Jan Brynhildsen, Faculty of Health Sciences, Linköping University, Sweden
The prevalence of obesity is still increasing. The most rapid increase during the last years has been in female adolescents. Obesity is associated with many health risks including cardiovascular disease, hypertension, the metabolic syndrome, malignancies and venous thromboembolism. Because hormonal contraception might interfere with these risks, both in negative and positive ways, it is important to address and discuss this issue.
The COC-associated risk of thromboembolism seems to be higher in obese than in normal weight women. The interpretations of these data vary and consequently also recommendations vary between different authorities. The situation might be confusing. The obese woman runs a higher risk of endometrial cancer and COC offers protection. COC offers protection against ovarian and endometrial malignancies etc.
During years it has been discussed whether obese women run a higher risk of contraceptive failure. Recent studies indicate that COCs seems to be as effective in obese as in normal weight women.
The management of contraceptive counselling and prescription to the obese woman will be discussed in relation to the options available in the specific situation. Even though fertility might be decreased in obese women there is a strong need for effective and safe contraception