Obesity And Contraception 2019 Flashcards
Does DMPA cause weight gain?
Appears to be associated.
Particularly if <18 and BMI > 30
What methods are affected by weight?
CHC patch (>90kg)
EC
LNG >BMI 26 or 70kg
UPA >BMI 30 or 85kg
What ukmec are all methods except COC if no other RF?
1
What UKMEC is CHC if BMI 30?
And 35?
2
And 3
What does SPC implant say re weight?
And FSRH?
Limited data re increased BMI year 2-3
FSRH says it fine for all up to 3 years
What’s the main problem with CHC and BMI?
Increased VTE risk. Unlikely as much as in preg but significant.
?mi/stroke also
If someone wants DMPA and is obese what do you need to consider?
Context-if other CV risk factors will go from ukmec 1 to 3
? S/C sayana as IM needle might not reach muscle
What are the considerations with EC/BMI?
As always Cu IUD best
Reduced efficacy >bmi 26 or 70kg for LNG
If able give UPA
If not give LNG 3mg
UPA also reduced efficacy but >BMI 30 or 85kg
(Evidence not great)
Post weight loss surgery are there any issues?
Depends on current BMI only for UKMEC.
But consider reduced absorption possible with oral methods. (Also consider if on weight loss meds that affect absorption/diarrhoea)
What do you do if taking CHC prior to weight loss (or any major surgery)
Stop 4 weeks before
Are there drug interactions between weight loss drugs and contraception?
No
(But caution re oral methods and side effects of diarrhoea/absorption)
Orlistat ok in pregnancy?
No-advise effective contraception
How long should pregnancy be avoided post weight loss surgery?
2 years
Bariatric surgery associated decreased BMD-why does this matter?
So is depo.
No evidence re combination and significance unknown but ? Consider methods not associated with reduced BMD
