Obesity and Contraception: An Approach to Clinical Practice


Ann Obes Disord. 2016; 1(2): 1008.

Obesity and Contraception: An Approach to Clinical Practice

de Melo AS*, Yamaguti EM, dos Reis RM, and Ferriani RA

Department of Gynecology and Obstetrics, University of São Paulo, Brazil

*Corresponding author: Anderson Sanches de Melo, Department of Gynecology and Obstetrics, University of São Paulo, Medical School of Ribeirão Preto, Ribeirão Preto, Brazil

Received: June 02, 2016; Accepted: June 07, 2016; Published: June 08, 2016


Obesity is an endocrine disease with a prevalence that ranges between 1.5% and 69.1%, depending on the ethnicity and geographic region [1]. Since this disorder is associated with an increased risk for the development of Systemic Arterial Hypertension (SAH), Diabetes Mellitus Type 2 (DM2), dyslipidemia, Metabolic Syndrome (MetS), vascular thrombosis, and other risk factors for Atherosclerotic Cardiovascular Disease (ACVD) [2], obesity is a major global public health problem that requires multidisciplinary attention in clinical practice.

Approximately 30% of women of reproductive age suffer from obesity (Body Mass Index (BMI) ≥30 kg/m²) [3] and the use of safe and effective contraceptives is fundamental to minimize risks from an unintended pregnancy, such as hypertensive syndrome in pregnancy, preeclampsia, preterm birth, gestational diabetes, and others [4].

The evaluation of the effectiveness of contraceptive methods in obese women has been limited, as women with a BMI ≥30kg/m² have been excluded from most studies due to the increased risk of associated comorbidities that affected their eligibility for hormonal contraceptives. A multicenter study including 3,319 women showed that the effectiveness of transdermal contraceptive patches could be reduced in women with a body weight higher than 90 kg [5], but no pharmacokinetic studies on this contraceptive method have been carried out with obese women, in order to confirm this finding. Moreover, a study on the pharmacokinetics of the vaginal ring in obese women showed no differences when compared to non-obese women, thus demonstrating the effectiveness of this method in obese women [6]. According to a meta-analysis published in the Cochrane, BMI does not seem to interfere with the effectiveness of contraceptive methods; but the evidence was weak and did not allow for evaluating individual contraceptive methods due to the scarcity of studies [7].

According to the World Health Organization (WHO) [8] and the Center for Disease Control and Prevention (CDC) [9], any hormonal contraceptive method may be prescribed for women suffering from isolated obesity, regardless of their BMI. However, the prescription of hormonal contraceptives for obese women demands caution due to its association of obesity with comorbidities that are rated category 3 or 4 (Figure 1) for prescription of Combined Hormonal Contraceptives (CHCs), such as DM2 and cardiovascular disease, SAH, and MetS.

Citation: de Melo AS, Yamaguti EM, dos Reis RM and Ferriani RA. Obesity and Contraception: An Approach to Clinical Practice. Ann Obes Disord. 2016; 1(2): 1008.