Description
Please add VI Pico Solution and VII Conclusion (please see attached rubric and paper) Please condense to 10 pages total (limit to 10 pages excluding appendices and references) –> each section of rubric states the page lengthPlease complete the attached Poster template (abstract not needed)
Unformatted Attachment Preview
I. Introduction: Background
and Significance of the
Problem, Development of
PICO or PICOT Question.
FHN I (Maximum: 2 pages)
5 to >4.5 pts
II. Theoretical Model to
Guide for Evidence Based
Research (ACE Star Model)
FHN I (½-1 page)
3 to >2.5 pts
III. Search Strategies and
Level of Evidence FHN II (1
page)
5 to >4.5 pts
IV. Literature Review FHN II
(1 page + table in
appendices)
10 to >9.5 pts
Exceptional clear and succinct explanation of
significance and need for the clinical question.
Development of high-level PICO(T) question that
can influence clinical practice. (Explanation of all
components of PICO or PICOT in FHN I only)
States a minimum of 2 background questions needed
to increase understanding of the clinical question and
explain why they are relevant. Background questions
should be answered in literature review.
Model overview and model constructs are
exceptionally and succinctly defined and applied to
the process of answering the PICO(T) question.
Guides research application to clinical practice.
An exemplary description of the search strategy
includes search words, databases, and inclusion &
exclusion criteria with a thorough explanation of
logic for this process. Includes the number of
findings from each database. Demonstrates
knowledge of article selection based on the level of
the evidence hierarchy.
Exemplary detailed presentation of 6 high-level
research articles related to the clinical question
published within the last 5 years, presented in the
Summary of Primary Source of Evidence Table or
Systematic Review Table. Demonstrates a higher
than expected level of knowledge regarding research
review and evidence hierarchy.
VI. PICO Solution,
Relevance to Clinical
Practice and
Implementation
Preceptorship II (1-2
pages)
15 to >14.5 pts
VII. Conclusion
Preceptorship II (½-1
page)
2 to >1.0 pts
The identified outcome and answer to PICO
question is clearly stated and reflects
research findings. Implementation of
findings to clinical practice is clearly
explained in a step-by-step format which is
logically and completely stated. Relates and
integrates the constructs of the theoretical
model by stating how the model guided the
EBP process to implementation.
Exemplary overview and succinctly written
summary of paper includes impact to
clinical practice and evidence based
process.
College of Nursing
TITLE
NAME OF STUDENT AND FACULTY
Abstract
Include a synopsis of your abstract
here.
Theoretical Framework
Include a description of your
theoretical framework and how you
applied it to your problem here.
Literature Review Outcome /
Evidence Based Solution
Include an outline of the proposed
outcome from your literature review
and a possible evidence based
solution / intervention.
Analysis of Literature
Significance of the Problem
Include a description of the problem
and background significance here.
Include a summary (can be in table form) of what was learned from your
literature review here as it applies to your problem.
Dissemination and Evaluation
Include a description of how you
could disseminate what was learned
from your clinical project and how
you would propose the evaluate the
proposed solution.
Review of Literature
PICOT Question
Include a synopsis of your search
strategy and literature review results
here.
1
The Impact of Oral Contraceptives and IUDs as Contraceptive Methods for Obese Women
Ages 25-40
AN ASSIGNMENT
SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE
DEGREE OF MASTER OF SCIENCE IN NURSING
IN THE GRADUATE SCHOOL OF THE
TEXAS WOMAN’S UNIVERSITY
COLLEGE OF NURSING
BY
DANIELLE MITCHELL
NURS
PROFESSOR
OCTOBER 1, 2023
2
The Impact of Oral Contraceptives and IUDs as Contraceptive Methods for Obese
Women Ages 25-40
Although women using contraceptive methods have relatively successful rates, many
develop complications in their adult lives. The debate on the impact of obesity on women using
contraception continues to invoke various options across the board. Understanding the extent to
which hormonal and non-hormonal contraceptive devices contribute to complications in obese
women is integral to developing measures that act as interventions for the most adverse methods.
This paper aims to critically compare the impact of oral contraceptives and IUDs as
contraceptive methods for obese women ages 25-40, assessing which of the two groups is at
higher risk of developing blood clots.
Development of PICOT Question
Are obese women ages 25 to 40 (P) who take oral contraceptives at greater risk (I) for
developing blood clots (O) compared with obese women ages 25 to 40 (P) who use IUDs for
contraception (C) over a 5-year time frame (T)?
Significance and Need
Researchers widely acknowledge the association between obesity and the excess estrogen
in hormonal contraceptive methods to pose cardiovascular risks. While even moderately healthy
women suffer the risk of being affected by cardiovascular complications, obese women often
have underlying issues that enhance the probability of the risks manifesting much earlier in their
lives. This research is necessary to establish the connection between the oral contraceptive pill
and blood clot formation in obese women.
3
Background
While exploring the connection between contraceptives, obesity, and chronic blood clots,
it is important to understand whether oral contraceptive pills and IUDs are responsible for the
same results. In this case, the major issues are the relationship between contraception in obesity
and the formation of blood clots. In addition, how can obese women prevent the cardiovascular
risks associated with contraceptive methods? The purpose of the study is to establish the etiology
of blood clots in obese women who are under specific contraceptive treatments.
ACE Theoretical Model
The ACE theoretical model allows researchers to perform research in five critical stages:
discovery, evidence summary, translation, integration, and evaluation. The evidence-based
project (EBP) would require a qualitative approach to determine whether obese women under
various contraception methods are at risk of having blood clots. In this case, using unstructured
interviews as a qualitative research methodology, women would be assessed to determine the
truth in this hypothesis. Evidence summary would allow the researchers to record all primary
evidence condensing the information into meaningful syntheses (Khialani et al., 2020). The
research would synthesize the raw data on obese women and the contraception indications,
where new findings could be plausible. Translation of the material aims to provide the
practitioners with a document they can implement. This means the research would have a final
database they can refer to or share concerning the data received from the obese women
population. Integration requires that practitioners implement the findings and mitigation
procedures they find as they perform the study (Khialani et al., 2020). The researchers in the
study would be inclined to suggest clinical practices that prevent obese women from
experiencing heightened risks in using contraceptive methods meant to help them. Evaluating the
4
material ensures that the EBP outcomes are desirable, or implementation can positively change
the quality of care and improve patient and provider satisfaction. Ultimately, obese women
should also be treated equitably, and if potential solutions exist, they should be implemented.
Search Strategy and Levels of Evidence
The search strategy started with defining the research question, which was “Are obese
women ages 25 to 40 (P) who take oral contraceptives at greater risk (I) for developing blood
clots (O) compared with obese women ages 25 to 40 (P) who use IUDs for contraception (C)
over a 5-year time frame (T)?” This was followed by identifying the inclusion and exclusion
criteria based on the PICOS framework. The population included obese women of reproductive
age. The intervention studied was contraceptive use, and the comparison was oral or IUD use.
The outcome was a blood clot, and the study design was either randomized controlled trials,
observational studies, or reports published in English. A search for relevant keywords then
followed this. Keywords used included contraceptive, obesity, blood clot, deep vein thrombosis,
and pulmonary embolism. The search was done in different databases, including MEDLINE,
EMBASE, Cochrane Library, PubMed, CINAHL, Web of Science, and Scopus.
Through an online database search, 21 studies were obtained. It is also important to note
that some of these studies were obtained by searching through the reference lists of the already
obtained studies. After excluding all the duplicates and those not perfectly aligned with the
research topic, 12 studies remained. With further screening, including a full-text review of each
article, 6 studies were finally considered for review in this project. See the appendix for the
figure showing a brief breakdown of the different studies considered for review.
The Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) rating scale was
adopted in evaluating the references used whereby:
5
Level I: Evidence based on well-randomized and controlled trial
Level II: Evidence gained through well-organized controlled trial, not including
randomization, quasi-experimental studies.
Level III: Evidence based on an analytic study of case-control or well-organized cohort
should be from either multiple research groups or centers, and meta-analyses.
Level IV: Evidence is achieved without intervention or various time series. Obtained
from experts consensus such as systematic reviews and national guidelines.
Level V: Evidence is obtained from individual expert opinions, case studies, and
descriptive studies.
Literature Review
Current literature has indicated a connection between formation of blood clots and oral
contraception use. Rambaran and Alzghari (2020) have explored this topic extensively. This
systematic review was carried out by searching PubMed from inception to April 2018 for
relevant articles published in English. The results herein showed that obese women who used
oral contraceptives were at a higher risk than nonusers of developing blood clots (Rambaran &
Alzghari, 2020). This study explained the current statistics showing that over 400 women in the
US die every year related to their use of oral contraception (Rambaran & Alzghari, 2020). This
study suggests the need for women to be educated about the risks involved in contraception for
better decision-making and management of any complications that may arise.
These results are similar to findings by Khialani et al. (2020) who explored the
relationship between combined oral contraception and the risk of venous thromboembolism. The
study is a systematic review of 86 articles. The result of this study indicated that even though
venous thromboembolism is a considerably rare condition, the risk of obese women developing it
6
significantly increases when they use oral contraceptives (Khialani et al., 2020). Nonetheless,
different from other studies, the researchers assert that the benefits of the different oral
contraceptives in preventing pregnancies outweigh the risks for obese women (Khialani et al.,
2020). This study included a review of different studies, and for this reason, it was assigned a
rate of one on the JHNEBP rating scale.
Another study was carried out to update current knowledge on the relationship between
oral contraceptive pills and cerebral venous sinus thrombosis risk. The study also aimed to
examine the impact of other forms of hormonal contraceptives, duration, type, and health
condition of the woman on this relationship (Abdalhabib et al., 2022). Carrying out this study
was based on the understanding that while there is a pool of studies that have examined the
relationship between oral contraceptives and the risk of blood clots among obese women, several
other defining aspects have not been factored in, and this limits the scope of understanding of
this topic (Abdalhabib et al., 2022). This study was in the form of a systematic review and metaanalysis in which a search was performed to identify a series of published articles on the
relationship between the use of hormonal contraceptives and the risk of blood clots among obese
women between 15 and 50 years of age (Abdalhabib et al., 2022). The researchers reviewed only
11 of the 861 studies identified from the search. The results of this review show that using oral
contraceptive pills significantly increases the risk of obese women of reproductive age
developing cerebral venous sinus thrombosis (Abdalhabib et al., 2022). However, the researchers
quickly note that the available data remains inadequate to draw definitive conclusions regarding
how the duration of the use of contraceptives affects this relationship. Nonetheless, it remains
evident that oral contraceptives significantly increase the likelihood of obese or overweight
7
women developing blood clots. Falling back on the JHNEBP rating scale, this study was rated
one since it extensively reviewed data from other studies.
Some studies have been conducted in a way that they compare the level of risk of blood
clots identifiable with different approaches to contraception. One such study by LaVasseur et al.
(2022) was carried out to examine the differences in the risk of thrombosis identifiable with
different methods of contraception and their interaction with different patient-centered factors.
This study was based on the understanding that different methods of contraception have been
closely linked to venous thromboses. The risk of thrombosis is identifiable in hormonal
contraceptive agents and in cases where intrauterine devices are used. This study involved
conducting a narrative review of a series of studies regarding contraceptives and the risk of blood
clots (LaVasseur et al., 2022). The study results indicated that different contraceptive types have
different risk levels of blood clots for obese women. However, it is important to note that the
results indicated that the risk of developing blood clots is significantly higher in obese women
who use oral contraceptives.
This is based on the idea that these women have a higher body mass index while alone is
a risk factor for blood clots (LaVasseur et al., 2022). However, the risk even increases because
oral contraceptives contain hormones that increase the risk of blood clots, more so in women
with other risk factors such as a family history of blood clots, smoking, or obesity. Conversely,
the risk of developing blood clots is relatively lower among obese women who use IUDs. This is
because these IUDs do not contain any hormones that can increase the risk of blood clots
(LaVasseur et al., 2022). Since this study was a systematic review, it was assigned a score of one
on the JHNEBP rating scale. These different results suggest that the risk of a blood clot is
8
significantly higher among obese women using oral contraceptives than their counterparts who
use IUDs.
Analysis of Literature
Abdalhabib, E. K., Jackson, D. E., Alzahrani, B., Elfaki, E., Hamza, A., Alanazi, F., Ali, E.
I., Algarni, A., & Ibrahim, I. (2022). Assessment of risk factors for deep vein
thrombosis associated with natural anticoagulants and fibrinolytic regulatory
proteins. Blood Coagulation & Fibrinolysis, 33(3), 149–152.
https://doi.org/10.1097/mbc.0000000000001116
The article investigates deep vein thrombosis (DVT) as a critical disease in Africa by
investigating its risk factors paying attention to its natural anticoagulants and fibrinolytic
regulatory proteins. The study is designed to understand the specific roles these regulatory
proteins play in the development of the disease among the Sudanese. A case-control study was
utilized which is level II on the JHNEBP rating scale and a suitable design when investigating
this kind of problem. The findings presented would have been more convincing if data had been
collected from more than one facility for the indicated year. The researchers also investigated
the right parameters descriptive of deep vein thrombosis in terms of its regulatory proteins. In
this study, 5.5% of the participants were determined to have Protein C deficiency and 8.5% of
participants were victims of protein S deficiency. 3% were diagnosed with antithrombin III
deficiency. The findings also demonstrate that early assessment of risk factors is important in
improving treatment outcomes of DVT. Overall, the article is straightforward and precise in the
way information is presented.
LaVasseur, C., Neukam, S., Kartika, T., Bannow, B. S., Shatzel, J., & DeLoughery, T. G.
(2022). Hormonal therapies and venous thrombosis: Considerations for prevention
and management. Research and Practice in Thrombosis and Haemostasis, 6(6),
e12763. https://doi.org/10.1002/rth2.12763
The article by LaVasseu et al., 2022, seeks to investigate venous thrombosis as one
complication of hormonal therapy. The study pays attention to the risk of developing thrombosis
9
in persons using hormonal contraceptive agents. The researchers used a narrative review is data
collection which is an ideal method considering that challenges experienced when collecting data
on hormone‐related thrombosis risks. The results indicate that thrombosis risk tends to increase
with an increment in oestrogen dosage. Thrombosis rates increase with age in women aged
above 30 years with an incidence rate of 2–3.7 events/10 000 women using oestrogen and
increases 10.2 times in women using third generation contraceptives. However, the study does
not identify effective management of complications of hormone therapy in patients diagnosed
with prothrombotic illnesses. Also, the article is a narrative review, placing it a level V, the
lowest on the JHNEBP rating scale which is very low quality of evidence.
Rambaran, K., & Alzghari, S. K. (2020). Gamer’s thrombosis: A review of published
reports. Ochsner Journal, 20(2), 182–186. https://doi.org/10.31486/toj.19.0058
This article investigates thrombosis as a common condition reported in elderly people
that develops in healthy adolescents. Published articles were reviewed to collect relevant data on
the relationship of immobility and increased risk of developing the VT. 12 out of the 26 articles
used in this study revealed instances where immobility led to the development of venous
thromboembolism, where 2 were fatalities reported. 15 patients were also determined to have
recurrent VT. The risk of developing VT was identified to be 2.33 for obesity which represents a
confidence interval of 95%. These results obtained confirm that immobile people are at a high
risk of developing thrombosis. Obesity, use of birth control and cigarette smoking are some risk
factors identified that can easily be modified. The recommendation for screening for venous
thromboembolism in gamers is justifiable owing to the prolonged sitting hours. The main
limitation of the study is that it is a level V evidence literature review, presenting low quality of
evidence.
10
Rosano, G. M., Rodriguez‐Martinez, M. A., Spoletini, I., & Regidor, P. A. (2022). Obesity
and contraceptive use: Impact on cardiovascular risk. ESC Heart Failure, 9(6),
3761-3767. https://doi.org/10.1002/ehf2.14104
The article considers obesity and contraceptives containing oestrogen as confirmed risk
factors for cardiovascular disease. The researchers are concerned that obese women still receive
hormonal products containing oestrogen. The study uses a narrative review making it possible to
identify the latest research, current research and contentious issues about overweight and
cardiovascular risk. The results confirm that overweight women using oral contraceptives are 1224 times more likely to have venous thromboembolism comparing them with non-obese women
that are not on contraceptives. Specifically women using combined oral contraceptives with a
BMI index above 25 had the VT risk increased by 12-fold. These findings reveal the importance
of clinicians considering the body weight and BMI indexes of a person when administrating
contraceptives containing estrogen. The study also indicates that Progestin-only products are
safer alternatives for use in obese patients. Overall, the article is specific in its highlight of the
dangers of oral contraceptives for obese women but is a narrative review (Level V evidence
rating) which makes it low quality evidence.
Sultanmuratova, G. U., Babadjanova, G. S., Nazarbayev, J. B., & Kerimova, N. M. (2022).
A safe and effective contraceptive method for women with obesity in the postpartum
period. American Journal of Medicine and Medical Sciences 12(8): 836-839.
https://doi.org /10.5923/j.ajmms.20221208.15
This article investigates the safety levels of using drospirenone-containing combined oral
contraceptive in women of reproductive age determined to be overweight. The study used an
appropriate inclusion criterion in selecting sixty five obese women participants on
contraceptives. 39 participants were diagnosed with polycystic ovary syndrome. These are fertile
women who cannot ovulate. 32 people showed clinical signs indicating that they were infertile
while 22 had functional hyperprolactinemia. The study indicates that oral contraceptives pose a
11
major risk in complications of young women’s reproductive system. This study is a high
evidence rating (level II) as it is a quasi-experimental study. The article conveys the importance
of proper screening of women before administering contraceptives to minimize infertility risk.
Khialani, D., Rosendaal, F., & van Hylckama Vlieg, A. (2020, November). Hormonal
contraceptives and the risk of venous thrombosis. In Seminars in Thrombosis and
Hemostasis 46(8), 865-871. https://doi.org/10.1055/s-0040-1715793
The article by Khialani et al. (2020), seeks to reveal how the risk of developing venous
thrombosis (VT) is influenced by the kind of progestogen contained in oral contraceptives. The
study considers that the component ethinyl estradiol has counteracting effects that minimize the
chances of developing VT. The findings create a good understanding of how novel oestrogens
are developed and determined to have a reduced risk of VT. The study succeeds to reveal the
VT risk of combined oral contraceptives but fails to identify the risks associated with other
methods such as injectable contraceptives and vaginal rings. Other risk factors were identified.
Inherited thrombophilia is an underlying condition indicated to increase the susceptibility to VT
in women using combined oral contraceptives. The incidence rate of VT is 0.36% in cases of
mild thrombophilia and 0.64% in severe cases. It is unfortunate that the authors did not research
VT risk in women who switch combined oral contraceptives. However, it is hypothesized that
switching from a low to a high dosage of combined oral contraceptives increases the risk of
developing the condition. The article is a narrative review of the literature and hence a low level
(level V) of evidence. In general, the researchers are justified by suggesting the importance of
identifying high-risk women to recommend alternative contraception methods.
12
References
Abdalhabib, E. K., Jackson, D. E., Alzahrani, B., Elfaki, E., Hamza, A., Alanazi, F., Ali, E. I.,
Algarni, A., & Ibrahim, I. (2022). Assessment of risk factors for deep vein thrombosis
associated with natural anticoagulants and fibrinolytic regulatory proteins. Blood
Coagulation & Fibrinolysis, 33(3), 149–152.
https://doi.org/10.1097/mbc.0000000000001116
Khialani, D., Rosendaal, F., & van Hylckama Vlieg, A. (2020, November). Hormonal
contraceptives and the risk of venous thrombosis. In Seminars in Thrombosis and
Hemostasis 46(8), 865-871. https://doi.org/10.1055/s-0040-1715793
LaVasseur, C., Neukam, S., Kartika, T., Bannow, B. S., Shatzel, J., & DeLoughery, T. G. (2022).
Hormonal therapies and venous thrombosis: Considerations for prevention and
management. Research and Practice in Thrombosis and Haemostasis, 6(6), e12763.
https://doi.org/10.1002/rth2.12763
Rambaran, K., & Alzghari, S. K. (2020). Gamer’s thrombosis: A review of published reports.
Ochsner Journal, 20(2), 182–186. https://doi.org/10.31486/toj.19.0058
Rosano, G. M., Rodriguez‐Martinez, M. A., Spoletini, I., & Regidor, P. A. (2022). Obesity and
contraceptive use: Impact on cardiovascular risk. ESC Heart Failure, 9(6), 3761-3767.
https://doi.org/10.1002/ehf2.14104
Sultanmuratova, G. U., Babadjanova, G. S., Nazarbayev, J. B., & Kerimova, N. M. (2022). A
safe and effective contraceptive method for women with obesity in the postpartum
period. American Journal of Medicine and Medical Sciences 12(8): 836-839.
https://doi.org /10.5923/j.ajmms.20221208.15
13
Appendix
Citation of
Objective,
Search
Inclusion/Exc
Data
SR
Aim, Purpose
Strategy
lusion
Criteria
Results
Recommenda
Level of
Extraction
tion/
Evidence
and Analysis
Implication
LaVasseur, C., the differences Large
Thematic
Different
When
Neukam, S.,
in thrombosis
pharmacy
analysis
types of
contemplating
Kartika, T.,
risk of the
databases,
contraceptives
contraception,
Bannow, B.
many
biomarker
have different
clinicians
S., Shatzel, J.,
hormonal
studies,
levels of risk
must factor in
&
preparations
centralized
of blood clots
different
DeLoughery,
available and
hospital
for obese
prothrombotic
T. G. (2022).
their
registries,
women.
risk factors to
Hormonal
interaction
cohort studies,
make more
therapies and
with patient‐
and case-
informed
venous
specific
control studies
decisions
thrombosis:
factors.
Level 1
14
Consideration
s for
prevention
and
management.
Research and
Practice in
Thrombosis
and
Haemostasis,
6(6), e12763
Khialani, D.,
from inception of objectively
Switching
It is important
Rosendaal, F.,
Understanding to April 2018
confirmed
COCs, even
to identify
& van
hormonal
venous
when
women at risk
Hylckama
contraceptives
thrombosis in
switching
of VT and
Vlieg, A.
and the risk of
healthy
from a high-
advise them
Level 1
15
(2020,
venous
women taking
to a low-risk
on alternative
November).
thrombosis
oral
COC,
contraception
contraceptives
increases the
methods.
Hormonal
contraceptives
and the risk of
venous
thrombosis. In
Seminars in
thrombosis
and
hemostasis
(Vol. 46, No.
08, pp. 865871). Thieme
Medical
risk of VT
16
Publishers,
Inc…
Abdalhabib,
To assess the
A search
Factors for
Thematic
The early
Risk factors
E. K.,
roles of
through PMC
deep vein
analysis
assessment of
should be
Jackson, D.
natural
thrombosis
risk factors,
assessed early
E., Alzahrani,
anticoagulants
associated
including the
enough to
B., Elfaki, E.,
and
with natural
measurements
prevent
Hamza, A.,
fibrinolytic
anticoagulants
of natural
occurrence of
Alanazi, F.,
regulatory
inhibitors, can
DVT
Ali, E. I.,
factors in the
predict the
Algarni, A., &
development
occurrence of
Ibrahim, I.
of DVT in
DVT before it
(2022).
Sudanese
is actually
Assessment of
patients.
detected in
risk factors for
patients.
LevelI
17
deep vein
thrombosis
associated
with natural
anticoagulants
and
fibrinolytic
regulatory
proteins.
Blood
Coagulation &
Fibrinolysis,
33(3), 149–
152.
https://doi.org/
10.1097/mbc.
18
00000000000
01116
Rambaran, K.,
To explore the
PubMed,
Thematic
Modifiable
Strongly
& Alzghari, S.
relationship
Scopus, Web
analysis
risk factors
encourage
K. (2020).
between
of Science,
included
screening
Gamer’s
combined oral
and EBSCO
cigarette use,
gamers for
thrombosis: A
contraception
for articles
being
possible VTEs
review of
and the risk of
overweight,
if clinically
published
venous
birth control
warranted.
reports.
thromboembol
use, and
Ochsner
ism
prolonged
Journal, 20(2),
immobility.
182–186.
Anticoagulatio
https://doi.org/
n was the
principal
Level 1
19
10.31486/toj.1
treatment
9.0058
modality in
patients
presenting
with gaming
thrombosis
Rosano, G.
Discuss the
The electronic
Cardiovascula
Exercise
M.,
latest
database
r risks, mainly
caution with
Rodriguez‐
evidence,
search in
VTE risks,
the use of
Martinez, M.
ongoing
PubMed
increase
COCs in
A., Spoletini,
research, and
between 12
patients with
I., & Regidor,
controversial
and 24 times
overweight
P. A. (2022).
issues on the
compared
and obesity,
Obesity and
synergistic
with non-
choosing the
contraceptive
effect of
obese non-
safest
use: impact on
obesity and
COC users.
alternatives
Level II
20
cardiovascular
contraceptive
when
risk. ESC
use in terms of
prescribing
heart failure.
cardiovascular
hormonal
risk
contraception
due to the
rising global
prevalence of
obesity.
Sultanmuratov This study
The electronic
The study
According to
Additional
a, G. U.,
aims to
database
included 65
the study
control should
Babadjanova,
determine the
search in
women of
results, a
be carried out
G. S.,
safety of
PubMed
reproductive
favorable
in patients
Nazarbayev, J. drospirenone-
age who were
effect of low-
with impaired
B., &
containing
prescribed OC
dose OC pills
carbohydrate
Kerimova, N.
combined oral
with 30 µg of
on body
metabolism.
M. (2022). A
contraceptives
ethinyl
weight and
Level II
21
safe and
(OC) in
estradiol and 3 lipid profile
effective
overweight/ob
mg of
was revealed
contraceptive
ese women of
drospirenone
without
method for
reproductive
for 3 months
significant
women with
age.
for therapeutic changes in
obesity in the
and preventive carbohydrate
postpartum
purposes. The
metabolism. C
period.
main
onclusion. Th
American
parameters
erefore, this
Journal of
evaluated
method of
Medicine and
were lipid and
contraception
Medical
carbohydrate
may be
Sciences
metabolism
recommended
2022, 12(8):
for
836-839.
overweight/ob
https://doi.org
ese patients to
22
/10.5923/j.ajm
control
ms.20221208.
fertility in the
15
postpartum
period.
Purchase answer to see full
attachment
