Contraception in the setting of obesity and bariatric surgery

Until recently, contraceptive research has generally excluded women over 130 % of ideal body weight. Given the dramatic increase in obesity worldwide, it has become a public health necessity to address the use and safety of contraception in obese women. Current research on contraceptive efficacy and safety in obese women is overall reassuring, and most contraceptives are given a category 1 rating (no restriction) for obesity by major regulatory agencies such as the World Health Organization. Likewise, women with a history of bariatric surgery are eligible for most methods of contraception without restriction. Like all women, obese women wishing to avoid pregnancy should be encouraged to use the best methods for preventing pregnancy, either long-acting reversible or permanent methods. Providers should feel reassured in offering obese women a range of contraceptive options, without expectation of increased side effects or weight gain. This chapter reviews data on the efficacy, pharmacokinetics, and safety of modern methods of contraception in obese women, and in women undergoing bariatric surgery. We also address the effect of these contraceptive methods on lipid profiles.