Contraception update (pdf, 1148kb) - Dr Angela Cooney

38 Pages·2014·1.12 MB·English

Contraception
cases
September 2014
Dr Angela Cooney
Sexual and Reproductive Health WA
Obesity and contraception
Josephine (Josie)
• 24 year old mother of 3
• 160 cm tall, 110kg, BMI 42
• First pregnancy age 17, was on the combined pill
• Second pregnancy age 19, using condoms and withdrawal
• Third pregnancy (new relationship) was planned, but now she
wants to stop!
• Why did Josie have 2 accidental pregnancies?
• Failed COCP? Failed condoms/withdrawal?

• Not because she is overweight!
• USER FAILURE, NOT METHOD FAILURE
What will you suggest to Josie?
• Sterilisation
• Vasectomy
• Double dose of the combined pill
• IUD
• Implant
Josie
• No other medical issues, no medications
• Babe 7 weeks old
• Not breastfeeding

1 Which method/s are safe to use in obesity?
2 Will any method/s lead to weight gain?
3 Does weight affect contraceptive efficacy?

6
WHO levels of contraindications
• 1. A condition for which there is no restriction
for the use of the contraceptive method
• 2. A condition where the advantages of using
the method generally outweigh the theoretical
or proven risks
• 3. A condition where the theoretical or proven
risks usually outweigh the advantages of using
the method
• 4. A condition which represents an unacceptable
health risk if the contraceptive method is used
Increased BMI & combined methods
contraindication due to VTE risk
THE BIGGER SHE IS, THE GREATER THE RISK

UK Medical Eligibility Criteria for Contraceptive Use
8
Do hormonal methods cause
weight gain?
Overall conclusions from research:

• No significant effect on weight of any method
– Except for Depo users who are already overweight

• Many women will avoid reliable methods because of
fear of weight gain – reassure them always less weight
gain than becoming pregnant!
9
Raised BMI & effectiveness
All methods appear to be effective at any BMI

Recent concerns re Levonorgestrel emergency
contraception from poorly designed studies

BUT TGA doing own review commencing this year.
In the meantime BETTER THAN NOTHING…..

Doubling of daily dose of progestogen-only pill in
women > 70kg NO LONGER RECOMMENDED