FSRH Guideline Overweight, Obesity & Contraception

1 FSRH Guideline Overweight, Obesity & Contraception April 2019 | FSRH Faculty of Sexual & Reproductive Healthcare (FSRH) provided funding to the Clinical Effectiveness Unit (of the FSRH) to assist them in the production of this Guideline ,Overweight, Obesity and Contraception (April 2019 ).Published by the Faculty of Sexual & Reproductive in England No. 2804213 and Registered Charity No. Faculty of Sexual & Reproductive Healthcare, April is granted to reproduce or transmit this document for non-commercial personal and non-commercial education use only. Commercial use of any kind, including copying, hiring and lending, is reproduction of the whole of this document must reproduce this copyright notice in its reproduction of a part of this document must include a statement that it is reproduced under licence from FSRH and the notice Copyright Faculty of Sexual & Reproductive Healthcare, April in the has accredited the process used by the Faculty of Sexual & Reproductive Healthcare to produce this Guideline .

2 More information on accreditation can be viewed at January 2019 the FSRH has published its electronic clinical guidelines on both its own website ( ) and as an electronic supplement to the BMJ Sexual & Reproductive Health (BMJ SRH) journal. The guidelines have the same content. If a Guideline is updated, the FSRH replace the version on its website and the BMJ Sexual & Reproductive Health (BMJ SRH) journal will ensure old versions of guidelines will clearly signpost the newer version. iiiCopyright Faculty of Sexual & Reproductive Healthcare 2019 FSRH Guideline .

3 Overweight, Obesity and ContraceptionAbbreviations usedBMDbone mineral densityBMIbody mass indexCEUC linical Effectiveness UnitCHCcombined hormonal Contraception /contraceptiveCIconfidence intervalCOCcombined oral Contraception /contraceptiveCu-IUDcopper intrauterine deviceCVDcardiovascular diseaseDMPA depot medroxyprogesterone acetateDSGdesogestrelECemergency contraceptionEEethinylestradiolENGetonog estrelFSRHF aculty of Sexual & Reproductive HealthcareGDGguideline development groupHCPhealthcare practitionerHFIhormone-free intervalHMBheavy menstrual bleedingHRhazard

4 RatioIMPprogestogen-only implantIUCintrauterine Contraception /contraceptiveLARC long-acting reversible Contraception /contraceptiveLNGlevonorges trelLNG-EClevonorgestrel (for emergency Contraception )LNG-IUSlevonorgestrel-rele asing intrauterine systemMImyocardial infarctionNET-ENnorethisterone enanthateNGMN norelgestrominOCoral Contraception /contraceptiveORodds ratioPOPprogestogen-only pillRCTrandomised controlled trialSPCS ummary of Product CharacteristicsUKMECUK Medical Eligibility for Contraceptive UseUPAulipristal acetateUPA-ECulipristal acetate (for emergency Contraception )VTEvenous thromboembolismWHOW orld Health Organizationiv Copyright Faculty of Sexual & Reproductive Healthcare 2019 FSRH Guideline .

5 Overweight, Obesity and ContraceptionGrading of recommendationsRefer to Appendix 1 for a full explanation of the classification of evidence level and grading of least one meta-analysis, systematic review or randomised controlled trial (RCT) rated as 1++, and directly applicable to the target population;orA systematic review of RCTs or a body of evidence consisting principally of studies rated as 1+, directly applicable to the target population and demonstrating overall consistency of body of evidence including studies rated as 2++ directly applicable to the target population and demonstrating overall consistency of results;orExtrapolated evidence from studies rated as 1++ or 1+.

6 CA body of evidence including studies rated as 2+ directly applicable to the target population and demonstrating overall consistency of results;orExtrapolated evidence from studies rated as 2++.DEvidence level 3 or 4;orExtrapolated evidence from studies rated as 2+. Good Practice Point based on the clinical experience of the Guideline development of tablesTable 1 Definition of weight categories and body mass indexTable 2 Percentage of women experiencing an unintended pregnancy within the first year of use with typical use and perfect use (modified from Trussell).

7 Table 3UK Medical Eligibility Criteria for Contraceptive Use (UKMEC) recommendations for contraceptive safety following bariatric surgery vCopyright Faculty of Sexual & Reproductive Healthcare 2019 FSRH Guideline : Overweight, Obesity and ContraceptionContentsAbbreviations used iiiGrading of recommendations ivList of tables ivExecutive summary of recommendations viiiResources x1 Purpose and scope 12 Definitions of overweight and Obesity 23 Why is this Guideline focusing on Contraception and raised BMI needed?

8 24 An overview of data on fertility, sexual activity, contraceptive use and unintended pregnancy among women with raised BMI 35 Suitability of contraceptive methods for women who are overweight or women with Obesity 4 Intrauterine Contraception (IUC) 6 IUC effectiveness 6 IUC safety 7 Weight gain with IUC 8 Health benefits of IUC 8 Practical

9 Considerations with IUC 8 Progestogen-only implants (IMP) 8 Implant effectiveness 9 Implant safety 11 Weight gain with implants 11 Health benefits of implants 11 Practical

10 Considerations with implants 11 Progestogen-only injectable 12 DMPA effectiveness 12 DMPA safety 13 Weight gain with DMPA 14 Health benefits of DMPA 15 Practical considerations with DMPA 15vi Copyright Faculty of Sexual & Reproductive Healthcare 2019 FSRH Guideline .