Contraceptive Care of Obese Women

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ImportanceIn the United States, 27% of reproductive-aged women are overweight, and 35% are obese. Until recently, contraceptive research excluded women greater than 130% of their ideal body weight. Gaps in data limit evidence-based decision making for effective contraceptive counseling and management in this rapidly growing population.ObjectivesThe aims of this summary are to review the benefits, adverse effects, and risk factors associated with contraceptive methods in obese women, with special attention to effectiveness, and provide contraceptive management and counseling recommendations for best clinical practice.Evidence AcquisitionWe performed a thorough search of PubMed for current literature, including original research articles, review articles, and guidelines on contraceptive counseling and management in obese women in the United States. We reviewed the body of evidence with special attention to studies published since recent Cochrane and systematic reviews on this topic.ConclusionsContraceptive use is safer than pregnancy, especially for obese women who have increased pregnancy risks. Baseline health is compromised by obesity, but contraceptive risks remain low. Long-acting, reversible contraceptive methods offer superior effectiveness, minimal risk, and numerous noncontraceptive benefits across body mass index groups. No substantial evidence supports ineffectiveness of any method in obese women except oral emergency contraception and the patch. Pharmacokinetic changes of obesity associated with other oral methods do not seem to result in clinically significant declines in effectiveness. Future contraceptive efficacy studies should include obese women to better discuss their contraceptive needs.RelevanceThis review is beneficial for all providers caring for reproductive-aged women wanting to avoid unintended pregnancy.Target AudienceObstetricians and gynecologists, family physicians, and internal medicine physicians.Learning ObjectivesAfter completing this CME activity, physicians should be better able to (1) identify the general health, fertility, and pregnancy implications of obesity in reproductive-aged women; (2) describe the epidemiology and recent trends in unintended pregnancy rates in the United States; (3) discuss the significance of weighing risks, advantages, and adverse effects of all contraceptive methods compared with risks of unintended pregnancy in obese women; and (4) recognize evidence-based contraceptive counseling and management guidelines for obese women.

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