From the Research
For obese women, microdose formulations of oral contraceptives are recommended over Levelen due to their potentially higher effectiveness in this population. The most recent and highest quality study on the topic of obesity management is 1, which evaluated the effectiveness of anti-obesity medications in a real-world primary care setting. Although this study did not directly compare Levelen to microdose formulations, it highlights the importance of considering the impact of body weight on medication effectiveness.
When considering the effectiveness of oral contraceptives in obese women, it is essential to note that higher body weight can alter drug metabolism and distribution, potentially reducing the effectiveness of hormonal contraceptives 2, 3. Microdose formulations, which contain 20 mcg or less of ethinyl estradiol, may provide better effectiveness for obese women compared to standard Levelen, which contains 30 mcg of ethinyl estradiol.
Key points to consider when prescribing oral contraceptives to obese women include:
- Taking the medication at the same time daily to maintain consistent hormone levels
- Considering backup contraception methods during the first week of use
- Being aware that liver metabolism of contraceptive hormones may be enhanced in obesity, further reducing bioavailability
- Recognizing that non-hormonal IUDs, implants, or injections may be the most reliable contraceptive options for obese women, as they are less affected by body weight
Overall, the goal is to prioritize morbidity, mortality, and quality of life outcomes when selecting a contraceptive method for obese women, and microdose formulations may offer a better option in this population.