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Adipositas - Ursachen, Folgeerkrankungen, Therapie 2021; 15(02): 86-91
DOI: 10.1055/a-1426-9804
Review

Kontrazeption und Adipositas

Contraception and Obesity
Thomas Römer
Frauenklinik Evangelisches Klinikum Köln-Weyertal
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Zusammenfassung

Ziel Die Kontrazeption bei Patientinnen mit einer Adipositas stellt eine klinisch spezielle Situation dar. Das erhöhte Risiko für venöse Thrombembolien ist zu beachten. Außerdem können spezielle Nebenwirkungen von Kontrazeptionsmethoden auftreten, und auch die Sicherheit einzelner Kontrazeptionsmethoden ist eingeschränkt.

Methodik Selektive Literatursuche

Ergebnisse Bei Patientinnen mit einer Adipositas sind weitere Risikofaktoren für Thrombembolien zu erfassen, da sich hieraus oft Kontraindikationen ergeben, vor allem für die Anwendung kombinierter hormoneller Kontrazeptionsmethoden. Bei adipösen Patientinnen ist bei der Anwendung von Gestagenmonopräparaten häufiger mit Blutungsstörungen zu rechnen. Die Daten bezüglich der Wirksamkeit einzelner Methoden sind limitiert. Einschränkungen bestehen für das transdermale kontrazeptive Pflaster. Bei höhergradiger Adipositas empfehlen die Leitlinien die Anwendung einer Hormon- oder Kupferspirale. Nach bariatrischer Chirurgie bedürfen Frauen bis zu 18 Monate einer sicheren Kontrazeption. Nach Malabsorptionschirurgie sind orale Kontrazeptiva zu vermeiden.

Schlussfolgerungen Die Wahl der Kontrazeptionsmethode bei adipösen Patientinnen bedarf einer individuellen Lösung, die abhängig von den Risikofaktoren für Thrombembolien, der Wirksamkeit und den Nebenwirkungen ist. Für die Notfallkontrazeption sind auch gewichtsbedingte Einschränkungen zu beachten.

Abstract

Purpose Contraception in obese patients is a specific clinical situation. A higher risk of thromboembolism and specific side effects should be considered. The safety of some contraceptive methods can be limited.

Methods Selective literature search.

Results In obese patients the other risk factors of thromboembolism should be checked because in some situation COC are contraindicated. During the use of POP in obese patients a higher number of bleeding disorders can occured. The data of efficacy of different contraceptive methods in obesity are limited. The use of the transdermal contraceptive patch in obese patients is not safe. In obesity grade II or III the guidelines recommended the use of LNG-IUD or copper IUD. After bariatric surgery the patients need a safe contraception until 18 months. Oral contraceptives should be avoided after malabsorption surgery.

Conclusions In obese patients the selection of the contraceptive method need an individual decision dependent on the risk factors of thromboembolism, the efficacy and the side effects of the methods. The limitations according to the body weigth must be give attention in the use of emergency contraception.

Schlüsselwörter

Kontrazeption - Adipositas - Notfallkontrazeption - Bariatrische Chirurgie - Sicherheit

Key Words

Contraception - obesity - emergency contraception - bariatric surgery - efficacy


Publication History

Article published online:
29 June 2021

© 2021. Thieme. All rights reserved.

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