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Semin Reprod Med 2010; 28(2): 156-163
DOI: 10.1055/s-0030-1248141
© Thieme Medical Publishers

Obesity and Contraception: Emerging Issues

Amitasrigowri S. Murthy1
  • 1Department of Obstetrics and Gynecology, New York University, School of Medicine, Bellevue Hospital Center, New York, New York
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Publication History

Publication Date:
29 March 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
    CrossrefPubMedGoogle Scholar
  • 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
    Google Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 4 Society of Family Planning . Clinical guidelines. Contraceptive considerations in obese women.  Contraception. 2009;  80(6) 583-590
    CrossrefPubMedGoogle Scholar
  • 5 Packianathan I, Finer N. Medical consequences of obesity.  Medicine. 2003;  31(4) 8-12
    PubMedGoogle Scholar
  • 6 Ogden C L, Yanovski S Z, Carroll M D, Flegal K M. The epidemiology of obesity.  Gastroenterology. 2007;  132 2087-2102
    CrossrefPubMedGoogle Scholar
  • 7 Nelson S M, Fleming R. Obesity and reproduction: impact and interventions.  Curr Opin Obstet Gynecol. 2007;  19(4) 384-389
    CrossrefPubMedGoogle Scholar
  • 8 Lash M M, Armstrong A. Impact of obesity on women's health.  Fertil Steril. 2009;  91(5) 1712-1716
    CrossrefPubMedGoogle Scholar
  • 9 Bianchini F, Kaaks R, Vainio H. Overweight, obesity, and cancer risk.  Lancet Oncol. 2002;  3(9) 565-574
    CrossrefPubMedGoogle Scholar
  • 10 Wuntakal R, Hollingworth T. The implications of obesity on pregnancy.  Obstet Gynecol Reprod Med. 2009;  19(12) 344-359
    PubMedGoogle Scholar
  • 11 Bray G A. Epidemiology risks and pathogenesis of obesity.  Meat Sci. 2005;  71 2-7
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 14 Irvine L M, Shaw R W. The effects of patient obesity in gynecological practice.  Curr Obstet Gynaecol. 2003;  13(3) 179-184
    CrossrefPubMedGoogle Scholar
  • 15 Fraser R B. Obesity complicating pregnancy.  Curr Obstet Gynaecol. 2006;  16 (5) 295-298
    PubMedGoogle Scholar
  • 16 Practice Committee of American Society for Reproductive Medicine . Obesity and reproduction: an educational bulletin.  Fertil Steril. 2008;  90(5, suppl) S21-S29
    PubMedGoogle Scholar
  • 17 Grimes D A, Shields W C. Family planning for obese women: challenges and opportunities.  Contraception. 2005;  72(1) 1-4
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 22 Westhoff C, Reape K, Hait H. Subject weight and oral contraceptive efficacy in recent clinical trials.  Contraception. 2008;  78 167
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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;
    Google Scholar
  • 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;
    Google Scholar
  • 26 Trussell J, Schwarz E B, Guthrie K. Obesity and oral contraceptive pill failure.  Contraception. 2009;  79(5) 334-338
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 31 Westhoff C. Higher body weight does not affect NuvaRing's efficacy [abstract].  Obstet Gynecol. 2005;  105(suppl 4) 56S
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 36 Curtis K M, Ravi A, Gaffield M L. Progestogen-only contraceptive use in obese women.  Contraception. 2009;  80(4) 346-354
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 41 Hubacher D, Grimes D A. Noncontraceptive health benefits of intrauterine devices: a systematic review.  Obstet Gynecol Surv. 2002;  57(2) 120-128
    CrossrefPubMedGoogle Scholar
  • 42 Kadir R A, Chi C. Levonorgestrel intrauterine system: bleeding disorders and anticoagulant therapy.  Contraception. 2007;  75(6, suppl) S123-S129
    CrossrefPubMedGoogle Scholar
  • 43 Seidell J C. Epidemiology of obesity.  Semin Vasc Med. 2005;  5(1) 3-14
    Article in Thieme ConnectPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 46 Guelinckx I, Devlieger R, Vansant G. Reproductive outcome after bariatric surgery: a critical review.  Hum Reprod Update. 2009;  15(2) 189-201
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 48 Merhi Z O. Challenging oral contraception after weight loss by bariatric surgery.  Gynecol Obstet Invest. 2007;  64(2) 100-102
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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;
    Google Scholar
  • 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
    Google Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 55 Samsioe G. Coagulation and anticoagulation effects of contraceptive steroids.  Am J Obstet Gynecol. 1994;  170(5 Pt 2) 1523-1527
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 57 Rosendaal F R, Helmorhorst F M, Vandenbroucke J P. Female hormones and thrombosis.  Arterioscler Thromb Vasc Biol. 2002;  22 201-210
    CrossrefPubMedGoogle Scholar
  • 58 Conard J. Biological coagulation findings in third-generation oral contraceptives.  Hum Reprod Update. 1999;  5(6) 672-680
    CrossrefPubMedGoogle Scholar
  • 59 Martínez F, Avecilla A. Combined hormonal contraception and venous thromboembolism.  Eur J Contracept Reprod Health Care. 2007;  12(2) 97-106
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    Article in Thieme ConnectPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar

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