Is hormonal contraception safe in obese women - what preparations should we choose?
ESC Congress Library. Edelman A. May 30, 2014; 53372; S19.2 Disclosure(s): This is noted on one of my slides
Assoc. Prof. Alison Edelman
Assoc. Prof. Alison Edelman
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Learning Objectives
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1. Be familiar with the evidence regarding obesity and hormonal contraception
2. Identify effective contraceptive methods for obese women
3. Review the pharmacokinetic changes caused by obesity
Obesity complicates many aspects of reproductive health care including contraception. However, since obesity also increases risks associated with pregnancy, a careful discussion of risks and benefits of hormonal contraception is an essential part of preventative care. Obesity may increase the risk of failure of some hormonal methods. Two mechanisms may be responsible for an observed increase on failure in some studies. The first is poor compliance, and the strong correlation of low socio-economic status with obesity in many areas (particularly in the United States) may influence this association. More importantly, obesity alters the pharmacokinetics of hormonal contraception. This is manifest chiefly as an increase in the time to reach steady state with standard and emergency use of oral contraception. Obesity is also an important risk factor for thromboembolic complications. For this reason, a careful clinical evaluation is essential prior to prescribing estrogen-based contraceptive in obese women. Oral progestogen-only methods offer an alternative to combined methods, but less is known about pharmacokinetic effects. Long acting reversible hormonal methods offer many advantages. An approach to contraceptive management of the obese woman will be discussed.
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