Is desogestrel suitable for contraception in a patient with a Body Mass Index (BMI) of 33?

Desogestrel is Safe and Effective for Contraception in Patients with BMI 33

Desogestrel is a suitable contraceptive option for patients with a BMI of 33, as progestin-only contraceptives are classified as Category 1 (no restrictions) for use in obesity according to the 2024 CDC Medical Eligibility Criteria. 1

Medical Eligibility for Desogestrel in Obesity

The 2024 U.S. Medical Eligibility Criteria for Contraceptive Use provides clear guidance on contraceptive options for patients with obesity:

• BMI ≥30 kg/m² is classified as Category 1 (no restrictions) for progestin-only pills (POPs) like desogestrel 1
• Combined hormonal contraceptives (CHCs) are classified as Category 2 (benefits generally outweigh risks) for patients with obesity 1

This means desogestrel is actually safer than estrogen-containing contraceptives for patients with a BMI of 33.

Efficacy Considerations

Progestin-only contraceptives like desogestrel maintain their efficacy in patients with higher BMI:

• Unlike emergency contraceptives which may have reduced efficacy with increased BMI 2, regular progestin-only contraceptives maintain consistent hormone levels
• Research on etonogestrel (another progestin) implants shows that hormone levels remain consistent across a wide BMI range, suggesting progestin-only methods maintain efficacy regardless of BMI 3

Practical Implementation

When starting desogestrel:

1. Timing of initiation:

   • Can be started at any time during the menstrual cycle 1
   • If started >5 days after menses began, use backup contraception (e.g., condoms) for 2 days 1

2. Required examinations:

   • No specific examinations or tests are required before initiating desogestrel 1
   • Unlike combined hormonal contraceptives, blood pressure measurement is not required 1

3. Follow-up:

   • No routine follow-up visit is required 4
   • Patient should return if experiencing side effects, problems, or wanting to change methods 4

Benefits of Desogestrel for Patients with Obesity

Desogestrel offers several advantages for patients with a BMI of 33:

• Strong antiovulatory properties even at low doses 5
• Low androgenic properties, making it suitable for patients with hyperandrogenic symptoms 5
• Avoids additional estrogen-related thrombosis risk that may be of concern in obesity 3
• Does not interfere with weight management efforts 6

Important Considerations

While desogestrel is safe and effective for patients with a BMI of 33, be aware of:

• Typical failure rate of progestin-only pills is 5-9% with typical use 4
• If higher efficacy is desired, consider long-acting reversible contraceptives (LARCs) like IUDs or implants, which have failure rates <1% 4
• Monitor for mood changes during the first 1-3 months after initiation 4

Conclusion

Desogestrel is a safe, effective, and appropriate contraceptive choice for patients with a BMI of 33. Its progestin-only formulation avoids the potential increased thrombosis risk associated with estrogen-containing contraceptives in patients with obesity.