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
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
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.
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:
3. Faculty of Sexual and Reproductive Healthcare Clinical
Effectiveness Unit. Progestogen only Pills. November 2008 (Updated June
[Accessed 13 July 2010].