Medard Lech

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    Combined oral contraception and weight changes

    Medard Lech, Fertility and Sterility Research Center Warsaw and L.Ostrowska, Medical University of

    Białystok, Poland

    Obesity is associated with a host of medical conditions, including diabetes mellitus, osteoarthritis, cardiovascular diseases, sleep apnea, breast, colon and uterine cancer, pregnancy and reproductive disorders.  Last but not least, overweight [and obesity] is of great  concern to most women in today’s world.

    There are many, complex, inter-related reasons for overweight and obesity in women, a phenomenon which is related to genetic, endocrine, social and other factors.  The most common reason for obesity is high food intake and low levels of physical activity. Some pharmaceutical products may also affect the energy balance in women and thus lead to overweight and obesity.  The list of such pharmaceuticals is not fully defined, but steroids (and most commonly, hormonal contraceptives) are often included here.

    As combined oral contraception [COC] is the most popular method of hormonal contraception, there is a large number of publications discussing the unwanted side-effects of COC. Generally the discussion focuses on cardiovascular problems, whereas the most common concerns of patients concentrate on weight gain and cancer risk, especially the risk of breast cancer.  This discrepancy between scientific concerns and the problems arising in clinical settings is even greater due to the long list of possible unwanted side-effects mentioned in COC pack inserts. 

    Clinical practice during the 60’s and 70’s showed that COC use was linked to estrogen related nausea, vomiting, headache and breast tenderness.  Since that time, the estrogen dose in COC has been markedly diminished, largely to reduce the rate of unwanted, cardiovascular effects, but also as the method of lowering the number of side effects related to quality of life [headache, breast tenderness, nausea and vomiting]. Most controlled clinical trials found neither a correlation between COC use and body weight nor any possible mechanisms affecting body weight in COC users.

    Although there is no - scientifically-proved - relationship between COC use and weight gain, many women have discontinued their use of hormonal contraceptives due to “weight gain”.  More than half of US women believe that COC causes weight gain. Gynecologists from all over the world report that their patients frequently consider COC one of the causes of their “weight gain”, but neither early [with COC containing more than 35 mg ethinyloestradiol] nor recent [with COC containing 20 – 35 mg ethinyloestradiol] placebo-controlled trials confirm this.

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    Concerning contraception

     

    Medard Lech, MD, Director of the Fertility and Sterility Research Center in Warsaw, Poland. He is also a Senior Consultant Gynecologist in ENELMED Medical System in Poland. After earning his medical degree from the Medical University of Warsaw in 1967 he has completed his postgraduate education at Bielanski Teaching Hospital of Warsaw obtaining the Fellowship Diploma of the Obstetrics and Gynecology College of Poland. He is also a specialist in Public Health. He has obtained broad clinical and educational experience during his service in State Postgraduate Medical Education Center of Poland, State University of Maiduguri (Nigeria) and St Luke’s Teaching Hospital of the University of Malta. The author of more than 100 published abstracts, peer-reviewed papers and reviews, he has served as Principal Investigator and Investigator on numerous clinical trials. He is Editor-in-Chief of Polish Quarterly Journal Antykoncepcja – Aktualności. He is a member of the Polish Gynecology Society and Society of Social Medicine and Public Health. He is a member of Board of Directors and the Executive Committee of European Society of Contraception.

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    It is important that couples have easy access to a  wide range of methods of birth control so they can freely exercise their choice in the matter of procreation. This can be achieved in several ways; sterilization (male or female), effective contraception, or abortion. Abortion  should be a “last resort method” of birth control. Wherever the availability of effective methods of contraception is restricted, the rates of induced abortions are high.

    51.5% out of 377.5 million of European women live, in Eastern/Central Europe (year 2003). Historically, induced abortion has been a common method of birth control in this part of Europe, mostly due to the lack of modern contraceptives (ie any method other than the rhythm method or coitus interruptus). In these countries in 1994, 43% of women aged 15-44 years used no contraceptive method, 27% relied on withdrawal and 6% the rhythm method. In 1996 the contraceptive prevalence rate was still only 35%. As a consequence of a low  usage of modern methods of contraception these countries have high birth rates in very young women (ie. 6% in Czech Republic, 7.4% in Poland, 9.1% in Hungary). The increased use of modern contraceptives is directly correlated with declining abortion rates.  As an example, the annual number of abortions in the Czech Republic declined by 65% from 107,100 in 1990 to 37,200 in 1999  as modern contraceptive use increased seven fold in the same period of time. Inverse correlation can be seen between the abortion rate and use of modern contraception in Romania and Bulgaria is very well documented for the years 1950 – 2000.

    Prevalence of contraceptive usage in Central/Eastern Europe (in women aged 15-49 years) varies from 20-23% in Lithuania, Moldova and Ukraine to 73-76% in Hungary and Bulgaria, In some countries, modern methods of contraception are unpopular (eg in Romania; use of all methods – 57%, but modern methods only - 14%.  Total fertility rates all over Central/Eastern Europe - in recent years - have fallen, and in most countries have reached less than 1.9 (excluding Albania). It seems unlikely that this is due to a decrease  in sexual activity of  the people; it must be due to increased use of birth control methods, especially the use of modern contraception. The increase availability of modern methods of contraception is a signum temporis for people living in Central/Eastern Europe, but from the other hand quality family planning services are getting less and less available in these countries. In many of these countries there are still barriers to proper information and sexual education of young people