Case of a Girl with Obesity Seeking Birth Control
There are several issues to consider when choosing a contraceptive method for an adolescent girl with obesity. When prescribing hormonal contraception, it is important to bear in mind that there is an increased risk for cardiovascular disease, diabetes, and other obesity-related comorbidities in addition to the increased risks associated with persisting obesity in adulthood. There is also evidence that increasing obesity may decrease the efficacy of some contraceptive modalities. Further, despite higher risks for pregnancy-related complications, overweight or obese females have been shown to be less likely to use contraception than their normal-weight peers. An inability to negotiate contraceptive use with a partner and provider inexperience with prescribing contraception are areas that need to be explored and addressed with such patients. Counseling related to effective emergency contraception is important especially if patients have concerns related to negotiating contraceptive use. A final consideration relates to the importance of providing effective contraception for obese adolescents who are contemplating bariatric surgery and require long-term effective contraception.
KeywordsObesity Contraception Efficacy Adolescent Medically complex
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