A new evidence-based clinical guideline by the Faculty of Sexual and Reproductive Healthcare (FSRH) reminds healthcare professionals that there is a wide range of safe and effective contraceptive options for women who are overweight or have obesity.
Familiarity with FSRH guidelines is essential for any healthcare professional providing contraceptive care in the community, primary care and hospital settings.
The new guideline reviews the current evidence on how weight impacts on contraceptive effectiveness and safety as well as the effect of contraceptive use on weight. The guideline also considers contraceptive use in relation to medical and surgical approaches to weight loss.
Currently, it is estimated that over half of the women in the UK are overweight or obese. Obesity rates continue to rise amongst women of reproductive age. The new FSRH guideline addresses the contraceptive needs of this important group.
Key recommendations include:
- For women with body mass index (BMI) 35kg/m2 or greater, the potential risks associated with use of combined hormonal contraception (CHC) generally outweigh the benefits.
- Past concerns that women with raised weight or BMI would require a double dose of progestogen-only pills, early DMPA injections or early replacement of the contraceptive implant are refuted; the evidence indicates that the effectiveness of these three methods is not affected by body weight or BMI.
- Oral emergency contraception, particularly levonorgestrel 1.5mg, could be less effective for women who are overweight or have obesity. The effectiveness of the copper intrauterine device is not affected by body weight or BMI, and healthcare professionals should inform women that this is the most effective method of emergency contraception.
- Women should be advised that the effectiveness of oral contraception, including oral emergency contraception, could be reduced during use of weight loss medications and after bariatric surgery; where possible, these should be avoided in favour of non-oral methods of contraception.
Dr Diana Mansour, Vice President Clinical Quality of the Faculty of Sexual and Reproductive Healthcare (FSRH), said: “Until now, there has not been clear guidance on contraception for women with obesity or who are overweight. The new FSRH guidelines show that there is a good range of safe and effective contraceptive options from which a woman with a higher weight can choose.
“Safe and effective contraception is important for all women so they can decide if and when to become pregnant. It also allows women who are planning a pregnancy the opportunity to optimise their health, including their weight before becoming pregnant, maximising their chances of a healthy pregnancy.
“We hope the new guidelines will support healthcare professionals to provide the best evidence-based contraceptive care and advice to women who are overweight or have obesity.”