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Contraception

OBesity Project. Contraception. “ Obese women are at a higher risk of pregnancy complications. ”. Problems with Interpretation of Research. Usually underpowered for obesity Usually retrospective Self reporting of BMI Weight underreported and height over reported

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Contraception

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  1. OBesity Project Contraception

  2. “Obese women are at a higher risk of pregnancy complications.”

  3. Problems with Interpretation of Research • Usually underpowered for obesity • Usually retrospective • Self reporting of BMI • Weight underreported and height over reported • Underreporting of unintended pregnancies ending in abortion • Many studies done before obesity increases • Done where obesity less and/or contraceptive use is better

  4. Importance of Contraception • Obese patients less likely to use effective contraception • Unclear whether related to patient, provider or a system issue • Obese women are more likely to be: • Older, black, hispanic, married, less educated, and underinsured

  5. Importance of Contraception • Although obese women have decreased fertility, most ovulate regularly • Obese women engage in sexual activity as frequently as all other weight categories • Contraception will always prevent more pregnancies than no contraception

  6. Importance of Contraception • Obese adolescents • Earlier coital debut • Higher rates of unprotected intercourse • Obese adult and adolescent women • Similar or increased risk of pregnancy as normal BMI

  7. Obesity and Contraceptive Effectiveness • Oral contraceptives • Conflicting studies on effectiveness in obese women • Obese women are as compliant as normal BMI women in taking pills • Overall, obese women appear to have a similar or slightly higher risk of pregnancy on oc’s • Bariatric surgery may decrease effectiveness due to decrease in absorption

  8. Obesity and Contraceptive Effectiveness • Etonogestrel(Implanon) contraceptive implant • No information available for women >130% ideal body weight • Sterilization: Laparoscopic and hysteroscopic (Essure, Adiana) • No change in effectiveness but procedures may be more difficult

  9. Deep Venous Thrombosis (VTE) and Estrogen Containing Contraceptives • Low dose estrogen • Incidence increases from 5-10 cases in nonusers to 15-30 cases in users per 10,000 women per year • At baseline, obesity doubles the risk of VTE compared to normal BMI

  10. Deep Venous Thrombosis (VTE) and Estrogen Containing Contraceptives • VTE risk with OCPs still remains below pregnancy/postpartum • Contraceptive patch risk of VTE has conflicting risks but still below the risk of pregnancy/postpartum • No good information on risks in patients with co-morbidities like hypertension, hypercholesterolemia, or diabetes • No safety information in women with BMI >40

  11. Contraceptive Benefits • Prevention of unplanned pregnancy in a high risk population • Hormonal contraception has been shown to decrease the risk of endometrial hyperplasia and cancer • OC’s reduce risk of Ovarian Cancer

  12. Contraception and Body Weight • Combined hormonal- no associated weight gain • Levonorgestrel-releasing IUD-small weight increase • Etonogestrol Implant-probably no increase • DepoMedroxyprogesterone acetate-more likely gain than loss, especially in obese teens • Non-hormonal-no weight increase • Non hormonal Contraception-no change in weight

  13. Contraceptive Points to Remember • CONTRACEPTION IS SAFER THAN PREGNANCY • Little information is available about safety of contraceptive use in women with a BMI=/> 40 kg/M2 • Pregnancy responsible for more permanent weight gain than contraception • Use of procedural methods highest in women with BMI > 25 • Hormonal contraception highest in women with BMI <25

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