I work with adolescent (13-16 years old) females, several of whom are morbidly obese (250-350 lbs.)  What are the recommended screening questions and particularly the most effective contraceptive methods for this population?

–   Nurse Practitioner                                                                                                                                                     School-based health clinic, New York, NY

Contraceptive Pearl Answer:

Obese teens can use any method. Estrogen-containing contraceptives (the pill, the patch and the vaginal ring) carry a higher risk of thromboembolism among obese women and teens. Although the overall risk is quite low, this increase leads the WHO and the CDC to give estrogen-containing methods a “2” rating for women and teens with a BMI over 30. (The “2” rating means that advantages generally outweigh risks.)

What about efficacy? Here, the data are mixed. The vaginal ring’s efficacy seems to be unaffected by BMI. The pill and the patch may have slightly lower efficacy for those who weigh more than 200 pounds. Even so, the pill and patch remain more effective than barrier methods alone.

Progestin injections (Depo) get a “2” rating for obese teens. This is because obese teens are more likely to gain weight on Depo than teens with normal BMI.

Long-acting reversible methods, including both IUDs and the implant, are great for obese teens that are willing to try them.

As for screening questions, just take a thorough medical history. For medical conditions that affect contraception selection, see: http://reproductiveaccess.org/resource/medical-eligibility-initiating-contraception/

The only common conditions that affect obese teens’ eligibility are migraines, diabetes and hypertension.

We appreciate your feedback! Please write us at pearls@reproductiveaccess.org with any questions, comments or additional resources to add to our list.

Helpful Resources

Medical Eligibility for Initiating Contraception

Your Birth Control Choices

Sources

Lopez LM, et al. Hormonal contraceptives for contraception in overweight or obese women. Cochrane Database of Systematic Reviews 2010, Issue 7. Art. No.: CD008452. DOI: 10.1002/14651858/CD008452.pub2.

Murthy AS. Obesity and contraception: emerging issues. Semin Reprod Med. 2010 Mar;28(2):156-63. Epub 2010 Mar 29.

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The Reproductive Health Access Project does not accept funding from pharmaceutical companies. We do not promote specific brands of medication or contraception. The information in the Contraceptive Pearls is unbiased, based on science alone.