USE OF HORMONAL

CONTRACEPTIVES
IN OBESE WOMEN

Majority of the unintended pregnancies are among obese women as obesity is significantly linked with contraceptive
non-use. Women with a Body Mass Index (BMI) more than 35 kg/m2 are is associated with lesser use of contraceptives
compared with women with a BMI less than 25 kg/m2. Unintended pregnancy in obese women can have serious impact
as obesity is associated with greater pregnancy risk (Table 1). 1

Table 1: Impact of obesity on pregnancy1

Maternal risks • Increase rate of caesarean section,

• Increase rate of gestational hypertension
• Increase rate of gestational diabetes
• Increase rate of preeclampsia

Foetal risks • Increase rate of Macrosomia

• Increase rate of Stillbirth
• Increase rate of Neural tube defects
• Increase rate of Orofacial defects
• Increase rate of Cardiac anomalies
• Increase rate of Hydrocephalus.
• Long-term sequelae of childhood obesity and type 2 diabetes

CONCERNS ASSOCIATED WITH CONTRACEPTION IN OBESE WOMEN

Weight Gain with Hormonal Contraceptives

hormonal contraceptives are the most appropriate form of birth control and the pill is the most commonly used form of
birth control over the globe.2 Obese women due to apprehension of further weight gain with contraceptives avoid its
use.1 But effect of contraceptives on weight is still unclear. Even the clinical studies also have reported inconsistent
results; some agreed that it causes weight gain some studies reported that contraceptives are associated with weight
loss. If a woman gains weight it is may be because of the following changes:2

• Fluid retention
• An increase in muscle tissue
• An increase in body fat

Hypothetically, hormonal contraceptives seem to contribute in weight gain if they caused fluid retention and increased
body fat.2 However, majority of the studies have shown that weight gain with many contraceptive methods is
comparable to age-related weight gain. A Cochrane review states that there is no relationship between combination oral
contraceptives or the patch on weight gain.1
 Bariatric Surgery

During the reproductive age most of the bariatric surgeries are done among women. The general recommendation for
women underwent bariatric surgery and are planning a family, to wait 1–2 years after surgery. This recommendation is
due to the risk of malnourishment to the foetus during the rapid weight loss following bariatric surgery. Although this
waiting period there are chances of unintended pregnancies due to lack of proper contraceptive use. This is might be
due to women are lack a knowledge on the contraceptive options post bariatric surgery. It is important that
contraception should be offered to all patients post bariatric surgery.1,3

RECOMMENDATIONS FOR CONTRACEPTION IN OBESE WOMEN

Following are the contraceptives recommended for obese women by the UK Medical Eligibility for Contraceptive Use4

RECOMMENDATIONS FOR CONTRACEPTION IN OBESE WOMEN

Condition Cu-IUD LNG-IUS IMP DMPA POP CHC

Obesity

BMI ≥ 30-34 Kg/m2 1 1 1 1 1 2

BMI ≥35 Kg/m2 1 1 1 1 1 3

History of bariatric surgery

With <30 kg/m2 BMI 1 1 1 1 1 1

With ≥30–34 kg/m2 BMI 1 1 1 1 1 2
With ≥35 kg/m2 BMI 1 1 1 1 1 3

Definition of category
Category 1: A condition for which there is no restriction for the use of the method; Category 2: A condition where the advantages of using the method
generally outweigh the theoretical or proven risks; Category 3 A condition where the theoretical or proven risks usually outweigh the advantages of using the
method. The provision of a method requires expert clinical judgement and/or referral to a specialist contraceptive provider, since use of the method is not
usually recommended unless other more appropriate methods are not available or not acceptable.

RECOMMENDATIONS FOR CONTRACEPTION IN OBESE WOMEN

• Educate obese patients about the obstetrical risk associated with obesity and discuss contraceptive options during
weight optimization.

• Make all patients understand that the weight gain with contraception is same as age related weight gain with a few
exceptions.

• Emphasize that even if the contraceptive options have slightly less efficacy, it is still better to use it to prevent
unintended pregnancy.

References:
1. Mody SK, and Han M et al. Obesity and Contraception. Clin Obstet Gynecol. 2014; 57(3): 501–507.
2. National Library of Medicine, National Institutes of Health. Contraception: Do hormonal contraceptives cause weight gain?
Available from: https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0093796/. Accessed on 16th July 2018.
3. Ostrowska L, Lech M, Stefańska E, et al. The use of contraception for patients after bariatric surgery. Ginekologia Polska.
2016;87(8):591–593.
4. The Faculty of Sexual and Reproductive Healthcare. UK MEDICAL ELIGIBILITY CRITERIA FOR CONTRACEPTIVE
USE-2016. Available from: https://www.fsrh.org/documents/ukmec-2016/fsrh-ukmec-full-book-2017.pdf. Accessed on
16th July 2018.