Obesity and ECP: Time for a Practice Change?

In March 2014 Health Canada released a warning about the effectiveness of levonorgestrel-only Emergency Contraceptive Pills (ie. Plan B, Norlevo, Next Choice, Option 2) and obese women. The SOGC currently has a similar statement on their website.

While interesting, it’s not so surprising.  There are still many unanswered

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2 thoughts on “Obesity and ECP: Time for a Practice Change?

  1. brenda.marsman@interiorhealth.ca

    HealthFile 91b Nov 2014 newest edition has the weight information/concern updated.

    The information about weight and ECP effectiveness comes from a warning from Health Canada in March 2014 http://healthycanadians.gc.ca/recall-alert-rappel-avis/hc-sc/2014/38701a-eng.php. However, just to add confusion, this article refutes weight as being a problem: http://www.ema.europa.eu:80/ema/index.jsp?curl=pages/news_and_events/news/2014/07/news_detail_002145.jsp&mid=WC0b01ac058004d5c1
    Here is a statement from SOGC that also recommends ECP regardless of weight if that is the only option: http://sogc.org/news_items/weight-effectiveness-emergency-contracetive-pill/ “regardless of a woman’s weight. If a copper IUD isn’t an option, a woman who weighs over 75 kilograms should still consider taking the emergency contraceptive pill as soon as possible, because it may help reduce the risk of pregnancy.”

    I think that the wording of the Health File 91b “Ecp are less effective in women who weigh…and are not effective in women who weigh over 176 pounds” is what is raising alarm bells for me, as this is not supported by OPT, the SOGC or the European article. It is prudent to let our heavier clients know that the ECP is less effective or perhaps not at all effective so that they can make an informed choice as to whether they should even take it, and to counsel them on copper IUDs as possibly being a more appropriate form of EC.
    But, sut to add fuel to the fire, AARHP recently highlighted this study: Effect of body weight and BMI on the efficacy of levonorgestrel emergency contraception by Nathalie Kapp, Jean Louis Abitbol, Henri Mathé, Bruno Scherrer, Hélène Guillard, Erin Gainer, André Ulmann
    Objectives: To further evaluate the effect of weight and body mass index (BMI) on the efficacy of levonorgestrel emergency contraception.
    Conclusions: All analyses showed a significant drop in the efficacy of levonorgestrel emergency contraception with increasing body weight, with pregnancy risk in the higher weight categories similar to expected rates in the absence of contraception. Like body weight, increasing BMI was highly correlated with increased pregnancy risk.

    So……are there any practice changes now in light of all of this confusion? Can we revisit the issue?

  2. Hannah Varto Post author

    Brenda raises some good questions. I find it so frustrating to have Health Canada or BC Health Files changing practice without consultation or follow up from other research and organizations dedicated to contraception. It makes our jobs so much harder. What are other people doing in terms of practice?

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