Overview of contraception in obesity
Effective contraception is important for individuals with obesity because unplanned pregnancy is associated with significant health risks. Challenges include:
- increased risk of venous thromboembolism (VTE) with combined hormonal contraception
- malabsorption of oral formulations after bariatric surgery
- potential exacerbation of weight gain by depot medroxyprogesterone
- reduction in bone mineral density by depot medroxyprogesterone, which may compound bone loss due to malabsorption after bariatric surgery
- reduced effectiveness of emergency hormonal contraception.
The etonogestrel implant and levonorgestrel-releasing and copper intrauterine contraceptive devices (IUDs) are effective and safe methods of contraception for individuals with obesity. Depot medroxyprogesterone is a second-line option.
Note: The etonogestrel implant and levonorgestrel-releasing and copper IUDs provide effective contraception in individuals with obesity.
IUDs should ideally be inserted by an experienced practitioner, because visualising the cervix, accessing the uterus and managing a vasovagal episode can be difficult in individuals with obesity.