Emerging Issues
Publikationsverlauf
Publikationsdatum:
29. März 2010 (online)
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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.
KEYWORDS
Obesity - bariatric surgery - efficacy - contraception - pregnancy - unplanned
REFERENCES
- 1 Finer L B, Henshaw S K. Disparities in rates of unintended pregnancy in the United States, 1994 and 2001. Perspect Sex Reprod Health. 2006; 38(2) 90-96
- 2 World Health Report 2002 .Overweight, obesity and high body mass, p. 60. Available at: http://www.who.int/whr/2002/en/whr02_en.pdf Accessed September 19, 2009
- 3 Mansour D. Implications of the growing obesity epidemic on contraception and reproductive health. J Fam Plann Reprod Health Care. 2004; 30(4) 209-211
- 4 Society of Family Planning . Clinical guidelines. Contraceptive considerations in obese women. Contraception. 2009; 80(6) 583-590
- 5 Packianathan I, Finer N. Medical consequences of obesity. Medicine. 2003; 31(4) 8-12
- 6 Ogden C L, Yanovski S Z, Carroll M D, Flegal K M. The epidemiology of obesity. Gastroenterology. 2007; 132 2087-2102
- 7 Nelson S M, Fleming R. Obesity and reproduction: impact and interventions. Curr Opin Obstet Gynecol. 2007; 19(4) 384-389
- 8 Lash M M, Armstrong A. Impact of obesity on women's health. Fertil Steril. 2009; 91(5) 1712-1716
- 9 Bianchini F, Kaaks R, Vainio H. Overweight, obesity, and cancer risk. Lancet Oncol. 2002; 3(9) 565-574
- 10 Wuntakal R, Hollingworth T. The implications of obesity on pregnancy. Obstet Gynecol Reprod Med. 2009; 19(12) 344-359
- 11 Bray G A. Epidemiology risks and pathogenesis of obesity. Meat Sci. 2005; 71 2-7
- 12 Brunner Huber L R, Toth J L. Obesity and oral contraceptive failure: findings from the 2002 National Survey of Family Growth. Am J Epidemiol. 2007; 166(11) 1306-1311
- 13 Kaneshiro B, Edelman A, Carlson N, Nichols M, Jensen J. The relationship between body mass index and unintended pregnancy: results from the 2002 National Survey of Family Growth. Contraception. 2008; 77(4) 234-238
- 14 Irvine L M, Shaw R W. The effects of patient obesity in gynecological practice. Curr Obstet Gynaecol. 2003; 13(3) 179-184
- 15 Fraser R B. Obesity complicating pregnancy. Curr Obstet Gynaecol. 2006; 16 (5) 295-298
- 16 Practice Committee of American Society for Reproductive Medicine . Obesity and reproduction: an educational bulletin. Fertil Steril. 2008; 90(5, suppl) S21-S29
- 17 Grimes D A, Shields W C. Family planning for obese women: challenges and opportunities. Contraception. 2005; 72(1) 1-4
- 18 Holt V L, Cushing-Haugen K L, Daling J R. Body weight and risk of oral contraceptive failure. Obstet Gynecol. 2002; 99(5 Pt 1) 820-827
- 19 Holt V L, Scholes D, Wicklund K G, Cushing-Haugen K L, Daling J R. Body mass index, weight, and oral contraceptive failure risk. Obstet Gynecol. 2005; 105(1) 46-52
- 20 Brunner Huber L R, Hogue C J, Stein A D, Drews C, Zieman M. Body mass index and risk for oral contraceptive failure: a case-cohort study in South Carolina. Ann Epidemiol. 2006; 16(8) 637-643
- 21 Zhang H F, LaGuardia K D, Creanga D L. Higher body weight and body mass index are not associated with reduced efficacy in Ortho Tri-Cyclen Lo users [abstract]. Obstet Gynecol. 2006; 107 50S
- 22 Westhoff C, Reape K, Hait H. Subject weight and oral contraceptive efficacy in recent clinical trials. Contraception. 2008; 78 167
- 23 Burkman R T, Fisher A C, Wan G J, Barnowski C E, LaGuardia K D. Association between efficacy and body weight or body mass index for two low-dose oral contraceptives. Contraception. 2009; 79(6) 424-427
- 24 Westhoff C, Torgal A, Mayeda E R, Lerner J, Paik M. Ovarian suppression during oral contraceptive use in normal-weight and obese women. Poster presented at: Annual Meeting of the Association of Reproductive Health Professionals October 1, 2009 Los Angeles, CA;
- 25 Westhoff C, Reape K, Shu H. Impact of body weight on observed pregnancy rates with a low dose estrogen, 91-day extended regimen oral contraceptive. Oral abstract presented at: Annual Meeting of the Association of Reproductive Health Professionals October 1, 2009 Los Angeles, CA;
- 26 Trussell J, Schwarz E B, Guthrie K. Obesity and oral contraceptive pill failure. Contraception. 2009; 79(5) 334-338
- 27 Edelman A B, Carlson N E, Cherala G et al.. Impact of obesity on oral contraceptive pharmacokinetics and hypothalamic-pituitary-ovarian activity. Contraception. 2009; 80(2) 119-127
- 28 Zieman M, Guillebaud J, Weisberg E, Shangold G A, Fisher A C, Creasy G W. Contraceptive efficacy and cycle control with the Ortho Evra/Evra transdermal system: the analysis of pooled data. Fertil Steril. 2002; 77(2, suppl 2) S13-S18
- 29 Abrams L S, Skee D, Natarajan J, Wong F A. Pharmacokinetic overview of Ortho Evra/Evra. Fertil Steril. 2002; 77(2, suppl 2) S3-S12
- 30 Dieben T O, Roumen F J, Apter D. Efficacy, cycle control, and user acceptability of a novel combined contraceptive vaginal ring. Obstet Gynecol. 2002; 100(3) 585-593
- 31 Westhoff C. Higher body weight does not affect NuvaRing's efficacy [abstract]. Obstet Gynecol. 2005; 105(suppl 4) 56S
- 32 Bjarnadóttir R I, Tuppurainen M, Killick S R. Comparison of cycle control with a combined contraceptive vaginal ring and oral levonorgestrel/ethinyl estradiol. Am J Obstet Gynecol. 2002; 186(3) 389-395
- 33 Cibula D, Hill M, Fanta M, Sindelka G, Zivny J. Does obesity diminish the positive effect of oral contraceptive treatment on hyperandrogenism in women with polycystic ovarian syndrome?. Hum Reprod. 2001; 16(5) 940-944
- 34 Rowland A S, Baird D D, Long S et al.. Influence of medical conditions and lifestyle factors on the menstrual cycle. Epidemiology. 2002; 13(6) 668-674
- 35 Hampton R M, Zhang H F, Barnowski C, Wan G J. Bleeding patterns with monophasic and triphasic low-dose ethinyl estradiol combined oral contraceptives. Contraception. 2008; 77(6) 415-419
- 36 Curtis K M, Ravi A, Gaffield M L. Progestogen-only contraceptive use in obese women. Contraception. 2009; 80(4) 346-354
- 37 Dinger J, Cronin M, Mohner S, Schellschimidt I, Minh T, Westhoff C. Oral contraceptive effectiveness according to body mass index, weight, age and other factors (EURAS-OC). Am J Obstet Gynecol. 2009; 201(3) 263
- 38 Kaunitz A M, Darney P D, Ross D, Wolter K D, Speroff L. Subcutaneous DMPA vs. intramuscular DMPA: a 2-year randomized study of contraceptive efficacy and bone mineral density. Contraception. 2009; 80(1) 7-17
- 39 Bonny A E, Ziegler J, Harvey R, Debanne S M, Secic M, Cromer B A. 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(1) 40-45
- 40 Graesslin O, Korver T. The contraceptive efficacy of Implanon: a review of clinical trials and marketing experience. Eur J Contracept Reprod Health Care. 2008; 13(suppl 1) 4-12
- 41 Hubacher D, Grimes D A. Noncontraceptive health benefits of intrauterine devices: a systematic review. Obstet Gynecol Surv. 2002; 57(2) 120-128
- 42 Kadir R A, Chi C. Levonorgestrel intrauterine system: bleeding disorders and anticoagulant therapy. Contraception. 2007; 75(6, suppl) S123-S129
- 43 Seidell J C. Epidemiology of obesity. Semin Vasc Med. 2005; 5(1) 3-14
- 44 Jamieson D J, Hillis S D, Duerr A, Marchbanks P A, Costello C, Peterson H B. Complications of interval laparoscopic tubal sterilization: findings from the United States Collaborative Review of Sterilization. Obstet Gynecol. 2000; 96(6) 997-1002
- 45 Maggard M A, Yermilov I, Li Z et al.. Pregnancy and fertility following bariatric surgery: a systematic review. JAMA. 2008; 300(19) 2286-2296
- 46 Guelinckx I, Devlieger R, Vansant G. Reproductive outcome after bariatric surgery: a critical review. Hum Reprod Update. 2009; 15(2) 189-201
- 47 Tice J A, Karliner L, Walsh J, Petersen A J, Feldman M D. Gastric banding or bypass? A systematic review comparing the two most popular bariatric procedures. Am J Med. 2008; 121(10) 885-893
- 48 Merhi Z O. Challenging oral contraception after weight loss by bariatric surgery. Gynecol Obstet Invest. 2007; 64(2) 100-102
- 49 Gerrits E G, Ceulemans R, van Hee R, Hendrickx L, Totté E. Contraceptive treatment after biliopancreatic diversion needs consensus. Obes Surg. 2003; 13(3) 378-382
- 50 Krishnan S, Hacker M, Haider S et al.. Contraceptive counseling and utilization in women who underwent bariatric surgery. Poster presented at: Annual Meeting of the Association of Reproductive Health Professionals October 1, 2009 Los Angeles, CA;
- 51 American College of Obstetricians and Gynecologists Practice Bulletin .Use of hormonal contraception in women with coexisting medical conditions. In: Clinical Management Guidelines for Obstetricians-Gynecologists. Number 73 Washington, DC; American College of Obstetricians and Gynecologists June 2006
- 52 Culwell K R, Curtis K M. Use of contraceptive methods by women with current venous thrombosis on anticoagulant therapy: a systematic review. Contraception. 2009; 80(4) 337-345
- 53 Sönmezer M, Atabekoğlu C, Cengiz B, Dökmeci F, Cengiz S D. Depot-medroxyprogesterone acetate in anticoagulated patients with previous hemorrhagic corpus luteum. Eur J Contracept Reprod Health Care. 2005; 10(1) 9-14
- 54 Goldstein J, Cushman M, Badger G J, Johnson J V. Effect of depomedroxyprogesterone acetate on coagulation parameter: a pilot study. Fertil Steril. 2007; 87(6) 1267-1270
- 55 Samsioe G. Coagulation and anticoagulation effects of contraceptive steroids. Am J Obstet Gynecol. 1994; 170(5 Pt 2) 1523-1527
- 56 Rosendaal F R, Van Hylckama Vlieg A, Tanis B C, Helmerhorst F M. Estrogens, progestogens and thrombosis. J Thromb Haemost. 2003; 1(7) 1371-1380
- 57 Rosendaal F R, Helmorhorst F M, Vandenbroucke J P. Female hormones and thrombosis. Arterioscler Thromb Vasc Biol. 2002; 22 201-210
- 58 Conard J. Biological coagulation findings in third-generation oral contraceptives. Hum Reprod Update. 1999; 5(6) 672-680
- 59 Martínez F, Avecilla A. Combined hormonal contraception and venous thromboembolism. Eur J Contracept Reprod Health Care. 2007; 12(2) 97-106
- 60 Lawrenson R, Farmer R. Venous thromboembolism and combined oral contraceptives: does the type of progestogen make a difference?. Contraception. 2000; 62(2, suppl) 21S-28S; discussion 37S–38S
- 61 Abdollahi M, Cushman M, Rosendaal F R. Obesity: risk of venous thrombosis and the interaction with coagulation factor levels and oral contraceptive use. Thromb Haemost. 2003; 89(3) 493-498
- 62 Pomp E R, le Cessie S, Rosendaal F R, Doggen C J. Risk of venous thrombosis: obesity and its joint effect with oral contraceptive use and prothrombotic mutations. Br J Haematol. 2007; 139 289-296
Amitasrigowri MurthyM.D. M.P.H.
Assistant Professor, Department of Obstetrics and Gynecology, New York University
School of Medicine, Bellevue Hospital Center, 555 First Avenue, NBV 9n1, New York, NY 10016
eMail: amitasrigowri.murthy@nyumc.org