Can you use Contraception safely when Overweight?

Dr Sylvia Kama-Kieghe summarises the latest advice on contraception for overweight ladies.

The Faculty of Sexual and Reproductive Health, FSRH qualifies experts on reproductive healthcare in the UK and has very useful advice on Contraception for overweight and obese women.

Being overweight contributes to an increased risk for some health conditions.

What You Should Know About Your BMI

When one factors in some of the clinical risks that contraceptive methods by themselves could cause, there is even more reason to study specific methods closely when one is overweight.

I thought it would be useful to review the recent guidance and remind ourselves about some key points to help stay safe and use contraception effectively.

The BMI (Body Mass Index) is in use to classify the degree of excess weight an individual has.

The BMI calculation divides an adult’s weight (in kilograms) by their height (in metres squared).

For example, A BMI of 25 means 25kg/m2.

Using BMI, a healthy weight range is between 18.5-and 24.9.

These guidelines apply to people with BMI>25 (within the overweight range).

 CHECK MY BMI – Tool checker

The key monitoring tools for using contraception safely include a Blood pressure monitor, weight and height scale.

What You Should Know If Your BMI is High

1. As an obese lady, you are more likely to develop the following conditions: venous and arterial thromboembolism (VTE/ATE), hypertension, Type 2 Diabetes and some cancers (endometrial, breast). 
2. You should let your doctor know whether you smoke, have had recent surgery or are planning to have surgery soon.
   • Other medications you take and should mention are – OTC (over-the-counter) weight loss aids/ slimming teas etc.

High BMI and Contraceptive Methods

IUC

Intrauterine Contraception.

This is safe to use and there should be no problem with fitting this if you are overweight.

…..however, your doctor may require larger sized equipment – A blood pressure cuff, examining couch and vaginal speculum.

Nexplanon

The subdermal implant. Ladies with high BMI should be able to use this safely and effectively – its proper placement is under the skin so insertion and removal should constitute no problem when done properly.

Depot Injection

The depot is the only form of contraception with a clinically proven association with causing weight gain.

…. this association is reportedly higher in women under the age of 18 years with BMA>30kg/m2.

 Tip – If you find that you have gained more than 5% of weight in 6 months of using a contraceptive method, then it is likely this weight gain will continue and you should consider other methods.

 While it is an effective method, there can be other safety concerns associated with the   Depot injection. 

Presently, there is no known association between the Depot and Venous Thrombo-embolism (VTE)

But, it is thought that if you are overweight and also smoke; have high blood pressure and/or Diabetes, then there is a possible risk of developing a DVT (Deep Vein Thrombosis).

In this case, an alternative method should be up for consideration.

POP (The Minipill or Progesterone Only Pill)

This is safe and effective for a woman with a BMI>25;

If you are overweight and taking a POP, we do not recommend doubling the dose of the contraceptive POP.

COC

The Combined Oral Contraceptive pills  (and the vaginal ring) “can” be used by a woman with BMI> 25 but with caution.

Because the ovarian activity is higher in overweight/obese ladies, it is possible that during the last week (pill-free or hormone-free period) there is a risk of contraceptive failure and falling pregnant. It may be preferable to use the pill or ring without the usual 1–week break or consider an alternative method.

Tip – The contraceptive patch is a method that may be less effective in a woman weighing > 90kg!

In respect of safety with the COC, for a lady whose BMI is over 35, it is thought that the risk of having a thrombotic event such as a DVT/ CVA (cerebrovascular accident or Stroke) is higher than the benefits of using the COC to prevent pregnancy. 

On the other hand, if your BMI is between 30 and 34, the risks are actually less and you may use the method with a reasonable degree of safety. 

Learn more about Oral Contraception and Weight Gain.

It is important to watch and monitor for weight changes to decide whether a method is safe or not and you should do so personally and discuss it with your doctor or health provider as well as expect weight checks when you have your clinical follow-up.

Emergency Contraception

EC – Pills containing Levonorgestrel (examples include – Post pill/ Postinor/ Levonelle) are NOT effective for women >70kg or BMI >26kg/m2.

Ulipristal – NOT effective for women >85kg or BMI >30kg/m2 Copper IUD – most effective form of EC; safe for women of all body weights or BMI. 

Female Sterilisation

All types of surgery carry basic complications which can increase when overweight. An overweight lady who has a laparoscopy (or mini-laparotomy) to block (or cut or seal) the tubes can be at a higher risk of complications. They may also experience ‘technical failure’ of the procedure – excess fatty tissue may contribute to this.

Conclusion

I hope you can carefully decide which contraceptive type soothes your BMI. Please leave a comment if you have any confusion.

More Reading

• Oral Contraceptives and Weight Gain
• Drugs used in Modern Contraceptive Methods
• Doc’s Corner: ‘Pregnant despite Contraception’
• Warning! Medicines that could affect your Safety when Driving.
• Emergency Pill Wahala! Why’s My Period All Over The Place?

Edited by AskAwayHealth Team

Disclaimer

All AskAwayHealth articles are written by practising Medical Practitioners on a wide range of health care conditions to provide evidence-based guidance and to help promote quality health care. The advice in our material is not meant to replace the management of your specific condition by a qualified health care practitioner.
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