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Sandy Goldbeck-Wood’s article¹ is very thought provoking and highlights how vital it is that health professionals recognise and engage with issues relating to obesity and sexual health.

With respect to contraception she comments on the ‘weight related dosage difficulties’ with the progestogen-only pill (POP). In a recent case report², we recognise that this is still a common area of confusion and discuss in detail the case of a woman weighing over 100kg who had two pill failures, one with a traditional POP and one with Cerazette®, both resulting in termination of pregnancy. In our article we examine the available literature on which the current Faculty of Sexual and Reproductive Health Clinical Effectiveness Unit guidance³ is based. We propose that, in the absence of more definite evidence, it is safer for a heavier woman to take two traditional pills per day than risk an unintended pregnancy.

We would agree that long acting reversible methods (LARC) should be promoted for this group as they are more effective and less dependent on adherence. Their long-acting effect is particularly important since, as Goldbeck-Wood highlights, obese women are less likely to regularly access contraceptive services and have more unplanned pregnancies.

There is no denying that the incidence of obesity continues to rise and if, in addition, the obese population have lower rates of use of effective methods of contraception, this compounds their negative health outcomes.

It is more important than ever that health professionals acknowledge and meet the contraceptive needs of this group and, as our case report highlights, the need for trials of hormonal contraception to include obese women becomes ever more relevant.

References:

1. Goldbeck-Wood S. Obesity and poor sexual health outcomes. BMJ 2010; 341: 56-57

2. Chandler J, Nash K. Contraceptive failure and the progestogen-only pill: the issue of body weight. J Fam Plann Reprod Health Care 2010; 36: 167-168

3. Faculty of Sexual and Reproductive Healthcare Clinical Effectiveness Unit. Progestogen only Pills. November 2008 (Updated June 2009). http://www.ffprhc.org.uk/admin/uploads/CEUGuidanceProgestogenOnlyPill09.pdf [Accessed 13 July 2010].

Competing interests: None declared

Competing interests: None declared

Julia L Chandler, General Practitioner

Kate Nash Consultant

Central Family Planning Clinic, Grove Road, Norwich, Norfolk, NR1 3RH

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