Obese women who use oral contraceptives containing oestrogen and progestin have a 24-fold increased risk of venous thromboembolism (VTE) compared to non-obese women who do not use the medications.
The study’s findings were published in the European Society of Cardiology’s journal ESC Heart Failure (ESC). “It is well documented that both obesity and oestrogen-containing contraceptives are risk factors for VTE,” stated study author Professor Giuseppe Rosano of the IRCCS San Raffaele Pisana in Rome, Italy. Despite this, obese women continue to be prescribed these medications. Obesity and combination oral contraceptives appear to have a synergistic effect on VTE risk, which should be addressed in prescribing choices.
In women bearing extra weight, progestin-only treatments such as tablets, intrauterine devices, or implants offer a safer option to the combination pill.”
This review article summarises the most recent research on the independent and synergistic effects of obesity and contraception on VTE risk and makes therapeutic recommendations. VTE is a blood clot in a vein that can lead to two potentially fatal conditions: deep venous thrombosis and pulmonary embolism.
According to the World Health Organization, the global prevalence of obesity nearly quadrupled between 1975 and 2016, with 15% of adult women obese. The risk of VTE grows gradually with body mass index (BMI), and it is more than twice in obese women compared to non-obese women.
Obesity has the greatest impact on VTE women under 40, who have a five-fold greater risk compared to non-obese women. “The particularly high risk among obese women under 40 is crucial,” Professor Rosano said, “since it is at this age that many seek contraception.”
Combined oral contraceptives are associated with an increased risk of VTE, with users having a three- to seven-fold increased risk compared to non-users. Progestin-only products, on the other hand, are not related with an increased risk of VTE.
Overweight/obesity coupled with the use of combined oral contraceptives increases the risk of blood clots in women of reproductive age.
A major population-based study, for example, discovered that being overweight or obese was related with 1.7-fold and 2.4-fold higher chances of VTE, respectively. When compared to normal weight non-users, the risk of VTE in combination pill users was 12-fold greater in overweight women and 24-fold higher in obese women.
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“Obese women on contraception are sensitive to VTE and should take efforts to decrease their other predisposing factors for cardiovascular disease, such as stopping smoking and boosting their physical activity levels,” Professor Rosano added.