Safety of hormonal contraception for obese women

ABSTRACT

Introduction: Obese women have special safety requirements for contraceptive choice, but the evidence supporting such decision is dispersed and sometimes conflicting. Despite being effective, well tolerated and safe for most women, hormonal contraceptives are underused by obese women due to fear of contraceptive failure, weight gain and venous thrombosis.

Areas covered: We performed a comprehensive literature search to identify studies about hormonal contraception in overweight and obese women, including safety concerns. We considered the safety of hormonal contraceptives for otherwise healthy obese women and for those with comorbidities such as hypertension, diabetes, vascular disease, or a history of deep venous thrombosis.

Expert opinion: Over time there is no convincing evidence that obesity increases the risk of contraceptive failure. Hormonal contraceptive users may have a modest weight gain that is comparable to that of non-users. Current evidence supports the safe use of combined hormonal contraceptives by obese women after detailed clinical screening to exclude comorbidities that may contraindicate the use of estrogens. Progestin-only methods are generally safe, and long-acting reversible contraceptives hold the best combination of efficacy, safety and convenience for this group, although individualization is advisable.

KEYWORDS:

• Hormonal contraception
• drug safety
• obesity
• thrombosis
• bariatric surgery

Article highlights

• It is well documented that overweight and obesity increase the risk of metabolic, cardiovascular and reproductive disorders. Moreover, obesity is associated to increased gestational morbidity.

• Proper and safe contraception in obese women is extremely important to reduce unintended pregnancy and allow for preconception interventions to reduce the gestational risks.

• Current evidence does not support a concern that obese women are less compliant or at greater risk of contraceptive failure.

• CHCs are generally safe to overweight or obese women who are otherwise free of conditions that further increase their thromboembolic risk. However, the coexistence of known risk factors of arterial vascular disease, such as older age, smoking, hypertension, diabetes mellitus, and dyslipidemia increases the risk of thromboembolism to a sufficient extent to advise against CHC use.

• Long-acting reversible contraceptives hold the best combination of efficacy, safety and convenience for this group, although individualization is advisable.

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Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

This paper was funded by Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) through the National Institute of Hormones and Women’s Health, Brazil.