For heavily overweight women, tailor-made contraception is needed. Two potentially very serious risks need to be limited, that of deep vein thrombosis and pulmonary embolism, the faces of venous thromboembolism (VTE). And the choice of contraceptive, if the woman is obese, becomes an important discriminant for the prevention of episodes of this type. To report it, in an article published on ESC Heart Failureis a scientific review by Giuseppe Rosano, of the Irccs San Raffaele Pisana in Rome. “It is well known that both obesity and estrogen-containing contraceptives are risk factors for VTE – reports the expert. Scientific evidence indicates that obesity and COCs have a synergistic effect on the risk of VTE and this should be considered in prescriptive choices “. In this sense, according to the expert’s conclusions, progestogen-only drugs, whether they are pills, intrauterine devices or implants, could represent a safer alternative for contraception in heavily overweight women.
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The burden of obesity
As estimated by the World Health Organization, about 15% of adult women would be obese. The risk of VTE gradually increases with body mass index and in obese women it is more than twice that of non-obese women. Obesity has the most substantial impact on women with VTE under the age of 40, who have a five times greater risk than non-obese women. And it is at this point that contraception can become an additional risk factor in this population. “The particularly high risk in obese women under 40 is important, since it is at this age that many seek contraception – reports Rosano”.
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The role of contraceptives
COCs are associated with a high likelihood of VTE. According to statistics, women who employ such treatments have a chance of develop venous thromboembolism three to seven times more than those who do not use contraceptives. It should also be noted that progestogen-only products are not associated with an increased risk of VTE. The association of overweight-obesity with the use of pills that contain a combination of drugs can therefore increase the risk of developing clotting problems in women of childbearing age. Practical advice from the expert: “Obese women taking contraceptives should take measures to limit other predisposing factors for cardiovascular disease, for example by stopping smoking and increasing physical activity levels”.
The greatest risk after surgery
Deep vein thrombosis can create a blockage of circulation within a vein, or even pulmonary embolism, which often follows this condition. This situation can be linked to different situations, such as an operation, in particular of an orthopedic type, which forces you to remain still in bed for a long time. In practice, for those who remain blocked for days after an operation, especially if in the presence of predisposing factors for the formation of these “plugs” along the veins, there is a risk of the appearance of deep vein thrombosis. These can manifest themselves as such, and therefore obstruct the flow of blood back to the heart by blocking circulation or allow small fragments of coagulated blood to leave which, once they reach the lungs, trigger the potentially fatal pulmonary embolism. In addition to the family “predisposition” to encounter venous thromboembolism, which alone can increase the dangers for those who have to be operated on, pregnancy can also be considered a risky moment. To reduce the risks, there are different systems: from the use of graduated compression elastic stockings which, by putting pressure on the leg muscles, facilitate the activity of the veins up to the early mobilization of those who have been operated on. This resource, although not always possible, helps a lot because thanks to the activity of the muscles that act as a real “clamp” on the vessels, the blood flows better inside the veins. But there are also specific drugs that have the task of keeping the blood fluid, reducing the risk of it thickening and forming clots inside the veins.
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