From the Guidelines
For obese women, Levlen is generally more effective than Microlevlen due to its higher hormone dose, which provides better contraceptive efficacy in women with higher body mass. The higher dose of ethinyl estradiol and levonorgestrel in Levlen helps to counteract the reduced effectiveness of hormonal contraceptives in obese women, which is caused by altered drug metabolism and distribution in increased body fat 1. When prescribing for obese women (BMI ≥30), Levlen should be taken once daily at the same time for 21 days, followed by 7 pill-free days or 7 placebo pills depending on the pack type.
- Key points to consider:
- Even with the higher dose formulation, contraceptive efficacy may still be somewhat reduced in women weighing over 90 kg compared to women of normal BMI 1.
- Additional barrier methods might be considered for maximum protection.
- Side effects may include nausea, headaches, and breakthrough bleeding, but these often diminish after the first few months of use.
- Regular follow-up appointments are recommended to monitor tolerance and effectiveness. It's also important to note that the U.S. Selected Practice Recommendations for Contraceptive Use, 2013, do not require weight (BMI) measurement to determine medical eligibility for any methods of contraception, as all methods can be used or generally can be used among obese women 1. However, measuring weight and calculating BMI at baseline might be helpful for monitoring any changes and counseling women who might be concerned about weight change perceived to be associated with their contraceptive method.
From the Research
Effectiveness of Levonorgestrel and Microlevlen in Obese Women
- The effectiveness of hormonal contraceptives, including Levonorgestrel and Microlevlen, in obese women has been studied in several research papers 2, 3, 4, 5, 6.
- A study published in 2017 found that there is no convincing evidence that obesity increases the risk of contraceptive failure 2.
- Another study published in 2018 found that long-acting, reversible contraceptive methods offer superior effectiveness, minimal risk, and numerous noncontraceptive benefits across body mass index groups, including obese women 3.
- A 2022 review found that progestin-only products, such as Levonorgestrel, are a safer alternative to combined oral contraceptives (COCs) in patients with overweight or obesity 4.
- A 2016 systematic review found that the evidence generally did not indicate an association between higher BMI or weight and effectiveness of hormonal contraceptives, including Levonorgestrel 5.
- A 2019 commentary found that there is no direct evidence that lower levonorgestrel plasma levels contributed to an increased pregnancy rate in obese women, and that emergency contraceptive pills (ECPs) could be taken regardless of body weight or BMI 6.
Comparison of Levonorgestrel and Microlevlen
- There is limited research directly comparing the effectiveness of Levonorgestrel and Microlevlen in obese women.
- However, studies suggest that progestin-only products, such as Levonorgestrel, are effective and safe for use in obese women 3, 4, 5.
- Microlevlen is a type of combined oral contraceptive, which may have a higher risk of venous thrombosis in obese women compared to progestin-only products 4.
Key Findings
- Obese women can use hormonal contraceptives, including Levonorgestrel and Microlevlen, but should be aware of the potential risks and benefits 2, 3, 4.
- Progestin-only products, such as Levonorgestrel, may be a safer alternative to combined oral contraceptives (COCs) in patients with overweight or obesity 4.
- The effectiveness of hormonal contraceptives is not significantly affected by obesity, but individual results may vary 5, 6.