Best Practice Contraception Care for Women with Obesity: A Review of Current Evidence

Abstract

The prevalence of obesity among females of reproductive age is increasing globally. Access to the complete range of appropriate contraceptive options is essential for upholding the reproductive rights of this population group. People with obesity can experience stigma and discrimination when seeking healthcare, and despite limited evidence for provider bias in the context of contraception, awareness for its potential at an individual provider and health systems level is essential. While use of some hormonal contraceptives may be restricted due to increased health risks in people with obesity, some methods provide noncontraceptive benefits including a reduced risk of endometrial cancer and a reduction in heavy menstrual bleeding which are more prevalent among individuals with obesity. In addition to examining systems-based approaches which facilitate the provision of inclusive contraceptive care, including long-acting reversible contraceptives which require procedural considerations, this article reviews current evidence on method-specific advantages and disadvantages for people with obesity to guide practice and policy.

Keywords

obesity - contraception - contraceptive failure - contraceptive safety - contraceptive benefits

Publikationsverlauf

Artikel online veröffentlicht:
06. Februar 2023

• References

• 1 World Health Statistics 2021: Monitoring Health for the SDGs, Sustainable Development Goals. Geneva: World Health Organisation; 2021
• 2 Obesity in Pregnancy. ACOG Practice Bulletin, Number 230. Obstet Gynecol 2021;137(06):
• 3 Burger T, Li J, Zhao Q. et al. Association of obesity with longer time to pregnancy. Obstet Gynecol 2022; 139 (04) 554-560
• 4 McKeating A, O'Higgins A, Turner C, McMahon L, Sheehan SR, Turner MJ. The relationship between unplanned pregnancy and maternal body mass index 2009-2012. Eur J Contracept Reprod Health Care 2015; 20 (06) 409-418
• 5 UK Medical Eligibility Criteria for Contraceptive Use (UKMEC). . Faculty of Sexual & Reproductive Healthcare. Clinical Effectiveness Unit; 2016 [updated September 2019; cited July 2, 2022]. Accessed December 5, 2022 at: https://www.fsrh.org/standards-and-guidance/documents/ukmec-2016/fsrh-ukmec-full-book-2019.pdf
• 6 Flink-Bochacki R, Flaum S, Betstadt SJ. Barriers and outcomes associated with unfulfilled requests for permanent contraception following vaginal delivery. Contraception 2019; 99 (02) 98-103
• 7 Flint S. Obesity stigma: prevalence and impact in healthcare. Br J Obes 2015; 1 (01) 14-18
• 8 Amy NK, Aalborg A, Lyons P, Keranen L. Barriers to routine gynecological cancer screening for White and African-American obese women. Int J Obes 2006; 30 (01) 147-155
• 9 Shaw E, Farris M, McNeil J, Friedenreich C. Obesity and endometrial cancer. Recent Results Cancer Res 2016; 208: 107-136
• 10 Janssen I, Katzmarzyk PT, Ross R. Waist circumference and not body mass index explains obesity-related health risk. Am J Clin Nutr 2004; 79 (03) 379-384
• 11 Guasch-Ferré M, Bulló M, Martínez-González MÁ. et al. Waist-to-height ratio and cardiovascular risk factors in elderly individuals at high cardiovascular risk. PLoS One 2012; 7 (08) e43275
• 12 Brambilla P, Bedogni G, Heo M, Pietrobelli A. Waist circumference-to-height ratio predicts adiposity better than body mass index in children and adolescents. Int J Obes 2013; 37 (07) 943-946
• 13 Schneider HJ, Friedrich N, Klotsche J. et al. The predictive value of different measures of obesity for incident cardiovascular events and mortality. J Clin Endocrinol Metab 2010; 95 (04) 1777-1785
• 14 Zhu L, Yang WJ, Spence CB, Bhimla A, Ma GX. Lean yet unhealthy: Asian American adults had higher risks for metabolic syndrome than non-Hispanic White adults with the same body mass index: evidence from NHANES 2011-2016. Healthcare (Basel) 2021; 9 (11) 1518
• 15 Goossens J, Van Den Branden Y, Van der Sluys L. et al. The prevalence of unplanned pregnancy ending in birth, associated factors, and health outcomes. Hum Reprod 2016; 31 (12) 2821-2833
• 16 Ralph LJ, Foster DG, Rocca CH. Comparing prospective and retrospective reports of pregnancy intention in a longitudinal cohort of U.S. women. Perspect Sex Reprod Health 2020; 52 (01) 39-48
• 17 Kaneshiro B, Edelman A, Carlson N, Nichols M, Jensen J. The relationship between body mass index and unintended pregnancy: results from the 2002 National Survey of Family Growth. Contraception 2008; 77 (04) 234-238
• 18 Bajos N, Wellings K, Laborde C, Moreau C. CSF Group. Sexuality and obesity, a gender perspective: results from French national random probability survey of sexual behaviours. BMJ 2010; 340: c2573
• 19 Ayoola AB. Late recognition of unintended pregnancies. Public Health Nurs 2015; 32 (05) 462-470
• 20 Foster DG, Jackson RA, Cosby K, Weitz TA, Darney PD, Drey EA. Predictors of delay in each step leading to an abortion. Contraception 2008; 77 (04) 289-293
• 21 Murphy LA, Thornburg LL, Glantz JC, Wasserman EC, Stanwood NL, Betstadt SJ. Complications of surgical termination of second-trimester pregnancy in obese versus nonobese women. Contraception 2012; 86 (04) 402-406
• 22 Lederle L, Steinauer JE, Montgomery A, Aksel S, Drey EA, Kerns JL. Obesity as a risk factor for complications after second-trimester abortion by dilation and evacuation. Obstet Gynecol 2015; 126 (03) 585-592
• 23 Benson LS, Micks EA, Ingalls C, Prager SW. Safety of outpatient surgical abortion for obese patients in the first and second trimesters. Obstet Gynecol 2016; 128 (05) 1065-1070
• 24 Mark KS, Bragg B, Talaie T, Chawla K, Murphy L, Terplan M. Risk of complication during surgical abortion in obese women. Am J Obstet Gynecol 2018; 218 (02) 238.e1-238.e5
• 25 Melchor I, Burgos J, Del Campo A, Aiartzaguena A, Gutiérrez J, Melchor JC. Effect of maternal obesity on pregnancy outcomes in women delivering singleton babies: a historical cohort study. J Perinat Med 2019; 47 (06) 625-630
• 26 Broughton DE, Moley KH. Obesity and female infertility: potential mediators of obesity's impact. Fertil Steril 2017; 107 (04) 840-847
• 27 Wang M, Yang X, Li L. et al. Incidence and risk factors for early pregnancy loss in women with first pregnancy undergoing in vitro fertilization-embryo transfer. BMC Pregnancy Childbirth 2022; 22 (01) 575
• 28 Magnus MC, Hockey RL, Håberg SE, Mishra GD. Pre-pregnancy lifestyle characteristics and risk of miscarriage: the Australian Longitudinal Study on Women's Health. BMC Pregnancy Childbirth 2022; 22 (01) 169
• 29 Maged AM, Fahmy RM, Rashwan H. et al. Effect of body mass index on the outcome of IVF cycles among patients with poor ovarian response. Int J Gynaecol Obstet 2019; 144 (02) 161-166
• 30 Mechanick JI, Youdim A, Jones DB. et al; American Association of Clinical Endocrinologists, Obesity Society, American Society for Metabolic & Bariatric Surgery. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient–2013 update: cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity (Silver Spring) 2013; 21 (01, Suppl 1): S1-S27
• 31 Micic DD, Toplak H, Micic DD, Polovina SP. Reproductive outcomes after bariatric surgery in women. Wien Klin Wochenschr 2022; 134 (1-2): 56-62
• 32 Steffen KJ, King WC, White GE. et al. Changes in sexual functioning in women and men in the 5 years after bariatric surgery. JAMA Surg 2019; 154 (06) 487-498
• 33 Thornton O, Daggett E, Zia L. et al. Counseling, contraception, and conception rates in patients undergoing bariatric surgery: a retrospective review. Contraception 2021; 104 (02) 202-205
• 34 Moreira de Brito C, de Melo ME, Mancini MC, Santo MA, Cercato C. Pharmacokinetics of oral levonorgestrel and ethinylestradiol in women after Roux-en-Y gastric bypass surgery. Surg Obes Relat Dis 2021; 17 (04) 673-681
• 35 Medical Eligibility Criteria for Contraceptive Use. . Geneva: World Health Organisation; 2015 [cited July 2, 2022]. 2015. Accessed December 5, 2022 at: https://apps.who.int/iris/rest/bitstreams/1243459/retrieve
• 36 Curtis KM, Tepper NK, Jatlaoui TC. et al. U.S. medical eligibility criteria for contraceptive use, 2016. MMWR Recomm Rep 2016; 65 (03) 1-103
• 37 Guerciolini R. Mode of action of orlistat. Int J Obes Relat Metab Disord 1997; 21 (Suppl. 03) S12-S23
• 38 Hartmann D, Güzelhan C, Zuiderwijk PB, Odink J. Lack of interaction between orlistat and oral contraceptives. Eur J Clin Pharmacol 1996; 50 (05) 421-424
• 39 FSRH Guideline. Drug Interactions with Hormonal Contraception: Faculty of Sexual & Reproductive Healthcare Statement. Clinical Effectiveness Unit; 2017 [cited July 2, 2022]. January 2019. Accessed December 5, 2022 at: https://www.fsrh.org/standards-and-guidance/documents/ceu-clinical-guidance-drug-interactions-with-hormonal/
• 40 Lazorwitz A, Pena M, Sheeder J, Teal S. Effect of topiramate on serum etonogestrel concentrations among contraceptive implant users. Obstet Gynecol 2022; 139 (04) 579-587
• 41 Jacobsen LV, Vouis J, Hindsberger C, Zdravkovic M. Treatment with liraglutide–a once-daily GLP-1 analog–does not reduce the bioavailability of ethinyl estradiol/levonorgestrel taken as an oral combination contraceptive drug. J Clin Pharmacol 2011; 51 (12) 1696-1703
• 42 Treasure J, Duarte TA, Schmidt U. Eating disorders. Lancet 2020; 395 (10227): 899-911
• 43 FSRH Guideline. Combined Hormonal Contraception: Faculty of Sexual & Reproductive Healthcare Statement. Clinical Effectiveness Unit; 2019 [cited July 2, 2022]. January 2019. Accessed December 5, 2022 at: https://www.fsrh.org/standards-and-guidance/documents/combined-hormonal-contraception/
• 44 Bhuva K, Kraschnewski JL, Lehman EB, Chuang CH. Does body mass index or weight perception affect contraceptive use?. Contraception 2017; 95 (01) 59-64
• 45 Rowlands IJ, Mishra GD, Lucke JC. Association between young women's physical and mental health and their method of contraception in a longitudinal, population-based study. BMJ Sex Reprod Health 2021; 47 (02) 129-136
• 46 Mosher WD, Lantos H, Burke AE. Obesity and contraceptive use among women 20-44 years of age in the United States: results from the 2011-15 National Survey of Family Growth (NSFG). Contraception 2018; 97 (05) 392-398
• 47 Schraudenbach A, McFall S. Contraceptive use and contraception type in women by body mass index category. Womens Health Issues 2009; 19 (06) 381-389
• 48 Jatlaoui TC, Zapata LB, Curtis KM. et al. Healthcare provider attitudes regarding contraception for women with obesity. J Womens Health (Larchmt) 2017; 26 (08) 870-877
• 49 Wolin KY, Carson K, Colditz GA. Obesity and cancer. Oncologist 2010; 15 (06) 556-565
• 50 Reavey JJ, Walker C, Murray AA. et al. Obesity is associated with heavy menstruation that may be due to delayed endometrial repair. J Endocrinol 2021; 249 (02) 71-82
• 51 Joham AE, Norman RJ, Stener-Victorin E. et al. Polycystic ovary syndrome. Lancet Diabetes Endocrinol 2022; 10 (09) 668-680
• 52 Gilbert EW, Tay CT, Hiam DS, Teede HJ, Moran LJ. Comorbidities and complications of polycystic ovary syndrome: an overview of systematic reviews. Clin Endocrinol (Oxf) 2018; 89 (06) 683-699
• 53 Li Z, Wang YH, Wang LL. et al. Polycystic ovary syndrome and the risk of endometrial, ovarian and breast cancer: an updated meta-analysis. Scott Med J 2022; 67 (03) 109-120
• 54 Teede HJ, Misso ML, Costello MF. et al; International PCOS Network. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Fertil Steril 2018; 110 (03) 364-379
• 55 Azziz R, Carmina E, Chen Z. et al. Polycystic ovary syndrome. Nat Rev Dis Primers 2016; 2: 16057
• 56 Grunloh DS, Casner T, Secura GM, Peipert JF, Madden T. Characteristics associated with discontinuation of long-acting reversible contraception within the first 6 months of use. Obstet Gynecol 2013; 122 (06) 1214-1221
• 57 Romano ME, Braun-Courville DK. Assessing weight status in adolescent and young adult users of the etonogestrel contraceptive implant. J Pediatr Adolesc Gynecol 2019; 32 (04) 409-414
• 58 Gallo MF, Lopez LM, Grimes DA, Carayon F, Schulz KF, Helmerhorst FM. Combination contraceptives: effects on weight. Cochrane Database Syst Rev 2014; (01) CD003987
• 59 Lopez LM, Ramesh S, Chen M. et al. Progestin-only contraceptives: effects on weight. Cochrane Database Syst Rev 2016; 2016 (08) CD008815
• 60 FSRH CEU Statement: Contraception and Weight Gain: Faculty of Sexual & Reproductive Health. Clinical Effectiveness Unit; 2019 [cited July 2, 2022]. Accessed December 5, 2022 at: https://www.fsrh.org/documents/fsrh-ceu-statement-contraception-and-weight-gain-august-2019/
• 61 Bonny AE, Secic M, Cromer B. Early weight gain related to later weight gain in adolescents on depot medroxyprogesterone acetate. Obstet Gynecol 2011; 117 (04) 793-797
• 62 Bonny AE, Ziegler J, Harvey R, Debanne SM, Secic M, Cromer BA. Weight gain in obese and nonobese adolescent girls initiating depot medroxyprogesterone, oral contraceptive pills, or no hormonal contraceptive method. Arch Pediatr Adolesc Med 2006; 160 (01) 40-45
• 63 Le YL, Rahman M, Berenson AB. Early weight gain predicting later weight gain among depot medroxyprogesterone acetate users. Obstet Gynecol 2009; 114 (2, Pt 1): 279-284
• 64 Scott N, Silver EJ, Dodson NA, Coupey SM. Does obesity influence body mass index changes in nulliparous adolescent users of long-acting reversible contraceptives?. J Pediatr Adolesc Gynecol 2021; 34 (06) 815-820
• 65 Yang G, De Staercke C, Hooper WC. The effects of obesity on venous thromboembolism: a review. Open J Prev Med 2012; 2 (04) 499-509
• 66 Stein PD, Beemath A, Olson RE. Obesity as a risk factor in venous thromboembolism. Am J Med 2005; 118 (09) 978-980
• 67 Zuurbier SM, Arnold M, Middeldorp S. et al. Risk of cerebral venous thrombosis in obese women. JAMA Neurol 2016; 73 (05) 579-584
• 68 Reed S, Koro C, DiBello J. et al. Prospective controlled cohort study on the safety of a monophasic oral contraceptive containing nomegestrol acetate (2.5 mg) and 17β-oestradiol (1.5 mg) (PRO-E2 study): risk of venous and arterial thromboembolism. Eur J Contracept Reprod Health Care 2021; 26 (06) 439-446
• 69 Dinger J, Möhner S, Heinemann K. Combined oral contraceptives containing dienogest and estradiol valerate may carry a lower risk of venous and arterial thromboembolism compared to conventional preparations: results from the extended INAS-SCORE study. Front Womens Health 2020; 5 (01) 8
• 70 Jick SS. Fresh evidence confirms links between newer contraceptive pills and higher risk of venous thromboembolism. BMJ 2015; 350: h2422
• 71 Lidegaard Ø, Nielsen LH, Skovlund CW, Skjeldestad FE, Løkkegaard E. Risk of venous thromboembolism from use of oral contraceptives containing different progestogens and oestrogen doses: Danish cohort study, 2001-9. BMJ 2011; 343: d6423
• 72 FSRH Guideline. Overweight, Obesity & Contraception: Faculty of Sexual & Reproductive Healthcare Statement. Clinical Effectiveness Unit; 2019 [cited July 2, 2022]. Accessed December 5, 2022 at: https://www.fsrh.org/standards-and-guidance/documents/fsrh-clinical-guideline-overweight-obesity-and-contraception/1overweight-obesity-and-contraception-guideline-april-2019.pdf
• 73 Tepper NK, Whiteman MK, Marchbanks PA, James AH, Curtis KM. Progestin-only contraception and thromboembolism: a systematic review. Contraception 2016; 94 (06) 678-700
• 74 Tepper NK, Jeng G, Curtis KM, Boutot ME, Boulet SL, Whiteman MK. Venous thromboembolism among women initiating depot medroxyprogesterone acetate immediately postpartum. Obstet Gynecol 2019; 133 (03) 533-540
• 75 Zhu J, Su X, Li G, Chen J, Tang B, Yang Y. The incidence of acute myocardial infarction in relation to overweight and obesity: a meta-analysis. Arch Med Sci 2014; 10 (05) 855-862
• 76 Strazzullo P, D'Elia L, Cairella G, Garbagnati F, Cappuccio FP, Scalfi L. Excess body weight and incidence of stroke: meta-analysis of prospective studies with 2 million participants. Stroke 2010; 41 (05) e418-e426
• 77 Roach RE, Helmerhorst FM, Lijfering WM, Stijnen T, Algra A, Dekkers OM. Combined oral contraceptives: the risk of myocardial infarction and ischemic stroke. Cochrane Database Syst Rev 2015; 2015 (08) CD011054
• 78 Horton LG, Simmons KB, Curtis KM. Combined hormonal contraceptive use among obese women and risk for cardiovascular events: a systematic review. Contraception 2016; 94 (06) 590-604
• 79 Shepherd R, Raker CA, Savella GM, Du N, Matteson KA, Allen RH. The effect of obesity on intraoperative complication rates with hysteroscopic compared to laparoscopic sterilization: a retrospective cohort study. Contracept Reprod Med 2016; 1: 1
• 80 Shepherd R, Raker CA, Du NR, Savella GM, Matteson KA, Allen RH. Interval surgical sterilization and obesity. Obstet Gynecol 2014; 123: 14S
• 81 Dragoman MV, Gaffield ME. The safety of subcutaneously administered depot medroxyprogesterone acetate (104 mg/0.65 mL): a systematic review. Contraception 2016; 94 (03) 202-215
• 82 Winner B, Peipert JF, Zhao Q. et al. Effectiveness of long-acting reversible contraception. N Engl J Med 2012; 366 (21) 1998-2007
• 83 Implanon NXT. (Etonogestrel) USA approved product information. Organon Global Inc; 2021
• 84 Implanon NXT. (Etonogestrel) Australia approved product information. Organon Pharma Inc; 2021
• 85 Nexaplon UK Product information. Organon Pharma (UK) Ltd; 2022
• 86 Huber J, Wenzl R. Pharmacokinetics of Implanon. An integrated analysis. Contraception 1998; 58 (6, Suppl): 85S-90S
• 87 Ciangura C, Corigliano N, Basdevant A. et al. Etonorgestrel concentrations in morbidly obese women following Roux-en-Y gastric bypass surgery: three case reports. Contraception 2011; 84 (06) 649-651
• 88 McNicholas C, Maddipati R, Zhao Q, Swor E, Peipert JF. Use of the etonogestrel implant and levonorgestrel intrauterine device beyond the U.S. Food and Drug Administration-approved duration. Obstet Gynecol 2015; 125 (03) 599-604
• 89 Morrell KM, Cremers S, Westhoff CL, Davis AR. Relationship between etonogestrel level and BMI in women using the contraceptive implant for more than 1 year. Contraception 2016; 93 (03) 263-265
• 90 Lopez LM, Bernholc A, Chen M. et al. Hormonal contraceptives for contraception in overweight or obese women. Cochrane Database Syst Rev 2016; 2016 (08) CD008452
• 91 Xu H, Wade JA, Peipert JF, Zhao Q, Madden T, Secura GM. Contraceptive failure rates of etonogestrel subdermal implants in overweight and obese women. Obstet Gynecol 2012; 120 (01) 21-26
• 92 Graesslin O, Korver T. The contraceptive efficacy of Implanon: a review of clinical trials and marketing experience. Eur J Contracept Reprod Health Care 2008; 13 (1, Suppl 1): 4-12
• 93 FSRH Guideline Progestogen-only Implant. Faculty of Sexual & Reproductive Healthcare. Clinical Effectiveness Unit; 2021 [cited July 2, 2022]. Accessed December 5, 2022 at: https://www.fsrh.org/standards-and-guidance/documents/cec-ceu-guidance-implants-feb-2014/
• 94 Sivin I, Wan L, Ranta S. et al. Levonorgestrel concentrations during 7 years of continuous use of Jadelle contraceptive implants. Contraception 2001; 64 (01) 43-49
• 95 Jadelle. (Levonorgestrel) USA approved product information. Bayer OY: 2016
• 96 Sundaram A, Vaughan B, Kost K. et al. Contraceptive failure in the United States: estimates from the 2006-2010 National Survey of Family Growth. Perspect Sex Reprod Health 2017; 49 (01) 7-16
• 97 Fotherby K, Koetsawang S. Metabolism of injectable formulations of contraceptive steroids in obese and thin women. Contraception 1982; 26 (01) 51-58
• 98 Smit J, Botha J, McFadyen L, Beksinska M. Serum medroxyprogesterone acetate levels in new and repeat users of depot medroxyprogesterone acetate at the end of the dosing interval. Contraception 2004; 69 (01) 3-7
• 99 Progestogen-Only Injectable contraception: Faculty of Sexual & Reproductive Healthcare Statement. Clinical Effectiveness Unit; 2019 [cited July 2, 2022]. Accessed December 5, 2022 at: https://www.fsrh.org/standards-and-guidance/documents/cec-ceu-guidance-injectables-dec-2014/
• 100 Dianat S, Fox E, Ahrens KA. et al. Side effects and health benefits of depot medroxyprogesterone acetate: a systematic review. Obstet Gynecol 2019; 133 (02) 332-341
• 101 Küçük T, Ertan K. Continuous oral or intramuscular medroxyprogesterone acetate versus the levonorgestrel releasing intrauterine system in the treatment of perimenopausal menorrhagia: a randomized, prospective, controlled clinical trial in female smokers. Clin Exp Obstet Gynecol 2008; 35 (01) 57-60
• 102 Heinemann K, Reed S, Moehner S, Minh TD. Comparative contraceptive effectiveness of levonorgestrel-releasing and copper intrauterine devices: the European Active Surveillance Study for Intrauterine Devices. Contraception 2015; 91 (04) 280-283
• 103 Jareid M, Thalabard JC, Aarflot M, Bøvelstad HM, Lund E, Braaten T. Levonorgestrel-releasing intrauterine system use is associated with a decreased risk of ovarian and endometrial cancer, without increased risk of breast cancer. Results from the NOWAC Study. Gynecol Oncol 2018; 149 (01) 127-132
• 104 Felix AS, Gaudet MM, La Vecchia C. et al. Intrauterine devices and endometrial cancer risk: a pooled analysis of the Epidemiology of Endometrial Cancer Consortium. Int J Cancer 2015; 136 (05) E410-E422
• 105 Mittermeier T, Farrant C, Wise MR. Levonorgestrel-releasing intrauterine system for endometrial hyperplasia. Cochrane Database Syst Rev 2020; 9 (09) CD012658
• 106 Pal N, Broaddus RR, Urbauer DL. et al. Treatment of low-risk endometrial cancer and complex atypical hyperplasia with the levonorgestrel-releasing intrauterine device. Obstet Gynecol 2018; 131 (01) 109-116
• 107 Iversen L, Sivasubramaniam S, Lee AJ, Fielding S, Hannaford PC. Lifetime cancer risk and combined oral contraceptives: the Royal College of General Practitioners' Oral Contraception Study. Am J Obstet Gynecol 2017; 216 (06) 580.e1-580.e9
• 108 Lethaby A, Wise MR, Weterings MAJ, Bofill Rodriguez M, Brown J. Combined hormonal contraceptives for heavy menstrual bleeding. Cochrane Database Syst Rev 2019; 2 (02) CD000154
• 109 Barrionuevo P, Nabhan M, Altayar O. et al. Treatment options for hirsutism: a systematic review and network meta-analysis. J Clin Endocrinol Metab 2018; 103 (04) 1258-1264
• 110 Arowojolu AO, Gallo MF, Lopez LM, Grimes DA. Combined oral contraceptive pills for treatment of acne. Cochrane Database Syst Rev 2012; 7: CD004425
• 111 Dragoman MV, Simmons KB, Paulen ME, Curtis KM. Combined hormonal contraceptive (CHC) use among obese women and contraceptive effectiveness: a systematic review. Contraception 2017; 95 (02) 117-129
• 112 Jick SS, Hagberg KW, Kaye JA, Jick H. The risk of unintended pregnancies in users of the contraceptive patch compared to users of oral contraceptives in the UK General Practice Research Database. Contraception 2009; 80 (02) 142-151
• 113 Brunner Huber LR, Hogue CJ, Stein AD, Drews C, Zieman M. Body mass index and risk for oral contraceptive failure: a case-cohort study in South Carolina. Ann Epidemiol 2006; 16 (08) 637-643
• 114 Schramm GA, Schrah G. The efficacy and safety of an oral contraceptive containing chlormadinone acetate: results of a pooled analysis of noninterventional trials in adult and adolescent women. Contraception 2011; 84 (04) 390-401
• 115 Nakajima ST, Pappadakis J, Archer DF. Body mass index does not affect the efficacy or bleeding profile during use of an ultra-low-dose combined oral contraceptive. Contraception 2016; 93 (01) 52-57
• 116 Burkman RT, Fisher AC, Wan GJ, Barnowski CE, LaGuardia KD. Association between efficacy and body weight or body mass index for two low-dose oral contraceptives. Contraception 2009; 79 (06) 424-427
• 117 Westhoff CL, Hait HI, Reape KZ. Body weight does not impact pregnancy rates during use of a low-dose extended-regimen 91-day oral contraceptive. Contraception 2012; 85 (03) 235-239
• 118 Vessey M. Oral contraceptive failures and body weight: findings in a large cohort study. J Fam Plann Reprod Health Care 2001; 27 (02) 90-91
• 119 Dinger JC, Cronin M, Möhner S, Schellschmidt I, Minh TD, Westhoff C. Oral contraceptive effectiveness according to body mass index, weight, age, and other factors. Am J Obstet Gynecol 2009; 201 (03) 263.e1-263.e9
• 120 Brunner Huber LR, Toth JL. Obesity and oral contraceptive failure: findings from the 2002 National Survey of Family Growth. Am J Epidemiol 2007; 166 (11) 1306-1311
• 121 Brunner LR, Hogue CJ. The role of body weight in oral contraceptive failure: results from the 1995 national survey of family growth. Ann Epidemiol 2005; 15 (07) 492-499
• 122 Edelman AB, Carlson NE, Cherala G. et al. Impact of obesity on oral contraceptive pharmacokinetics and hypothalamic-pituitary-ovarian activity. Contraception 2009; 80 (02) 119-127
• 123 Yamazaki M, Dwyer K, Sobhan M. et al. Effect of obesity on the effectiveness of hormonal contraceptives: an individual participant data meta-analysis. Contraception 2015; 92 (05) 445-452
• 124 Zieman M, Guillebaud J, Weisberg E, Shangold GA, Fisher AC, Creasy GW. Contraceptive efficacy and cycle control with the Ortho Evra/Evra transdermal system: the analysis of pooled data. Fertil Steril 2002; 77 (2, Suppl 2): S13-S18
• 125 Nelson AL, Kaunitz AM, Kroll R. et al; SECURE Investigators. Efficacy, safety, and tolerability of a levonorgestrel/ethinyl estradiol transdermal delivery system: Phase 3 clinical trial results. Contraception 2021; 103 (03) 137-143
• 126 Westhoff C. Higher body weight does not affect Nuvaring's efficacy. Obstet Gynecol 2005; 105 (4, Suppl): 56S
• 127 Dragoman M, Petrie K, Torgal A, Thomas T, Cremers S, Westhoff CL. Contraceptive vaginal ring effectiveness is maintained during 6 weeks of use: a prospective study of normal BMI and obese women. Contraception 2013; 87 (04) 432-436
• 128 Westhoff CL, Torgal AH, Mayeda ER. et al. Pharmacokinetics and ovarian suppression during use of a contraceptive vaginal ring in normal-weight and obese women. Am J Obstet Gynecol 2012; 207 (01) 39.e1-39.e6
• 129 Archer DF, Merkatz RB, Bahamondes L. et al. Efficacy of the 1-year (13-cycle) segesterone acetate and ethinylestradiol contraceptive vaginal system: results of two multicentre, open-label, single-arm, phase 3 trials. Lancet Glob Health 2019; 7 (08) e1054-e1064
• 130 Progestogen-Only Pills. Faculty of Sexual & Reproductive Healthcare. Clinical Effectiveness Unit; 2019 [updated January 2016; cited July 2, 2022]. Accessed December 5, 2022 at: https://www.fsrh.org/standards-and-guidance//documents/cec-ceu-guidance-pop-mar-2015/
• 131 McCann MF, Potter LS. Progestin-only oral contraception: a comprehensive review. Contraception 1994; 50 (6, Suppl 1): S1-S195
• 132 Kimble T, Burke AE, Barnhart KT, Archer DF, Colli E, Westhoff CL. A 1-year prospective, open-label, single-arm, multicenter, phase 3 trial of the contraceptive efficacy and safety of the oral progestin-only pill drospirenone 4 mg using a 24/4-day regimen. Contracept X 2020; 2: 100020
• 133 Cleland K, Zhu H, Goldstuck N, Cheng L, Trussell J. The efficacy of intrauterine devices for emergency contraception: a systematic review of 35 years of experience. Hum Reprod 2012; 27 (07) 1994-2000
• 134 Kapp N, Abitbol JL, Mathé H. et al. Effect of body weight and BMI on the efficacy of levonorgestrel emergency contraception. Contraception 2015; 91 (02) 97-104
• 135 Natavio M, Stanczyk FZ, Molins EAG, Nelson A, Jusko WJ. Pharmacokinetics of the 1.5 mg levonorgestrel emergency contraceptive in women with normal, obese and extremely obese body mass index. Contraception 2019; 99 (05) 306-311
• 136 Praditpan P, Hamouie A, Basaraba CN. et al. Pharmacokinetics of levonorgestrel and ulipristal acetate emergency contraception in women with normal and obese body mass index. Contraception 2017; 95 (05) 464-469
• 137 Jatlaoui TC, Curtis KM. Safety and effectiveness data for emergency contraceptive pills among women with obesity: a systematic review. Contraception 2016; 94 (06) 605-611
• 138 Festin MP, Peregoudov A, Seuc A, Kiarie J, Temmerman M. Effect of BMI and body weight on pregnancy rates with LNG as emergency contraception: analysis of four WHO HRP studies. Contraception 2016
• 139 Edelman AB, Cherala G, Blue SW, Erikson DW, Jensen JT. Impact of obesity on the pharmacokinetics of levonorgestrel-based emergency contraception: single and double dosing. Contraception 2016; 94 (01) 52-57
• 140 Moreau C, Trussell J. Results from pooled Phase III studies of ulipristal acetate for emergency contraception. Contraception 2012; 86 (06) 673-680
• 141 Glasier A, Cameron ST, Blithe D. et al. Can we identify women at risk of pregnancy despite using emergency contraception? Data from randomized trials of ulipristal acetate and levonorgestrel. Contraception 2011; 84 (04) 363-367
• 142 Edelman AB, Hennebold JD, Bond K. et al. Double dosing levonorgestrel-based emergency contraception for individuals with obesity: a randomized controlled trial. Obstet Gynecol 2022; 140 (01) 48-54
• 143 FSRH Guideline. Emergency Contraception: Faculty of Sexual & Reproductive Healthcare Statement. Clinical Effectiveness Unit; 2017 [updated December 2020; cited July 2, 2022]. Accessed December 5, 2022 at: https://www.fsrh.org/documents/ceu-clinical-guidance-emergency-contraception-march-2017/fsrh-guideline-emergency-contraception03dec2020.pdf
• 144 Scott-Ram R, Chor J, Bhogireddy V, Keith L, Patel A. Contraceptive choices of overweight and obese women in a publically funded hospital: possible clinical implications. Contraception 2012; 86 (02) 122-126
• 145 Kaneshiro B. Contraceptive use and sexual behavior in obese women. Semin Reprod Med 2012; 30 (06) 459-464
• 146 Khan AI, Patil D, Kawwass JF, Zholudev V, Mehta A. Surgical sterilization among US men and women with employer-based insurance: a claims data analysis. Contraception 2018; 98 (03) 247-251
• 147 Richters J, Fitzadam S, Yeung A. et al. Contraceptive practices among women: the second Australian study of health and relationships. Contraception 2016; 94 (05) 548-555
• 148 Jamieson DJ, Hillis SD, Duerr A, Marchbanks PA, Costello C, Peterson HB. Complications of interval laparoscopic tubal sterilization: findings from the United States Collaborative Review of Sterilization. Obstet Gynecol 2000; 96 (06) 997-1002
• 149 Deshpande NA, Labora A, Sammel MD, Schreiber CA, Sonalkar S. Relationship between body mass index and operative time in women receiving immediate postpartum tubal ligation. Contraception 2019; 100 (02) 106-110