contraceptives--postcoital and Obesity

Topics: Body Weight; Contraception, Postcoital; Contraceptives, Postcoital; Female; Humans; Levonorgestrel; Obesity; Pregnancy; Pregnancy Rate

Emergency contraception provides a critical and time-sensitive opportunity for women to prevent undesired pregnancy after intercourse. Both access and available options for emergency contraception have changed over the last several years.. Emergency contraceptive pills can be less effective in obese women. The maximum achieved serum concentration of levonorgestrel (LNG) is lower in obese women than women of normal BMI, and doubling the dose of LNG (3 mg) increases its concentration maximum, approximating the level in normal BMI women receiving one dose of LNG. Repeated use of both LNG and ulipristal acetate (UPA) is well tolerated. Hormonal contraception can be immediately started following LNG use, but should be delayed for 5 days after UPA use to avoid dampening the efficacy of UPA. The copper intrauterine device (IUD) is the only IUD approved for emergency contraception (and the most effective method of emergency contraception), but use of LNG IUD as emergency contraception is currently being investigated. Accurate knowledge about emergency contraception remains low both for patients and healthcare providers.. Emergency contraception is an important yet underutilized tool available to women to prevent pregnancy. Current options including copper IUD and emergency contraceptive pills are safe and well tolerated. Significant gaps in knowledge of emergency contraception on both the provider and user level exist, as do barriers to expedient access of emergency contraception.

Topics: Adult; Contraception; Contraception, Postcoital; Contraceptive Agents, Female; Contraceptives, Postcoital; Female; Health Services Accessibility; Humans; Intrauterine Devices, Copper; Levonorgestrel; Norpregnadienes; Obesity; Pregnancy

As the proportion of women with obesity increases worldwide, understanding the influence of body weight on sexual behavior, fertility, and contraceptive effectiveness is critical for health-care professionals and patients. Although many have theorized that obese women are different from normal-weight women regarding sexual health and behavior, current evidence for the most part disproves this. The exception is in adolescents where body image may play a role in riskier behavior, placing them at a greater risk of an unintended pregnancy. Given that most modern contraceptives were not originally evaluated in obese women, understanding how weight affects contraceptive pharmacokinetics and efficacy should be a focus of ongoing research. Evidence is reassuring that most modern contraceptive methods are safe and effective in obese women. This paper reviews what is known about sexual and contraceptive behavior, as well as the effectiveness and pharmacokinetics of modern contraceptives, for overweight and obese women.

Topics: Adolescent; Adult; Body Weight; Contraception; Contraceptive Agents; Contraceptives, Postcoital; Female; Fertility; Humans; Obesity; Pregnancy; Pregnancy in Adolescence; Pregnancy, Unplanned; Reproductive Health; Risk-Taking; Sexual Behavior

Rates of obesity are increasing worldwide. Due to the medical consequences of obesity, routine health care like family planning becomes complicated. Conflicting data exists regarding efficacy of hormonal contraceptives in obese women, while little data on efficacy of emergency contraception in obese women exists. Much of what is available suggests lower serum hormonal levels in obese women with little effect on ovulation inhibition. Contraceptive steroids can cause a number of deteriorating metabolic changes, particularly in obese women; whether these changes are clinically significant is unknown. Venous thromboembolic risk is increased with both obesity and use of hormonal contraceptives; however the question remains if the risk is additive or multiplicative. Bariatric surgery can lead to digestive changes which may affect absorption of contraceptive hormones. While long acting reversible contraceptives may be the best option in the post operative obese patient, little data, beyond a simple recommendation to avoid pregnancy for at least one year, exists to help guide appropriate contraceptive choice.

Topics: Bariatric Surgery; Contraception; Contraceptive Agents, Female; Contraceptives, Postcoital; Female; Humans; Obesity; Pregnancy; Risk; Venous Thromboembolism

Obesity is a major public health concern affecting an increasing proportion of reproductive-aged women. Avoiding unintended pregnancy is of major importance, given the increased risks associated with pregnancy, but obesity may affect the efficacy of hormonal contraceptives by altering how these drugs are absorbed, distributed, metabolized or eliminated. Limited data suggest that long-acting, reversible contraceptives maintain excellent efficacy in obese women. Some studies demonstrating altered pharmacokinetic parameters and increased failure rates with combined oral contraceptives, the contraceptive patch and emergency contraceptive pills suggest decreased efficacy of these methods. It is unclear whether bariatric surgery affects hormonal contraceptive efficacy. Obese women should be offered the full range of contraceptive options, with counseling that balances the risks and benefits of each method, including the risk of unintended pregnancy.

Topics: Bariatric Surgery; Body Mass Index; Contraceptive Agents, Female; Contraceptive Devices, Female; Contraceptives, Oral, Hormonal; Contraceptives, Postcoital; Counseling; Drug Implants; Estrogens; Female; Humans; Intrauterine Devices; Obesity; Pregnancy; Pregnancy, Unplanned; Progestins; Women's Health

To assess the pharmacokinetics (PK) of levonorgestrel after 1.5 mg oral doses (LNG-EC) in women with normal, obese and extremely obese body mass index (BMI).. Ten normal-BMI, 11 obese-BMI, 5 extremely obese-BMI women were studied. After LNG-EC, mean total LNG metrics were lower in the obese and extremely obese groups compared to normal (Cmax 10.5 and 10.5 versus 16.2 ng/mL, both p<.01; AUC 208 and 197 versus 360 h × ng/mL, both p<.05). Mean bioavailable LNG Cmax was lower in obese (7.03 ng/mL, p<.05) and extremely obese (7.53 ng/ml, p=.198) compared to normal BMI (9.39 ng/mL). Mean bioavailable LNG AUC values were lower in obese and extremely obese compared to normal (131.6 and 127.5 vs 185.0 h × ng/mL, p<.05 for both).. Obese and extremely obese women were exposed to lower total and bioavailable LNG than normal BMI women.. Lower 'bioavailable' (free plus albumin bound) LNG AUC in obese women may play a role in the purported reduced efficacy of LNG-EC in obese users.

Topics: Administration, Oral; Adolescent; Adult; Body Mass Index; California; Contraceptive Agents, Hormonal; Contraceptives, Postcoital; Female; Humans; Levonorgestrel; Obesity; Obesity, Morbid; Prospective Studies; Radioimmunoassay; Young Adult

To estimate the cost-effectiveness of ulipristal acetate (UPA) and levonorgestrel (LNG) emergency contraception (EC) on pregnancy prevention among combined oral contraceptive (COC) pill users with an extended pill-free interval. We accounted for the potential interaction of COCs and obesity on EC efficacy.. We built a decision-analytic model using TreeAge software to evaluate the optimal oral EC strategy in a hypothetical cohort of 100,000 twenty-five-year-old women midcycle with a prolonged "missed" pill episode (8-14 days). We used a 5-year time horizon and 3% discount rate. From a healthcare perspective, we obtained probabilities, utilities and costs inflated to 2018 dollars from the literature. We set the threshold for cost-effectiveness at a standard $100,000 per quality-adjusted life-year. We included the following clinical outcomes: number of protected cycles, unintended pregnancies, abortions, deliveries and costs.. We found that UPA was the optimal method of oral EC, as it resulted in 720 fewer unintended pregnancies, 736 fewer abortions and 80 fewer deliveries at a total cost savings of $50,323 and 79 additional adjusted life-years. UPA continued to be the optimal strategy even in the case of obesity or COCs impacting UPA efficacy, in which a COC interaction would have to change efficacy of UPA by 160% before LNG was the dominant strategy.. Our models found that UPA was the dominant choice of oral EC among COC users with a prolonged "missed" pill episode, regardless of body mass index or an adverse interaction of COCs on UPA.. Ulipristal acetate is the dominant choice of oral emergency contraception among combined oral contraceptive users.

Topics: Adult; Body Mass Index; Contraceptives, Oral, Combined; Contraceptives, Postcoital; Cost-Benefit Analysis; Female; Humans; Levonorgestrel; Models, Theoretical; Norpregnadienes; Obesity; Pregnancy; Pregnancy, Unplanned; United States; Young Adult

Topics: Canada; Contraceptives, Postcoital; Drug Labeling; Female; Humans; Levonorgestrel; Obesity; Pregnancy; Treatment Failure