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Miller, H.*; Chmielewski,S.*; Mysore, N.*; Hackel,C.*; Acker,B.*; Miranda,K.*; Ashton,B.+
Murdoch, EF.+; Parikh, N.+
* KMG, New York, NY + Thirty Madison, New York, NY
ABSTRACT:
Obesity and combined hormonal contraception safety: a telemedicine analysis
Introduction: Obesity impacts women's health, including contraceptive use. Although the current Medical Eligibility Criteria recently introduced new guidance regarding appropriate use of combined hormonal contraceptives (CHC) in people with overweight and obesity, clear criteria are lacking due to limited data. While it is known that obesity and CHC are independent risk factors for venous thromboembolic events (VTE), few studies have examined the interaction between them. This study aimed to examine the association between obesity and the risk of adverse events (AEs) related to the use of contraceptives.
Methods: This retrospective study analyzed data among women prescribed contraception between 2017 and 2024 collected from Thirty Madison’s Nurx asynchronous telecontraception platform. Patients were categorized based on body mass index (BMI) into three groups: 0-29 (underweight, healthy, or overweight), 30-39 (Class 1 & 2 Obesity), and ≥40 (Class 3 Obesity). Self-reported thrombotic AE rates, including VTE, stroke, and myocardial infarction were assessed. AE rates per 100,000 users were calculated for CHC and progesterone-only methods (POM) users by BMI category and other risk factor categories.
Results: This evaluation of nearly 1.5 million women seeking contraception on the telemedicine platform demonstrated a clear correlation between AEs and higher BMI. Specifically, CHC users in the BMI ≥40 group had the highest rate of AEs (108 per 100,000 users), notably higher than the BMI 0-29 group (23 per 100,000 users). A similar trend was observed for POM users, though the overall incidence of AEs was lower (BMI ≥40: 24 per 100,000 vs. 0-29: 13 per 100,000). Higher AE rates were also correlated with smoking history for users 35+ years, ages ≥40 years, and history of high blood pressure.
Conclusion: This study provides compelling evidence that higher BMI is associated with increased risk of thrombotic AEs in women prescribed CHC, with the risk being over four times greater compared to those using POM. Further research is needed to understand underlying mechanisms for this association and to assess the long-term implications of contraceptive use in at-risk populations. Healthcare providers should engage in shared decision-making with patients and provide counseling, considering individual risk factors and preferences when prescribing contraceptives, particularly for those with high BMI.
Authors
Hayley Miller, MD, is the Medical Director of Metabolic Health at Nurx, where she uses data-driven strategies to improve access, streamline care, and provide personalized treatment for patients managing overweight and obesity. Her early interest in metabolic health shaped her career, focusing on effective, patient-centered care that empowers patients to achieve lasting health improvements.
Sarah Chmielewski Pharm D, CPPS, CPHQ is the Director of Clinical Quality at KMG. With 22 years experience in healthcare, a pharmacist licensed to practice in 9 states, and 3 years in Clinical Quality she is a pharmacist who found her purpose in Clinical Quality with an asynchronous telehealth company.
Navya Mysore is the Medical Director of Women’s Health at NURX. She is a primary care provider with an expertise in sexual & reproductive health. She has over 15 years of experience in Primary Care and was previously working at One Medical as the Program Director for Sexual & Reproductive Health
Cristin Hackel NP has practiced as a Women's Health NP for 25 years and started with Nurx over 7 years ago. She has practiced in various parts of the U.S. and Japan in OBGYN offices and centers. She is passionate about reproductive health and freedom. She received her BSN and MSN degrees from the University of Pennsylvania.
Betty Acker MD is an OB/GYN physician with over 35 years of clinical experience. She received her MD degree from Georgetown University and did her residency training as an officer in the US Navy.
Kristen Miranda MD is a Family Medicine Physician who has dedicated her career to increasing access to high quality care for underserved populations. She has worked in Federally Qualified Community Health Centers, with the MediCaid population at Kaiser Permanente and trained at San Francisco General Hospital.
Brett Ashton BA is a healthcare-focused data analyst with experience in telehealth operations, clinical outcomes, pharmacy, and insurance.
Elizabeth Murdoch MBA, MPH. Prior to leading Clinical Research for Thirty Madison, Lizzie Murdoch has over 10 years of health economics and outcomes research experience as a consultant for pharmaceutical companies. She received her MBA/MPH from University of California, Berkeley.
Neil Parikh MD, MPH is the Chief Medical Officer for Thirty Madison. He is also an Assistant Clinical Professor at UCLA. He received his MD from Keck School of Medicine, USC and his MBA at the Wharton School, UPenn.
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