Obesity and Emergency Contraception
ESC Congress Library. Carocha A. 05/28/14; 50537; A-122
Dr. Ana Carocha
Dr. Ana Carocha
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Abstract
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Objective: In many European countries, the prevalence of obesity has tripled in the last two decades. There are little data on efficacy of emergency contraception among overweight and obese women. Obesity may impact the bioavailability of hormonal contraception, including the hormonal methods of emergency contraception.


Design and Methods: The authors proposed to review the literature regarding the subject and to examine the effectiveness of emergency contraception in preventing unplanned pregnancies among women who are overweight or obese. A MEDLINECENTRAL, POPLINE and ClinicalTrials.gov search was performed in November 2013.


Results: We only found two studies that investigated the effects of obesity on the efficacy of emergency contraception.


Glasier et al. performed a meta-analysis including 3445 women and found that the use of levonorgestrel for emergency contraception in overweight and obese women was not associated with a significant reduction in pregnancy rate compared to no medication. Obese women treated with ulipristal acetate had a two-fold risk of pregnancy, while overweight women appeared to have no increase in risk.


Moreau and Trussell performed a pooled analysis of ulipristal acetate efficacy and found that obese women were twice as likely to experience an emergency contraception failure compared with nonobese women.


Conclusions: Copper intrauterine device may be the first option for these women, because it is more effective than oral emergency contraceptives and its effectiveness is not reduced in overweight and obese women. Regarding the use of ulipristal or levonorgestrel, the studies revealed that this may be less effective or not effective.


Nevertheless, more evidence is needed before specific recommendations can be made for obese women.

Objective: In many European countries, the prevalence of obesity has tripled in the last two decades. There are little data on efficacy of emergency contraception among overweight and obese women. Obesity may impact the bioavailability of hormonal contraception, including the hormonal methods of emergency contraception.


Design and Methods: The authors proposed to review the literature regarding the subject and to examine the effectiveness of emergency contraception in preventing unplanned pregnancies among women who are overweight or obese. A MEDLINECENTRAL, POPLINE and ClinicalTrials.gov search was performed in November 2013.


Results: We only found two studies that investigated the effects of obesity on the efficacy of emergency contraception.


Glasier et al. performed a meta-analysis including 3445 women and found that the use of levonorgestrel for emergency contraception in overweight and obese women was not associated with a significant reduction in pregnancy rate compared to no medication. Obese women treated with ulipristal acetate had a two-fold risk of pregnancy, while overweight women appeared to have no increase in risk.


Moreau and Trussell performed a pooled analysis of ulipristal acetate efficacy and found that obese women were twice as likely to experience an emergency contraception failure compared with nonobese women.


Conclusions: Copper intrauterine device may be the first option for these women, because it is more effective than oral emergency contraceptives and its effectiveness is not reduced in overweight and obese women. Regarding the use of ulipristal or levonorgestrel, the studies revealed that this may be less effective or not effective.


Nevertheless, more evidence is needed before specific recommendations can be made for obese women.

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