PHARM W8 Response: Birth Control Options for Obese Patients

This discussion board post, titled "PHARM W8 RESPONSE," addresses contraceptive options for an obese, hypertensive patient named Margaret, who also smokes. The student analyzes the risks associated with combination oral contraceptives (COCs) due to potential thromboembolic events and hypertension, recommending progesterone-only methods (POPs) and vaginal rings as safer alternatives. The response incorporates insights from peer discussions, emphasizing the importance of patient counseling on medication compliance, smoking cessation, and weight management. The post references multiple studies to support the recommendations, highlighting the efficacy and safety of POPs in the context of obesity and contraindications to estrogen-containing contraceptives. The student also discusses the impact of smoking on birth control efficacy and advocates for lifestyle modifications to improve contraceptive outcomes.

Running head: PHARM W8 RESPONSE
Pharm w8 response
Name of the Student
Name of the University
Author note

1PHARM W8 RESPONSE
Answer one
Contraceptives are likely to fail in obese patients and they need to be counselled about
the appropriate birth control options. Combination oral contraceptives (COCs) put obese women
at risk for venous and arterial thromboembolic disease (Lopez et al., 2013). Similarly, in the
given case study, Margaret is obese and at a high risk of unintended pregnancy as compared to
non-obese counterparts. The overall effectiveness of contraceptives in reduced in obese women.
Moreover, she is hypertensive and estrogen induced contraceptives cannot be used as it sharply
increases the risk of hypertension. Margaret should not receive estrogen-containing oral pills as
hypertension can be heightened by risk factors like obesity. Obesity is also considered a risk
factor for her arterial thromboembolic events in COC users. She is obese and increases the risk
of acute myocardial infarction (AMI) (Brynhildsen, 2014). Considering these factors,
Progesterone-only methods are the only options that comprises of progesterone-only pills
(POPs), newer subcutaneous DMPA, depot medroxypro-gesterone acetate (DMPA) and depo-
subQ Provera 104. From a safety standpoint, this birth control method is the most viable
alternative for Margaret with contraindications to estrogen. There is increased risk for vascular
complications as she is obese and have a high risk for COC and hypertension, the preferred
option for her may be progesterone-only method (Suchon et al., 2016).
POPs comprises of long-acting reversible contraceptives (intrauterine devices [IUDs,
implants], pills and injections. Levonorgestrel (LNG)-releasing intrauterine systems, (LNG-IUS)
are highly effective and prevent pregnancy for more than three years. This hormone delivers the
hormone directly to endometrium that causes endometrial thinning, decidualization and as a
result, ovulation is suppressed in half cycles. These implants deliver the hormone progestin
continuously to show its contraceptive effect via ovulation suppression and have mediated

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effects on endometrium and cervical mucus (Heikinheimo & Gemzell‐Danielsson Kristina,
2012). POP is minipill that causes thickening of cervical mucus and endometrial lining thinning
that makes the uterus non-receptive to the ovum implantation. According to a study by
Tzankova, Petrov & Danchev (2010) there is an increased risk for deep vein thrombosis due to
lethal combination of smoking and contraceptives. Margeret also smokes around 15 cigarettes a
day and therefore, she needs to be counselled to quit smoking to enhance the efficacy of birth
control pills that she is intended to take. It is also important for her to lose weight and maintain a
proper BMI as to increase the efficacy of birth control measures. Vaginal contraceptive ring is
also a reasonable birth control option for Margaret. Vaginal ring are more efficacious as
compared to oral contraceptives with precise and stable serum levels. The ring is hypothesized to
offer high hormone levels for overweight women as hormones are absorbed directly in the
mucosa of vagina and do not go through liver metabolism. Therefore, POPs and vaginal ring are
the safest birth control options for Margaret (Lopez et al., 2013).
Answer two
POPs and vaginal rings mentioned in the discussion by Crystal Richardson are the safest
birth control options for Margaret. This pill is helpful for individuals with high blood pressure as
it reduces the risk for vascular complications. POPs are moderately efficacious and combination
hormonal contraceptives (CHCs) mentioned in the discussion cannot be used as it increases the
risk of thromboembolism and cardiovascular diseases (CVDs). Estrogen is present in CHCs that
stimulates fibrinolytic and coagulation pathways. This would increase the risk of CVDs even
higher for her (Horton, Simmons & Curtis, 2016). The copper IUD mentioned is an emergency
contraception option that may be good for obese women like Margaret if there is high failure rate
of oral contraception. Education counseling recommended by Crystal is a good option for

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helping her to maintain a proper weight and normal blood pressure level. She also needs to be
counseled for medication compliance to achieve the maximum efficacy of the pill in birth control
(Robinson & Burke, 2013). Therefore, in response to my peer’s discussion, the birth control pills
recommended for Margaret are safest and efficacious.
Answer three
Alisha Carter also recommended POPs or mini pill as the most effective birth control
measure for Margaret. This prevents the release of the egg through ovulation suppression,
thickening of uterus and vagina mucous that makes it hostile for sperms. She also recommended
patient teaching for medication compliance that is effective for birth control. My peer also
suggested discontinuing the estrogen-containing combination hormonal contraceptives (CHCs)
as it increases the risk of venous thromboembolic events (VTEs) that includes pulmonary
embolism (PE) and deep vein thrombosis (DVT). This is a good recommendation and POPs have
shown to have no contraindication in obese patients (Lauring et al., 2016). Therefore, POPs are
the safest option for Margaret, as she is obese, hypertensive and a smoker.

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References
Brynhildsen, J. (2014). Combined hormonal contraceptives: prescribing patterns, compliance,
and benefits versus risks. Therapeutic advances in drug safety, 5(5), 201-213.
Heikinheimo, O., & Gemzell‐Danielsson, Kristina. (2012). Emerging indications for the
levonorgestrel‐releasing intrauterine system (LNG‐IUS). Acta obstetricia et gynecologica
Scandinavica, 91(1), 3-9.
Horton, L. G., Simmons, K. B., & Curtis, K. M. (2016). Combined hormonal contraceptive use
among obese women and risk for cardiovascular events: a systematic
review. Contraception, 94(6), 590-604.
Lauring, J. R., Lehman, E. B., Deimling, T. A., Legro, R. S., & Chuang, C. H. (2016). Combined
hormonal contraception use in reproductive-age women with contraindications to
estrogen use. American Journal of Obstetrics & Gynecology, 215(3), 330-e1.
Lopez, L. M., Grimes, D. A., Chen, M., Otterness, C., Westhoff, C., Edelman, A., &
Helmerhorst, F. M. (2013). Hormonal contraceptives for contraception in overweight or
obese women. Cochrane Database Syst Rev, 4.
Lopez, L. M., Grimes, D. A., Gallo, M. F., Stockton, L. L., & Schulz, K. F. (2013). Skin patch
and vaginal ring versus combined oral contraceptives for contraception. The Cochrane
Library.
Robinson, J. A., & Burke, A. E. (2013). Obesity and hormonal contraceptive efficacy. Women’s
health, 9(5), 453-466.

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Suchon, P., Al Frouh, F., Henneuse, A., Ibrahim, M., Brunet, D., Barthet, M. C., ... & Morange,
P. E. (2016). Risk factors for venous thromboembolism in women under combined oral
contraceptive. Thrombosis and haemostasis, 116(01), 135-142.
Tzankova, V., Petrov, V., & Danchev, N. (2010). Impact of oral contraceptives and smoking on
arterial and deep venous thrombosis: a retrospective case-control study. Biotechnology &
Biotechnological Equipment, 24(3), 2026-2030.