From the Guidelines
Oral contraceptive pills (OCPs) pose a significant risk for overweight individuals, particularly those with a BMI over 30, due to an increased risk of venous thromboembolism (VTE) 1.
Key Considerations
- For women with a BMI over 30, combined hormonal contraceptives carry an increased risk of VTE, including deep vein thrombosis and pulmonary embolism 1.
- Excess adipose tissue can alter estrogen metabolism and increase clotting factors, contributing to this risk.
- Progestin-only methods like the mini-pill, depot medroxyprogesterone acetate injections, or non-hormonal options like copper IUDs may be safer alternatives for overweight women 1.
Recommendations
- If an overweight woman has no additional risk factors for VTE, combined OCPs might still be considered after careful evaluation by a healthcare provider 1.
- Regular follow-up appointments are essential to monitor for any complications.
- Women should be aware of warning signs of VTE, such as leg pain, swelling, chest pain, or shortness of breath, which would require immediate medical attention.
Important Factors
- The effectiveness of OCPs may not be significantly affected by body weight or BMI, but the patch's effectiveness decreases among women who weigh >90 kg 1.
- Obese women who use OCPs are more likely to experience VTE than obese women who do not use OCPs 1.
From the FDA Drug Label
Oral contraceptives may compound the effects of well-known risk factors, such as hypertension, diabetes, hyperlipidemias, age and obesity (13). The risk of vascular disease from oral contraceptives is dose-related and obesity is a risk factor that may be compounded by oral contraceptive use.
- Key points:
- Oral contraceptives may increase the risk of vascular disease in women with risk factors such as obesity.
- The risk of vascular disease is dose-related and depends on the balance of estrogen and progestogen in the oral contraceptive.
- Obesity is a risk factor that may be compounded by oral contraceptive use, particularly in women with other underlying risk factors for coronary artery disease. 2
From the Research
Risk of OCP when Overweight
- The risk of Oral Contraceptive Pills (OCP) when overweight is a concern, as it may lead to various side effects and health complications 3.
- A study published in 2007 found that overweight women may benefit from a formulation with 20 microg EE, whereas underweight women may require a formulation with at least 30 microg EE 3.
- The same study suggested that the choice of progesterone is crucial, as it may have residual androgenic activity that can have negative metabolic repercussions 3.
- Another study published in 1980 compared the metabolic and clinical effects of four oral contraceptive formulations and found that there was no significant difference in metabolic parameters among the four oral contraceptives, except for a slight decrease in triglycerides and cholesterol levels in the groups receiving the compounds with 30 or 35 micrograms estrogen 4.
- A 1997 study evaluated the efficacy and safety of a new low-dose monophasic combination oral contraceptive containing 100 micrograms of levonorgestrel and 20 micrograms of ethinyl estradiol, and found that it provided contraceptive efficacy similar to higher-dose oral contraceptives, while maintaining a safety and common OC side effect profile 5.
- A 2018 study found that oral hormonal therapy with ethinylestradiol-levonorgestrel improved insulin resistance, obesity, and glycogen synthase kinase-3 independent of circulating mineralocorticoid in estrogen-deficient rats, suggesting a positive cardiometabolic effect of oral EEL therapy in estrogen-deficient rats 6.
Key Findings
- Overweight women may benefit from a low-dose OCP formulation with 20 microg EE 3.
- The choice of progesterone is crucial, as it may have residual androgenic activity that can have negative metabolic repercussions 3.
- Low-dose OCP formulations may have a positive effect on metabolic parameters, such as triglycerides and cholesterol levels 4.
- Oral hormonal therapy with ethinylestradiol-levonorgestrel may improve insulin resistance, obesity, and glycogen synthase kinase-3 in estrogen-deficient rats 6.