Substance use disorder: contraceptive options counseling

What’s New in Contraception?

Contraceptive Technology Conference!

Biologic sexism of STIs

Excess breast cancer deaths after COVID-19

Contraception for patients with medical conditions

Pelvic Floor Dysfunction

Treating vulvodynia

Puzzling Over the Hurt Down-Under

Serious Mental Illness and Contraception

New 13-Cycle Vaginal Contraceptive System

The Future of Family Planning in Post-COVID America

New ASCCP Guidelines: Implications for FP

On the alert: mood disorders during 2020 stressors

Sex in the Time of COVID-19

Challenges old and new during the pandemic

Reproductive health in the time of Covid-19

Talking about toys

Missed Pills: The Problem That Hasn’t Gone Away

Find the “yes! . . . and” rather than “no” or “but”

Digital Family Planning: the Future is Now

Irregular Bleeding Due to Contraceptives

When she’s low on libido…

Ouch! Best approaches to menstrual pain

Contraceptive efficacy: understanding how user and method characteristics play their part

Strategizing treatment for chronic heavy menstrual bleeding


Untangling the literature on obesity and contraception

High tech apps for no-tech FABM

Menstrual exacerbation of other medical conditions

From Princeton University: Thomas James Trussell (1949-2018)

The Short and Long of IUD Use Duration

Selecting a Method When Guidance Isn’t Clear-cut

Healthcare in the Time of Digital Expansion

The Scoop on Two New FDA-Approved Contraceptive Methods

Pregnancy of unknown location—meeting the challenge

Big “yes” (with caveats) to CHCs during perimenopause

The role of IUDs (LNG IUDs, too!) in emergency contraception

Combined pills’ effect on mood disorders

Abortion in the U.S.: safe, declining, and under threat

Hope for ovarian cancer screening test

Breast cancer still a small risk with some hormonal contraceptives

New treatment modality for BV

Record rate of HPV-related throat cancer

Viruses in semen potentially transmissible

Don’t Abstain from Your Role in Abstinence

Teens births declining but geographic ‘hotspots’ defy trend

Online Medical Abortion Service Effective and Safe

Do Women Really Need to Wait That Long?

Reassuring news on depression and OC use

PMDD: Genetic clues may lead to improved treatment

Breast cancer risk when there is a family history

Body weight link to breast and endometrial cancers (and 11 others)

Family Planning in 2017 and Beyond

Make Me Cry: Depression Link (Again)?

Managing implant users’ bleeding and spotting

Zika: Updated guidance for providers

Pharmacist-prescribed contraceptives

Hot off the press! 2016 MEC and SPR

Zika virus fears prompt increased request for abortion in nations outlawing abortions

Opioid use epidemic among reproductive-age women

Good news on the family planning home front!

War Against Planned Parenthood Hurts Women

Win-win for both treatment and prevention

Center of the Storm


Menopause, mood, mental acuity, and hormone therapy

Emergency contraception for teens

Postpartum Contraception: Now, Not Later

Reproductive tract infections, sexually transmitted infections, or sexually transmitted diseases: “a rose by any other name…”

Are we practicing what we preach?

Be alert to VTE in hormonal contraceptive users

LARC among teens increased 15-fold, but not enough

Brain cancer and hormonal contraception

Free tools: Easy access to the US Medical Eligibility Criteria for Contraceptive Use

Alcohol consumption when pregnancy is unwanted or unintended

Latest Data on Contraceptive Use in the United States

LateBreaker sampler from Contraceptive Technology conference

Emergency Contraceptive Pill Efficacy and BMI/Body Weight

Handout on Unintended Pregnancy and Contraceptive Choice

Ask About Withdrawal (Really!)

Rules to Practice By: Safety First and Cleanliness is Close to. . .

What’s Vanity Fair Got Against the NuvaRing?

Promising New Treatment for Hepatitis C

Numbers matter, so make them simple for patients

The Recession’s Effect on Unintended Pregnancies

Lessons Learned from the Contraceptive CHOICE Project: The Hull LARC Initiative

Applying the “New” Cervical Cytology Guidelines in Your Practice

Acute Excessive Uterine Bleeding: New Management Strategies

Medical indications for IUD use in teens

Whatever happened to PID?

Update on Emergency Contraception New and Improved

Body weight link to breast and endometrial cancers (and 11 others)
February 2017


A new analysis reveals that the cancer burden from overweight/obesity is greater than previously reported. The International Agency for Cancer Research (IARC) of the World Health Organization (WHO) reported that sufficient evidence exists to link high BMI to 13 different cancers, including endometrial and postmenopausal breast cancers.[1] In addition, it may be that the risks for obesity-related cancers may compound over time.[2]

The IARC reviewed more than 1,000 studies looking at the association between weight and cancer risk.1 Several years ago, the IARC had found a link between greater BMI and 8 different cancers.  In this newest review, the group found sufficient evidence to link body weight/BMI to 14 cancers:

Cancer site or type Relative risk of highest BMI to normal BMI
Corpus uteri 7.1 [6.3-8.1]
Esophagus: adenocarcinoma 4.8 [3.0-7.7]
Gastric cardia 1.8 [1.3-2.5]
Liver 1.8 [1.6-2.1]
Kidney: renal cell 1.8  [1.7-1.9]
Pancreas 1.5 [1.2-1.8]
Meningioma 1.5 [1.3-1.8]
Multiple myeloma 1.5 [1.2-2.0]
Colon and rectum 1.3 [1.3-1.4]
Gall bladder 1.3 [1.4-1.4]
Breast: postmenopausal 1.1 [1.1-1.2]
Ovary 1.1 [1.1-1.2]
Thyroid 1.1 [1.0-1.1]

Source: IARC, 2016

The association between BMI and endometrial cancer, especially type 1, showed a strong dose-response relationship—the higher the BMI, the stronger the association. For overweight women, the relative risk was 1.5; for women with class 1 obesity, RR was 2.5; for class 2 obesity, RR 4.5; for class 3, RR 7.1. For epithelial ovarian cancer, the association was modest (RR 1.1).

The IARC found numerous studies showing a positive association between weight and waist circumference in adult women and their risk of postmenopausal breast cancer, particularly for estrogen-receptor positive cancers. No similar risk appeared among premenopausal women, though the data were inconsistent.

Duration of Overweight/Obese

A recent study potentially adds more detail to the type of association between body weight and cancer risks.2 In a longitudinal observational study, researchers used data from the Women’s Health Initiative trial of postmenopausal women. They selected a cohort of nearly 74,000 women with a mean follow-up of 12.6 years, during which 6,300 cancers were diagnosed. Thirty percent of the women were ‘ever’ overweight and had been so for an average of 30 years. Thirty percent were ‘ever’ obese and had been so for an average of 20 years.

In this study, the overall increased risk for endometrial cancer was 17%, followed by kidney cancer (16%). The increased risk for breast cancer was 5%. However, this particular study did not reveal significant associations with rectal, liver, gallbladder, pancreatic, ovarian, or thyroid cancers.

When the researchers looked at how excess weight affected risk over time, they found a dose-response relationship. For every 10 years of a woman being obese, the risk of being diagnosed with endometrial cancer rose 23%. For the same time increments, the hazard ratio for breast cancer rose 7%. Add to duration the degree of overweight, and the association increased even further. At highest BMI category, the risk for endometrial cancer increased 37% each decade.

What plausible mechanisms?

Current thinking about the mechanisms contributing to a body weight/cancer link echo those from two notable review papers.[3],[4] These reviewers said evidence points to the metabolic and endocrine abnormalities of obesity itself. These include “alterations in sex hormone metabolism, insulin and insulin-like growth factor signaling, and adipokines or inflammatory pathways.”1 Evidence is strong for the role of sex hormones—e.g., adiposity promotes estrogen formation and synthesis—and for the role of chronic inflammation.

Hormone/binding globulin Obese vs. normal weight women
Insulin Increased levels with obesity
Insulin-like growth factor1 (IGF) Non linear but peak levels w/ BMI 24-27
Free IGF1 Increased levels with obesity
IGF-binding protein1 Decreased levels with obesity
IGFBP2 Increased levels with obesity or no effect
Sex-hormone-binding globulin Decreased levels with obesity
Total and free estradiol Increased levels with obesity in postmenopausal women (not in premenstrual women)
Total testosterone Increased levels in premenopausal women with PCOS
Free testosterone Increased levels with obesity

Source: Calle EE, Kaaks R. Nat Rev Cancer 2004

Can weight loss help reduce cancer risk?

IARC researchers conclude that an “absence of body fatness lowers the risk of most cancers.” Counsel women to keep adiposity at normal weight levels. However, many women, young and old, are already at levels that may put them at increased risk for some cancers. Can losing some of their weight help reduce their risk?

There is some suggestion that intentional weight loss could be effective in minimizing cancer risks. Studies of intentional weight loss in animals show a cancer-preventive effect. Laboratory-oriented studies of the changes in metabolic and hormonal mechanisms accompanying weight loss are also suggestive.

The evidence from humans is thin, largely because the studies are observational or small, rather than because some evidence points another way. A review of studies of patients who have undergone bariatric surgery suggest a positive effect on oncologic risk and mortality, with the formerly obese women having a 0.68 relative risk of cancer when compared with obese women who did not undergo the surgery.[5] The reduction in risk was most notable for cancer of the breast and endometrium. The studies examining this question remain limited and of insufficient quality, but reducing excess adiposity remains good advice on other health measures. We may just find out one day that weight reduction has an added bonus advantage when it comes to cancer reduction.

—Submitted by Deborah Kowal, MA,PA, executive editor of Contraceptive Technology

[1] Lauby-Secretan B, Scoccianti C, Loomis D, et al. Body fatness and cancer — viewpoint of the IARC Working Group. N Engl J Med 375;8 August 25, 2016

[2] Melina Arnold , Luohua Jiang, Marcia L. Stefanick, et al. Duration of adulthood overweight, obesity, and cancer risk in the Women’s Health Initiative: a longitudinal study from the United States. August 16, 2016

[3] Calle EE, Kaaks R. Overweight, obesity and cancer: epidemiological evidence and proposed mechanisms. Nat Rev Cancer 2004; 4: 579-91.

[4] Renehan AG, Zwahlen M, Egger M. Adiposity and cancer risk: new mechanistic insights from epidemiology. Nat Rev Cancer 2015; 15: 484-98.

[5] Tee MC, Cao Y, Warnock GL, Hu FB, Chavarro JE. Effect of bariatric surgery on oncologic outcomes: a systematic review and meta-analysis. Surg Endosc 2013; 27: 4449-56.