Optimising contraceptive counselling: insights for obesity and bariatric surgery patients

Women with obesity and those undergoing bariatric surgery face unique challenges when selecting contraceptive methods due to metabolic alterations, surgical malabsorption, and increased thromboembolic risk. This narrative review aims to summarise current evidence and provide practical guidance for safe and effective contraceptive counselling in these populations.

A comprehensive narrative search was conducted in PubMed, Scopus and Google Scholar up to May 2025 using terms related to 'contraception', 'obesity', and 'bariatric surgery'. Recent international guidelines and clinical studies were synthesised to identify evidence-based recommendations and knowledge gaps.

Combined hormonal contraceptives are relatively contraindicated in women with obesity, particularly in those with additional cardiovascular risk factors. Long-acting reversible contraception (LARC) methods, including intrauterine devices and subdermal implants, demonstrate the highest safety and effectiveness. Progestogen-only methods may be appropriate alternatives, while oral routes are less reliable after malabsorptive procedures.

Tailored contraceptive counselling is essential for women with obesity and post-bariatric surgery. Prioritising LARC options, assessing individual thrombotic and metabolic risk, and providing multidisciplinary follow-up can optimise reproductive health outcomes in this growing population.