Obesity increases VTE risk in women taking oral contraceptives: Study

The critical points of the review are as follows:

• There is compelling evidence of an interplay between obesity and contraception in increasing cardiovascular risk.
• Women who present both uses of combined oral contraceptives (COCs) and obesity have a higher risk (between 12 and 24 times) of developing venous thromboembolism than non-obese non-COC users.
• Data offer new insights to raise awareness of clinicians on the cardiovascular risk in the clinical management of obese women.
• The synergistic effect of obesity and COCs on deep venous thrombosis risk must be considered when prescribing hormonal contraception.
• Progestin-only products are a safer alternative to COCs in overweight or obese patients.
• Obese women taking contraceptives should be viewed as an 'at risk' population. As such, they should receive advice to change their lifestyle and avoid other cardiovascular risk factors as a form of primary prevention. This indication should be extended to young women, as data show that COCs should be avoided in obese women of any age.

The findings imply that progestin-only products (POPs) should be considered a safer alternative compared to combined oral contraceptives in obese women and women connecting several risks of thromboembolism seeking hormonal contraception.

The researchers wrote, "Combined oral contraceptives increase the risk of arterial thromboembolism (ATE) and venous thromboembolism versus non-use."

"The procoagulant state induced by oxidative stress, COCs, and a pro-inflammatory state provides the COCs-mediated predisposition to ATE and VTE. POPs do not raise risks of ATE and VTE, with some remaining doubts with injectable depot medroxyprogesterone (DMPA)," they conclude.

Reference:

Rosano GMC, Rodriguez-Martinez MA, Spoletini I, Regidor PA. Obesity and contraceptive use: impact on cardiovascular risk. ESC Heart Fail. 2022 Sep 14. doi: 10.1002/ehf2.14104. Epub ahead of print. PMID: 36103980.