Overweight, Obesity and Contraception: new clinical guideline by the FSRH

May 2019. The UK’s Faculty of Sexual & Reproductive Healthcare (FSRH) just published Overweight, Obesity and Contraception, a guideline that brings together evidence and expert opinion on the provision of contraception to women who are overweight and women with obesity. Recommendations are based on available evidence and the consensus opinion of experts and the guideline development group (GDG).

With regards to emergency contraception, the guideline provides the following key information and clinical recommendations (see page ix of the document):

• The available evidence suggests that effectiveness of the copper intrauterine device (Cu-IUD) is not affected by body weight or BMI.
• 1.5 mg levonorgestrel emergency contraception (LNG-EC) appears to be less effective in women with BMI >26 kg/m² or weight >70 kg.
• Ulipristal acetate EC (UPA-EC) may be less effective in women with BMI >30 kg/m² or weight >85 kg.
• Women should be informed that the Cu-IUD is the most effective method of EC.
• Women should be informed that BMI >26 kg/m² or weight >70 kg may reduce the effectiveness of oral EC, particularly of LNG-EC.
• Consider UPA-EC and, if this is not suitable, double-dose (3 mg) LNG-EC if BMI >26 kg/m² or weight >70 kg. The effectiveness of double-dose LNG-EC is unknown.
• Double-dose UPA-EC is not recommended for women of any body weight or BMI.

The full guideline can be downloaded directly from the FSRH website.