Consider this if you want hormonal contraception

February 26, 2018

 

1.Hormonal contraception provides ovulation suppression and eventually this correlates with overall hormone control as well. Hormones have the ability to affect weight, affect weight gain, affect weight loss, and cause fluid shifts that ultimately shouldn't alter the scale; and all these weight issues can affect the hormonal levels in turn. As your plans for reproduction and contraception change, we suggest that you come to discuss both nutritional management and contraception.

 

2. When the blood level of your contraceptive hormones change, the effect in a woman can be that she sees change in both her symptoms and even effectiveness of her pills. If levels of your hormonal contraception dip low escape ovulation can occur, and this is how the production of estrogen, progesterone and testosterone from the ovaries can alter weight, as well as hormonal changes that cause a patient to develop bleeding or other undesirable side effects, such as pregnancy. 

 

3. As hormone levels fluctuate the effects on weight will vary. The levels have been known to change secondary to medications such as antibiotics or other medicines, and some foods could cause issues. At the time of vomiting or other minor illnesses, you may not actually get the full dosage of medicine absorbed. It's an important subject to discuss with your gyno.

 

4. If your hormonal concentration changes your response to insulin, changes your cortisol levels, causes you to have higher blood pressure, or changes your thyroid hormone levels, then weight consequences are possible.

 

5.  Women who are extremely overweight present challenges to hormonal contraception. Not only because many methods have not properly studied large groups of large patients, but the obese patient also has greater blood volume in which the hormones in contraceptive methods is distributed. This in effect will decrease their blood level and could put them at greater jeopardy of getting an unplanned pregnancy. When obese patients have surgery, the changes in how they absorb food and medication, as well rapid weight transition can put a woman at greater risk of hormonal level fluctuations from her contraception. Since over 1/3 of us American women are obese, this subject of how they fair on hormonal contraception, is a common cause for concern among gynos.

 

6. At Women's Health Practice we suggest the option of using the NuvaRing contraception or the patch both of which should have a more consistent blood level, rather than the oral contraceptive pill which might not be absorbed as well in the patient who has been banded or whom has had gastric banding.

 

7. The American Congress of Obstetricians and Gynecologists stated that there "patients who have had bariatric surgery should consider non-hormonal methods" such as ParaGard or Essure, or barrier methods of contraception. So there are choices, but we will have to see what direction some of the studies go. In a recent editorial in Contraception by Zaher Merhi from the University of Vermont College of Medicine, it is pointed out that studies of blood levels need to be done, especially for the popular method of IUD with the hormone levonorgesterel: Mirena. Until these studies are done, you need to work closely with your gyno as your weight changes so that you can be protected from pregnancy when you aren't prepared, and prepared the best when you are ready for pregnancy. And then once pregnant if you have had weight loss or bariatric surgery there are other nutritional considerations.

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