Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Obesity and Hormonal Contraceptives

Is there increased risk of unintended pregnancy?

Obese women may have a higher pregnancy rate during combination oral hormonal contraceptive (COC) use compared to non-obese women, according to a meta-analysis of seven clinical trials with 14,024 obese and non-obese women. An overall hazard ratio of 1.44 suggests a 44% higher pregnancy rate during COC use for obese women after adjusting for age and race.

Citation: Yamazaki M, Dwyer K, Sohban M, et al. Effect of obesity on the effectiveness of hormonal contraceptives: An individual participant data meta-analysis. Contraception. [Published online ahead of print August 3, 2015]. doi: 10.1016/j.contraception.2015.07.016.

Commentary: Combined oral contraceptives are the most frequently used of the effective contraceptive methods. Oral contraceptives have a perfect user rate of 0.3%, and an average user rate of 8%, meaning of 100 women using this method for a year, the quoted percent represents the number of women who, on the average, would become pregnant using that method.1 Long-acting reversible contraception (LARC), specifically IUDs and implanted contraceptive devices, have similar or slightly better perfect user rates, with no gap in the rate for average user. The 44% increased pregnancy rate for women is an important part of our informed discussion with women about choice of contraceptive method. —Neil Skolnik, MD

1. U.S. Medical Eligibility Criteria for Contraceptive Use, MMWR; 2010(59):1-6.

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