Combined Hormonal Contraceptive (CHC) Use Among Obese Women and Contraceptive Effectiveness: a Systematic Review

Overview

Journal Contraception

Publisher Elsevier

Specialty Reproductive Medicine

Date 2016 Nov 9

PMID 27823942

Citations 7

Authors

Monica V Dragoman

Katharine B Simmons

Melissa E Paulen

Kathryn M Curtis

Affiliations

Soon will be listed here.

Abstract

Objective: To evaluate from the literature whether combined hormonal contraception (CHC), including combined oral contraception pills (COCs), transdermal patch, vaginal ring or combined injectables, have different effectiveness or failure rates by body weight or body mass index (BMI).

Study Design: We searched PubMed and the Cochrane Library databases for all articles in all languages published between inception and February 2016, for evidence relevant to body weight or BMI, CHC use and contraceptive effectiveness. The quality of each individual study was assessed using the system for evaluating evidence developed by the United States Preventive Services Task Force.

Results: From 2874 articles, we identified 15 reports for inclusion, all of fair to poor quality. Fourteen studies measured the association of obesity status and contraceptive failure among COC users. Three fair quality and one poor quality study reported increased COC failure among a heterogeneous population of overweight and obese women compared with normal weight women, while eight fair quality and two poor quality studies did not find an association. Two fair quality studies reported on contraceptive transdermal patches. One pooled analysis described a higher proportion of pregnancies among women using the patch who weighed ≥90 kg; another secondary analysis suggested BMI>30 was associated with increased failure. No studies directly compared contraceptive effectiveness using the combined vaginal ring or combined injectable.

Conclusion: Current available evidence addressing the risk of CHC failure in obese compared to normal weight women is limited to fair and poor quality studies. Studies of COCs show mixed results, though absolute differences in COC failure by body weight and BMI are small. Based on limited evidence, it appears that increasing body weight and BMI may contribute to decreasing contraceptive patch effectiveness.

Citing Articles

U.S. Medical Eligibility Criteria for Contraceptive Use, 2024.

Nguyen A, Curtis K, Tepper N, Kortsmit K, Brittain A, Snyder E MMWR Recomm Rep. 2024; 73(4):1-126.

PMID: 39106314 PMC: 11315372. DOI: 10.15585/mmwr.rr7304a1.

Hormonal therapies in females with blood disorders: thrombophilia, thrombosis, hemoglobinopathies, and anemias.

Baldwin M, Samuelson Bannow B, Rosovsky R, Sokkary N, Srivaths L Res Pract Thromb Haemost. 2023; 7(4):100161.

PMID: 37274174 PMC: 10238261. DOI: 10.1016/j.rpth.2023.100161.

[Contraception in adolescents with obesity and diabetes mellitus].

Shaydullina M, Valeeva F, Soubchankoulova A, Khusieva P Probl Endokrinol (Mosk). 2023; 68(6):137-145.

PMID: 36689719 PMC: 9939967. DOI: 10.14341/probl12760.

Contraception for Adolescents and Young Women with Type 2 Diabetes-Specific Considerations.

Merino P, Codner E Curr Diab Rep. 2022; 22(2):77-84.

PMID: 35150410 DOI: 10.1007/s11892-022-01448-1.

Contraceptive use among women through their later reproductive years: Findings from an Australian prospective cohort study.

Harris M, Egan N, Forder P, Coombe J, Loxton D PLoS One. 2021; 16(8):e0255913.

PMID: 34379661 PMC: 8357106. DOI: 10.1371/journal.pone.0255913.

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