Hormonal Contraceptives: Obesity

Daily practice issues are:

  • Are
    • Hormonal contraceptives (birth control pills) associated with weight gain?
    • Hormonal contraceptives safe in obesity (overweight)?
    • The emergency contraceptives in obesity safe?

Body weight

Combined oral contraceptives (COCs; contraceptives containing estrogen and progestin) and progestin monocontraceptives have no significant effect on body weight or body mass index (BMI; body mass index).

  • Exception
    • Long-term use of depot medroxyprogesterone acetate. Long-term use increases body weight.

Obesity

Obesity/Pearl IndexThe contraceptive effect is usually guaranteed with hormonal contraceptives.

  • Limitation:
    • In obesity grade II (BMI: 35-39.9) and III (BMI: > 40), data are conflicting. Efficacy may be limited with a combined contraceptive (hormonal) patch.

Recommendation: in obesity grade II or III, an IUD (intrauterine device; coil) should be used.

Obesity/emergency contraception

With a BMI ≥ 30, the efficacy.

  • Significantly limited with levonorgestrel
  • Questionably reduced with ulipristal acetate

Recommendation: copper IUD (copper IUD).