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Recent estimates place the prevalence of obesity in adolescent women at approximately 18 %. Thus, providing contraception for adolescents and young women who are obese represents an increasingly common clinical scenario. Unfortunately, there is little research regarding hormonal contraceptive efficacy in obese adult women and almost no research which includes adolescents. While all contraceptives appear to be safe in obese teens, studies of hormonal contraceptives in adults suggest efficacy may be slightly impaired with increasing weight for the combined oral contraceptive pill and the transdermal contraceptive patch. Most contraceptives are not associated with weight gain; however, there may be a subset of adolescents who are susceptible to weight gain with depot medroxyprogesterone acetate (DMPA).

Until recently, contraceptive research has generally excluded women over 130 % of ideal body weight. Given the dramatic increase in obesity worldwide, it has become a public health necessity to address the use and safety of contraception in obese women. Current research on contraceptive efficacy and safety in obese women is overall reassuring, and most contraceptives are given a category 1 rating (no restriction) for obesity by major regulatory agencies such as the World Health Organization. Likewise, women with a history of bariatric surgery are eligible for most methods of contraception without restriction. Like all women, obese women wishing to avoid pregnancy should be encouraged to use the best methods for preventing pregnancy, either long-acting reversible or permanent methods. Providers should feel reassured in offering obese women a range of contraceptive options, without expectation of increased side effects or weight gain. This chapter reviews data on the efficacy, pharmacokinetics, and safety of modern methods of contraception in obese women, and in women undergoing bariatric surgery. We also address the effect of these contraceptive methods on lipid profiles.